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Mon Aug 31 17:37:38 BST 2009

Well that was some article.

Every time I've read about the events at Memorial I've wondered at how  
differently they played out there than at Charity. Was it "just" that  
they lacked a courageous leader at Memorial? I've also wondered at how  
multiple people needed to buy into this bizarre thinking to allow it  
to happen. I think it would have been fascinating in a longer article  
or book to tell the two stories, Memorial vs. Charity in a parallel  
manner. And I've wondered why the story that has gotten the most press  
seems to be the tragic one at Memorial rather than Dr. McSwain's  
heroic one at Charity.

To me for some reason, the most disturbing/disgusting part of the  
story was reading about Dr. Pou's apparently successful efforts to  
indemnify medical workers in disasters from any future sanctions no  
matter what they do.

Rob Smith

On Aug 31, 2009, at 10:37 AM, Bjorn, Pret wrote:

> And lest ye read too quickly: I disagree with Dr. Hardcastle's  
> missive;
> not Matt's or Anthony's or Ron's or Ken's or Norm's...
>
> Katrina surely did have its heroes.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent: Monday, August 31, 2009 10:30 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Katrina - Lessons remembered
>
> 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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