List Archives

Tue Sep 16 15:16:30 BST 2008

I am looking to re-locate to the NY , either NYC or Syracuse/upstate area.  Or for a really amazing, unique opportunity , might be open to anywhere! I realize I'm in demand but  have to be in  a faster-pace and the trauma environment. As a trauma RN , would love to stay within a level one , teaching atmosphere.  Worked in ER and Burn, TICU settings.  Would love to find an ER where I could just care for trauma pt's all day.   Any suggestions for hospitals?? 
And being from Florida, I am no stranger to sleeping in the hospital , no power, water or gas for days, and looking forward to eating anything cooked on a grill ,  during the hurricanes. I pray for all the Texas residents , hoping everything returns to normal very soon. Thanks

Angela
----------------------------------------
> From: trauma-list-request at trauma.org
> Subject: trauma-list Digest, Vol 63, Issue 25
> To: trauma-list at trauma.org
> Date: Tue, 16 Sep 2008 12:00:16 +0100
> 
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> When replying, please edit your Subject line so it is more specific
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> 
> Today's Topics:
> 
>    1. RE: Federal Government Role for Ike (Jeffery Hammond)
>    2. Re: Federal Government Role for Ike (Louis N. Molino, Sr.)
>    3. Re: Medical Response to IKE  - Monday 11:00 AM (Larry Torrey)
>    4. Needle Decompression (Sahaj Khalsa)
>    5. RE: Needle Decompression (Bjorn, Pret)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Mon, 15 Sep 2008 17:00:41 -0400
> From: Jeffery Hammond 
> Subject: RE: Federal Government Role for Ike
> To: "'Trauma & Critical Care mailing list'"
> 	
> Message-ID: 
> Content-Type: text/plain; charset=us-ascii
> 
> This is broadly not true. Perhaps the trauma system is not involved in your
> states, but don't extrapolate this nationally. 
> 
> Health care, especially non-BT trauma care, can be an after thought if we
> let it. State and county OEMs will tend to focus on police, fire and first
> response issues. Public health may tend to forget about acute care
> provisions, just assuming we'll be there because we're always there. 
> 
> However, I can say that we in NJ have a good realtionship between our Trauma
> Center Council and state emergency planners. Not perfect, and a work in
> progress, but good. You have to work at it.
> 
> Jeff Hammond 
> 
> Jeffrey Hammond MD, MPH
> New Brunswick, NJ
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Robert F. Smith
> Sent: Monday, September 15, 2008 3:36 PM
> To: 'Trauma & Critical Care mailing list'
> Subject: RE: Federal Government Role for Ike
> 
> Exactly. And with all the money spent preparing for terrorist events, none
> of the planning and/or organization seems to involve trauma centers.
> 
> Rob Smith
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of KMATTOX at aol.com
> Sent: Monday, September 15, 2008 1:59 PM
> To: trauma-list at trauma.org
> Subject: Re: Federal Government Role for Ike
> 
>  
> In a message dated 9/15/2008 12:57:05 P.M. Central Daylight Time,
> gflores911 at gmail.com writes:
> 
> Who is  the liaison between the trauma center and the state's emergency
> operation's  center (EOC)?
> 
> 
> It does NOT EXIST, despite multiple requests.   It is all  LOCAL, if at all.
>  
> k
> 
> 
> 
> **************Psssst...Have you heard the news? There's a new fashion blog, 
> plus the latest fall trends and hair styles at StyleList.com.      
> (http://www.stylelist.com/trends?ncid=aolsty00050000000014)
> --
> trauma-list : TRAUMA.ORG
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> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Mon, 15 Sep 2008 21:30:18 +0000
> From: "Louis N. Molino, Sr." 
> Subject: Re: Federal Government Role for Ike
> To: "Trauma & Critical Care mailing list" 
> Message-ID:
> 	
> 	
> Content-Type: text/plain
> 
> Thanks Jeff I was about to comment on the past in terms of pre 2002 as I knew Cooper had a great working relationship with state OEM etc. 
> 
> The failings as I said before are all over the map and those too can be very local in nature. 
> 
> Louis N. Molino, Sr. FF/NREMT-B/FSI/EMSI
> LNMolino at aol.com   
> Sent via BlackBerry by AT&T
> 
> -----Original Message-----
> From: Jeffery Hammond 
> 
> Date: Mon, 15 Sep 2008 17:00:41 
> To: 'Trauma & Critical Care mailing list'
> Subject: RE: Federal Government Role for Ike
> 
> 
> This is broadly not true. Perhaps the trauma system is not involved in your
> states, but don't extrapolate this nationally. 
