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Mon Aug 31 15:29:47 BST 2009

I disagree completely.  

Four years later, and based only on this one investigative report --
read during a quiet sunny weekend afternoon a thousand miles from New
Orleans -- I'd assert that the initial triage scheme at Memorial was
unconscionably flawed, and that the staff's subsequent actions, while
undeniably well-intended, can as truthfully be described as hysterical
(in the psychiatric sense).  This is a tragic and chilling example of
hyperbolic group-think, superimposed on a woefully ill-prepared and
ill-executed emergency preparedness system.

I don't for an instant pretend any immunity to the situational stressors
that these clinicians were under; nonetheless, the suggestion that Dr.
Deichmann's decisions or Dr. Pou's performance might somehow be wholly
justifiable belies an unwillingness to confront critically important
errors and learn from them:

1: Triage does not favor the walking wounded.  Nature does. 

2: DNR does not equal expectant.   

3: Willfully hastening a patient's death -- even under extreme
conditions, but especially in the absence of consent -- is simple
manslaughter.  

4: Abandonment is abandonment.  Healthy doctors and nurses don't leave
needful patients behind -- much less in the hands of the euthanists.

I pray that Dr. Fink's article contains broad omissions and breathtaking
editorial flaws.

Pret Bjorn, RN
Inveterate Skunk-Poker
Self-Righteous Bastard
Bangor, ME, USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Timothy
Hardcastle
Sent: Sunday, August 30, 2009 11:53 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Katrina - Lessons remembered

K

Thanks for the summary and cudos to the McSwain team. What this brave Dr
did was to invoke the expectant category. Use of the Triage Sieve/Sort
system (as used by Nato and MIMMS) in the USA would have made it much
easier to justify her actions in this kind of scenario.

If you are not up to speed on this system, I can forward you a brief
summary.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa

> Four years ago today, Norman McSwain and I were chatting on the phone
on
> Sunday, still speculating what this Category 4 Hurricane was going to
do
> to
> the  people of the Gulf coast and to our own lives in particular.   We
had
> chatted over the previous few days as Katrina made up her mind as to
which
> direction to go and how strong she was going to be.    As it  turned
out,
> she
> dodged to the East of New Orleans and there was a short sigh of
relief,
> until the levees broke and the flood waters came to a city that was
lower
> than the lake, river, and oc
>
> ean.    The rest is history, which does not need to be  repeated here.
> Norman lived in Charity Hospital until the last  patient, nurse, and
> doctor
> were out.   Thank you Norm, for your  dedication to your fellow man.
> Your
> emotions, your actions,  your own survival, in addition to the many
> stories
> of your hospital are yet  untold in the detail which needs to be felt
by
> all.
>   Perhaps that  will be the focus of your talk in Las Vegas next year,
if
> you  agree.
>
> In yet another horrible tale of medical decision making is reported
this
> morning in the New York Times.
> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2009-August/_http://www.nytimes.com/2009/08/30/magazine/30doctors.html?th&emc=th_
> (http://www.nytimes.com/2009/08/30/magazine/30doctors.html?th&emc=th)
>  This is also a must read article in all 18 pieces
> by everyone on this list  server.    Each of us might face similar
> conditions at any  time.
>
> The leaders of your community during your own disaster and crisis are
> currently reading this post to Trauma-list.
>
> At this point of 4 years anniversary of Katrina, I offer respect and
hope
> to all the families who endured the horror and fear.  To the thousands
> who
> came to their aid, I offer my greatest respect and gratitude.  To
those
> who
> were slow to respond or created confusion, I would ask that we learn
from
> this sad past event.
>
> k   .
> --
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Katrina - Lessons remembered