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Wed Sep 17 19:35:59 BST 2008

Dr McSwain and list

Sorry for jumping in so late on this but, I had the experience of learning a bit of your disaster response systems when I was sent to help on hurricane Katrina with the Mexican Army convoy that stayed at San Antonio 3 y ago.  First of all I know we were there only for political reasons (probably most of you do not know we were there, but we were)...  Yes our cooks helped feed some of the refugees from Katrina that were staying in shelters in the City and we attended the meetings or debriefings at the ICP.....  I was sent with 2 others to give medical support, of course I was really mad because of no coordination at all (We did not have any license to practice of course, and did not have the place to do it any way, we were only bringing first aid resources for our own troops)... but as I said before the really only purpose of our visit was political (that I found out later when all the nice pictures of our camp were taken and a lot of military, local,
 state and federal authorities visiting and bringing medals, deplomas, etc....),  Any way I tried to get the best out of the situation and had the chance to meet Dr Ronald Stewart at the UTHSC trauma center, he is a GREAT person and host and, made us feel like at home (we only told our authorities we were coordinating efforts and had the chance to be away of the Texan heat in late summer by staying at the hospital, doing rounds, M&Ms meetings, visiting the library, etc).  It was in one of those visits that I had the chance to witness the Operation Center and, as explained to me by Dr Stewart, was the only one in the county and probably around the state of Texas.  What I saw was ONE administrator of EVERY hospital or trauma center from their county or regional level, sat there in one area of the library with a computer and a telephone directly connected with their hospital so at any moment the person in charge would know exactly the number of beds, ORs,
 ERs spaces available and coordinate the medical assistance with better understanding of that particular point.  I have annexed an article I found where they show their system published in the Am J Surg. 
Any comments?
greetings

Ruy Cabello Pasini, MD
Trauma Surgeon
Hospital Central Militar
MEXICO

Titre du document / Document title
A regional medical operations center improves disaster response and inter-hospital trauma transfers. Discussion
Auteur(s) / Author(s)
EPLEY Eric E. (Commentateur (texte écrit)) (1) ; STEWART Ronald M. (1 2 3) ; LOVE Preston (1 2) ; JENKINS Donald (4) ; SIEGWORTH Gina M. (5) ; BASKIN Toney W. (6) ; FLAHERTY Stephen (6) ; COCKE Robert (1) ; SHATNEY Clayton ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) The Southwest Texas Regional Advisory Council for Trauma, San Antonio, TX, ETATS-UNIS
(2) The University of Texas Health Science Center at San Antonio, San Antonio, TX, ETATS-UNIS
(3) The University Health System, San Antonio, TX, ETATS-UNIS
(4) Wilford Hall Medical Center, San Antonio, TX, ETATS-UNIS
(5) Greater San Antonio Area Hospital Council, San Antonio, TX, ETATS-UNIS
(6) Brooke Army Medical Center, San Antonio, TX, ETATS-UNIS
Résumé / Abstract
Background: Delays in both inter-hospital trauma transfers and disaster response are common. We hypothesized patient flow could be improved by formal adoption of systems that improve cooperation and communication. Methods: The regional trauma database of the Southwest Texas Regional Advisory Council for Trauma and the Regional Medical Operations Center (RMOC) database were queried to test the hypothesis. Results: A total of 9507 trauma patients were transferred. Medcom resulted in decreased transfer process times. The RMOC was activated during Hurricanes Katrina and Rita. During two 24-hour periods, the RMOC coordinated the inter-hospital transfer of 781 patients and the movement of thousands of evacuees and special needs patients. Conclusions: Medcom, an organized system combining a communications center with formal trauma center cooperation, improves patient flow and reduces trauma transfer times. The RMOC, based on the same principles of cooperation
 and communication, allows for rapid transfer of hospitalized and special needs patients during disaster/mass casualty situations.
Revue / Journal Title
The American journal of surgery   ISSN 0002-9610   CODEN AJSUAB 
Source / Source
Congrès
Annual Meeting of the South Western Surgical Congress No58, Kauai, Hawaï , ETATS-UNIS (03/04/2006) 
2006, vol. 192, no 6 (201 p.)  [Document : 7 p.] (15 ref.), pp. 853-859 [7 page(s) (article)]
Langue / Language
Anglais
Editeur / Publisher
Elsevier, New York, NY, ETATS-UNIS  (1905) (Revue)
Mots-clés anglais / English Keywords
Treatment ; Surgery ; Cooperation ; Communication ; Planning ; Patient ; Human ; Lesion ; Wound ; Discussion ; Transfer ; Hospital ; Disaster ; Improvement ; Center ; Operation ; Disaster medicine ; Regional ; Trauma ;
Mots-clés français / French Keywords
Catastrophe ; Traitement ; Chirurgie ; Coopération ; Communication ; Planification ; Malade ; Homme ; Lésion ; Plaie ; Discussion ; Transfert ; Hôpital ; Sinistre ; Amélioration ; Centre ; Intervention ; Médecine catastrophe ; Régional ; Traumatisme ;
Mots-clés espagnols / Spanish Keywords
Tratamiento ; Cirugía ; Cooperación ; Comunicación ; Planificación ; Enfermo ; Hombre ; Lesión ; Herida ; Discusión ; Transferencia ; Hospital ; Siniestro ; Mejora ; Centro ; Operación ; Medicina catástrofe ; Regional ; Traumatismo ;
Mots-clés d'auteur / Author Keywords
Trauma centers ; Wounds and injuries ; Patient transfer ; Disaster planning ; Regional medical systems ; Communication ; Cooperation ;
Localisation / Location
INIST-CNRS, Cote INIST : 5070, 35400014525522.0290