> 
> Health care, especially non-BT trauma care, can be an after thought if we
> let it. State and county OEMs will tend to focus on police, fire and first
> response issues. Public health may tend to forget about acute care
> provisions, just assuming we'll be there because we're always there. 
> 
> However, I can say that we in NJ have a good realtionship between our Trauma
> Center Council and state emergency planners. Not perfect, and a work in
> progress, but good. You have to work at it.
> 
> Jeff Hammond 
> 
> Jeffrey Hammond MD, MPH
> New Brunswick, NJ
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Robert F. Smith
> Sent: Monday, September 15, 2008 3:36 PM
> To: 'Trauma & Critical Care mailing list'
> Subject: RE: Federal Government Role for Ike
> 
> Exactly. And with all the money spent preparing for terrorist events, none
> of the planning and/or organization seems to involve trauma centers.
> 
> Rob Smith
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of KMATTOX at aol.com
> Sent: Monday, September 15, 2008 1:59 PM
> To: trauma-list at trauma.org
> Subject: Re: Federal Government Role for Ike
> 
>  
> In a message dated 9/15/2008 12:57:05 P.M. Central Daylight Time,
> gflores911 at gmail.com writes:
> 
> Who is  the liaison between the trauma center and the state's emergency
> operation's  center (EOC)?
> 
> 
> It does NOT EXIST, despite multiple requests.   It is all  LOCAL, if at all.
>  
> k
> 
> 
> 
> **************Psssst...Have you heard the news? There's a new fashion blog, 
> plus the latest fall trends and hair styles at StyleList.com.      
> (http://www.stylelist.com/trends?ncid=aolsty00050000000014)
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> ------------------------------
> 
> Message: 3
> Date: Mon, 15 Sep 2008 22:34:34 -0400
> From: Larry Torrey 
> Subject: Re: Medical Response to IKE  - Monday 11:00 AM
> To: "Trauma & Critical Care mailing list" 
> Message-ID: 
> Content-Type: text/plain; charset=ISO-8859-1; format=flowed
> 
> So you have identified problems that exist.  That is a start.
> 
> And why do they exist today?  Why is there only 'a start' in a Gulf 
> coastal state in 2008?  Were these lessons not learned after Katrina, or 
> the storms prior to that?
> 
> What do you plan to do about it.  Laments to an internet list make 
> interesting reading, but would seem to do little to solve real world 
> problems.
> 
> What are the next steps to make progress, so that these problems don't 
> occur next time?  Obviously, there will be a next time.
> 
> Best,
> LT
> 
> KMATTOX at aol.com wrote:
>> It is now Monday AM 2 1/2 days after IKE hit Galveston and passed  through 
>> Houston.   
>>  
>> Houston is the 4th largest city in the US.    The  Houston/Galveston greater 
>> area has upwards of 4.5 million people, depending  on just where you draw the 
>> line.    It is safe to say that NO ONE  in this area is untouched by this 
>> storm.   NO  ONE.   Galveston was totally under water from both the gulf and  the 
>> bay.    UTMB and its famous burn center was  evacuated.     Bolivar Island is 
>> still "off limits" to  anyone visiting it.    West Galveston Island, with its 
>> beach  houses was under water and many destroyed.      The  famous Balinese 
>> Room of Galveston is GONE.    The Galveston Sea  Wall is 17 feet above sea level 
>> and the sea ran over it.      This was a wind and SEA SURGE storm, not 
>> particularly a wet  storm.     
>>  
>>>From Galveston to Houston one travels Interstate 45, and that is the route  
>> that IKE took.   The areas of NASA, Kemah, Seabrook, are yet to be  fully 
>> assessed.     
>>  
>> Over 95% of the area lost electrical power in the entire greater Houston  
>> area, and most are still without electricity.    NO HOME or yard  is without some 
>> sort of damage, either shingles, an entire roof, glass broken,  fences down, 
>> or trees fallen and limbs broken.    I do not mean  just any tree.   Many huge 
>> Oak trees over 100 years old are broken  like match sticks or up rooted.   
>> The many faithful health workers  were at work despite their homes being blown  
>> apart.      
>>  
>> First, I must give tremendous credit and recognition to thousands of  
>> individual health heroes who were here at the Ben Taub General Hospital and many  
>> other hospitals for many hours straight.    They gave and gave  and then gave 
>> more of themselves so that others would have a place to receive  health related 
>> attention.     
>>  
>> Second, I was impressed by the leadership of the State Government both  
>> during Gustav and IKE in the days before the storms hit, in creating a 5000+  
>> person 2-3 times a day conference call to address known course of storm, local  
>> needs, evacuation, gas, search & rescue (SAR), and  recovery.    Both State, 
>> County, Local governments were on this  conference call as well as other assets 
>> such as hospitals, EMS agencies,  etc.  It appeared that most items were covered 
>> and  addressed.   It was obvious that jurisdictional turfs  existed.   
>>  
>> At the LOCAL area, different jurisdictions set up in different  locations:  
>> Galveston, Transtar (Harris County), HEC (City of Houston) and  assets of the 
>> State, such as Texas Task Force 1 set up in several different  locations.      
>> Ownership of various assets was under  different, but communicating agencies.  
>>   What we did not have  during IKE, but did have during Katrina was a region 
>> wide JOINT UNIFIED  COMMAND.    We really needed that during and for the first 
>> 2 days  after IKE hit.   
>>  
>> At the hospital and emergency room level, every hospital in the area did  
>> their part, but all entered the hours of the storm with full ICUs.    We (and 
>> everyone else) had patients ready to be dismissed from the hospital, but  we 
>> would have sent them to an area of high risk of flooding.   That  would not have 
>> been good, but we did need their bed for new ER  patients.   No local "medical" 
>> home health care type shelters were set  up in the Greater Houston area.   We 
>> must address this next  time.    In my view, this would be an excellent role 
>> for DMAT  teams, to be both up front for some few minor problems and to 
>> establish an up to  500 bed "medical" observation shelter as opposed to a "clinic" 
>> or  hospital.   We really do not need mobile hospitals, what we need is  the 
>> intermediate "medical" shelter to unload the existing local  hospitals.   
>>  
>> By 12 hours after the storm had cleared the area the mass property  
>> destruction was noted and people began to clear their property, including using  chain 
>> saws they had never read the instructions on, and climbing  ladders.   We had 
>> lots of falls.     Also many  hospitals wanted to "evacuate" merely because 
>> their rooms were warm and humid as  they were only on emergency generators.   
>> The water for the entire  community was feared to be contaminated due to low 
>> water  pressure.     Therefore, we were requested to receive  patients with 
>> relatively minor conditions, such as a need for a lower  temperatured room and 
>> nasal oxygen in an elderly patient.   Some such  patients came by outside the area 
>> contracted private ambulances who knew nothing  about the working of the 
>> local EOCs, although those were  multiple.      We really needed the DMAT type run 
>>  medical holding area shelter for these type of patients, who never needed to 
>>  come to the hospital to use the hospital as a shelter.   One of more  DMATs 
>> were set up in the Greater Houston area, but initially coordination with  
>> existing Trauma Center facilities was sparse.   If there was  coordination, it was 
>> with one of the many supervisory silos. 
>>  
>> It became interesting to me that within 24 hours after the storm cleared,  
>> many of the persons in each of the silos, including representatives, and  
>> including press people, who by now were very tired; began to point fingers and  to 
>> try to get credit for what was done right and dodge when there was a  criticism 
>> for what went wrong.      I could write a  book on this subject.  
>>  
>> In the 5 state area around Texas there is a fantastic trauma network among  
>> the trauma centers and trauma surgeons, headed up by Dr. Ron Stewart in San  Ant
>> onio.    This excellent integrated disaster network is as  sophisticated as 
>> ANYTHING I have seen from the well funded federal programs, and  it costs 
>> NOTHING.     The doctors and nurses on this network  and the network itself are 
>> well known to each of the federal, state, regional,  county, and city EOS silos 
>> in the 5 state region.   However, neither  for planning, implementation, 
>> evacuation, or recovery do these silos utilize  this very mature sophisticated 
>> trauma network.     It is  almost as if the hands on trauma personnel who in at 
>> least 6 of the cities of  the network(Houston, Galveston, San Antonio, New 
>> Orleans, Oklahoma  City) have a composite experience of active involvement in more 
>> disasters  than any group that I know about in the country; are purposefully 
>> omitted from  the government run silos.    In my humble opinion, this  
>> disconnect between the governmental mandated EOS silos and the JCAHO mandated  trauma 
>> center communications led by the American College of Surgeons and their  trauma 
>> center and disaster committee MUST somehow get together as has happened  in 
>> the state of Connecticut.     
>>  
>> We are approaching 48 hours since it has been able to move around after the  
>> storm.     There is lots of frustration and  depression.    Criticism that the 
>> government did not move fast  enough to clear the roads, turn back on the 
>> power, "bring me water", etc. is  distressing.  Even by FEMA rules, such response 
>> is not required until 72  hours.   If there is gas available, and if the 
>> electricity is  back on, many complaints will disappear.       