Copyright 2008 INIST-CNRS. All rights reserved
Toute reproduction ou diffusion même partielle, par quelque procédé ou sur tout support que ce soit, ne pourra être faite sans l'accord préalable écrit de l'INIST-CNRS.
No part of these records may be reproduced of distributed, in any form or by any means, without the prior written permission of INIST-CNRS.
Nº notice refdoc (ud4) : 18445437

--- On Mon, 9/15/08, McSwain, Norman E Jr. <nmcswai at tulane.edu> wrote:

> From: McSwain, Norman E Jr. <nmcswai at tulane.edu>
> Subject: RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
> To: "Trauma &" <trauma-list at trauma.org>, "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Cc: coletta.barrett at ololrmc.com
> Date: Monday, September 15, 2008, 2:07 AM
> I would add one additional but very important thought. It is
> what Dr Mattox and I have been saying but perhaps not too
> clearly. The system that is currently in use is composed of
> a bunch of silo's (Ken's term) all of which function
> within their own silo and do not talk to those in other
> silo's. or if they do communicate it is hours or days
> later. This leads to frustration but most importantly it
> leads to misuse of resources and lack of coordination. It
> slows the progress of the management of the disaster at
> hand.
>  
>  It would be like two surgeons in the same operating room
> working on the same patient at the same time but working on
> different sides of the abdomen without talking to each
> other. Both trying to use the same instruments and telling
> the anesthiologist to do different things to the patient
> because they have different philosophies of resuscitation
> and what is the best for the patient. Neither surgeon is the
> leader but both are doing their own thing with no
> coordination. One surgeon is much slower than the other (one
> is a plastic surgeon who must make very meticulous
> movements, is used to dealing with a very stable patient and
> has plenty of time to think and centuplicate the next move,
> and the other surgeon usually takes care of GunShotWounds
> with a rapidly bleeding patient, who is very unstable, the
> movements must be very quick and decisive. The patient
> suffers.
>  
> That is exactly what is happening with disaster management.
> There are a bunch of silo leaders who think that they are in
> charge but do not understand the entire scope of the problem
> and may not even know what is happening in the other silos.
> None have the same training. Some are used to quick action
> and others are used to planning for weeks before making a
> move. Each has a different philosophy of disaster
> management. There is no leadership. No one is in charge of
> all of the silos, so each silo does its own thing. The
> progress of the disaster flounders
>  
> Perhaps I am being too severe but I do not think so.
>  
>  
>  
> Norman
>  
> Norman McSwain MD
> Trauma Director, Charity Hospital
> Professor of Surgery, Tulane University
> New Orleans LA
> 504 988 5111
> norman.mcswain at tulane.edu
> <mailto:norman.mcswain at tulane.edu> 
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of Richard
> Besserman, M.D., M.S., CHS-V
> Sent: Sun 9/14/2008 7:26 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: [CCM-L] ?? DMAT "Military" hospital
> and/or clinic
> 
> 
> 
> Bob
> 
> As one potential after thought to another, I really
> appreciate your
> explanation.  I get it.  I recognize that the perspective
> of the planners is
> global (save as many lives as possible) and that could be
> in conflict with a
> narrower trauma mission.  These folks have a broad range of
> non-trauma
> issues to address.
> 
> I sense that the trauma community is far better motivated
> than other
> specialties in medicine to keep involved in disaster
> issues.  I have great
> faith in the value of leadership when fighting uphill
> battles and am
> impressed with the motivation and zeal I have seen so far.
> Thanks again.
> I'll sit back and listen for now.
> 
> Dick Besserman
> 
> 
> On 9/14/08 4:55 PM, "ALS79 at aol.com"
> <ALS79 at aol.com> wrote:
> 
> > With all due respect Dr. Besserman, what you're
> reading is the frustration on
> > the part of trauma surgery experts who are tired of
> having federal program
> > proponents foisting their ideologies and administrivia
> into local matters. To
> > me, the entry point is those who stick their hands
> into the chests, bellies
> > and
> > extremities of those with whom they are expected and
> entrusted to protect,
> > rather than professional planners in DC, who for the
> most part have no "real
> > world" experience in the mitigation of surgical
> and medical emergencies -
> > especially on a massive scale.
> >
> > What they are saying is that the system is vertically
> integrated (top-down)
> > along federal funding guidelines, and not constructed
> around rational local
> > needs and requirements based on resources and demand.
> In fact, the medical
> > community has been bypassed, and is considered by many
> an afterthought.
> > Property be
> > damned, for my money, I want someone who can save my
> life - even within the
> > construct of the federal template. But, no one's
> listening. Thus, these
> > postings.
> >
> > Bob Kellow
> >
> >
> > **************
> > 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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> >
> 
> 
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[CCM-L] ?? DMAT "Military" hospital and/or clinic