>>  
>> I have tried to write concurrently with my frank feelings and observations  
>> of the real time.    Sometimes I was more frustrated than  others.    On the 
>> whole I have been very proud of my local  community, proud of the citizens, and 
>> so very proud of the FANTASTIC TEAM OF  MEDICAL PROFESSIONALS AT THE BEN TAUB 
>> GENERAL  HOSPITAL.       This team could put a man on Mars  in a week.   This 
>> team seeks to be a resource to take care of the  sickest of the sick, that no 
>> one else wants, especially during a  crisis.     This team could reach the 
>> illusive peace in the  Middle East in 5 days.      Congratulations to the many  
>> many unsung heroes at every unit level of this team.    
>>  
>> k
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Mon, 15 Sep 2008 22:47:34 -0600
> From: "Sahaj Khalsa" 
> Subject: Needle Decompression
> To: "Trauma &, Critical Care mailing list" 
> Message-ID:
> 	
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Hello all,
> 
> Many thanks to all of those who have been keeping all of us updated about
> their situations during this horrible hurricane season.  I have lots of
> family in Houston so I felt like I had a more real and direct line to what
> was going on than the news, which was great.  Our thoughts and prayers are
> with all of you who are still recovering from all of the devastation.
> 
> So I am interested in the opinions of anybody on this list who cares to
> share them and has a few spare minutes...
> 
> I am a Paramedic and a paramedic instructor and we are trained that when we
> decompress a chest (usually with a 14 ga catheter) and get blood flow back,
> we should pull the catheter.  Why?
> 
> I have discussed this with a number of the ER docs that I work with and
> there is no real clear consensus.  Some of them say that I should leave the
> catheter in the chest as relieving the pressure is a good thing, whether
> that pressure is caused by blood or air.  However, most Paramedic textbooks
> advise us to pull it.
> 
> Assuming that I have put the dart in correctly (and have not hit the vessels
> in the chest wall), understanding that I do not have the capability of
> putting in a chest tube and that I am often times more than 60 minutes by
> ground from the nearest hospital with no alternative transport (helo)
> available, what is your opinion?
> 
> Any replies would be appreciated.
> 
> Sahaj Khalsa
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Tue, 16 Sep 2008 06:20:24 -0400
> From: "Bjorn, Pret" 
> Subject: RE: Needle Decompression
> To: "Trauma & Critical Care mailing list" 
> Message-ID:
> 	
> Content-Type: text/plain;	charset="us-ascii"
> 
> I for one would be interested in hearing how often this really occurs.
> Blood venting from the anterior chest in a supine patient suggests one
> hell of a lot of hemorrhage.  Assuming that it was placed properly, your
> catheter thus represents the least of this patient's problems (or
> solutions).  Frankly, the mess isn't worth the clinical effect.  Pull
> the cath and drive faster.
> 
> If on the other hand you've struck vessel (umm, eek), then let's
> remember that high-volume phlebotomy is a bad thing.  Again, though, I'd
> like to have some idea of the real-world, first-hand experience.  I
> expect that these anecdotes are largely the stuff of prehospital
> folklore.
> 
> Look at it this way: the indication for needle decompression is tension
> pneumothorax.  Blood is therefore a clue that either your assessment or
> your technique is in error.  Abort, make note, and move on.
> 
> Pret Bjorn, RN
> Bangor, ME USA
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sahaj Khalsa
> Sent: Tuesday, September 16, 2008 12:48 AM
> To: Trauma &, Critical Care mailing list
> Subject: Needle Decompression
> 
> 
> Hello all,
> 
> Many thanks to all of those who have been keeping all of us updated
> about
> their situations during this horrible hurricane season.  I have lots of
> family in Houston so I felt like I had a more real and direct line to
> what
> was going on than the news, which was great.  Our thoughts and prayers
> are
> with all of you who are still recovering from all of the devastation.
> 
> So I am interested in the opinions of anybody on this list who cares to
> share them and has a few spare minutes...
> 
> I am a Paramedic and a paramedic instructor and we are trained that when
> we
> decompress a chest (usually with a 14 ga catheter) and get blood flow
> back,
> we should pull the catheter.  Why?
> 
> I have discussed this with a number of the ER docs that I work with and
> there is no real clear consensus.  Some of them say that I should leave
> the
> catheter in the chest as relieving the pressure is a good thing, whether
> that pressure is caused by blood or air.  However, most Paramedic
> textbooks
> advise us to pull it.
> 
> Assuming that I have put the dart in correctly (and have not hit the
> vessels
> in the chest wall), understanding that I do not have the capability of
> putting in a chest tube and that I am often times more than 60 minutes
> by
> ground from the nearest hospital with no alternative transport (helo)
> available, what is your opinion?
> 
> Any replies would be appreciated.
> 
> Sahaj Khalsa
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 63, Issue 25
> *******************************************

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