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Thu Jun 4 13:32:18 BST 2009

We've instituted SBIRT at JSUMC...its only recent, but it is important that 
it be done. At least it is a start.

----- Original Message ----- 
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
Sent: Thursday, June 04, 2009 6:49 AM

AGREED!!! AGREED!!!
Not to mention the fact that many states still carry the law passed decades 
ago by the insurance companies that allow them to deny payment for any and 
all medical care associated with DUI.  I am proud to say that the COT in CT 
lead the charge 3 years ago and got that law repealed.  Personally, I list 
"acute alcohol intoxication, alcohol abuse" as my primary diagnosis for all 
patients who come to the ED injured and drunk.  At least that way if the 
records do get subpoenaed there is something concrete - along with the 
mandatory blood alcohol and urine tox screen that I insist on - that can be 
used.  And while I am on my soap box, exactly how many on this list take the 
time and make the effort to actually do screening and intervention?
Gotta go - time for a little nip......(Sometimes I really crack myself up!)
Take care,
Ron

Ronald I. Gross, MD, FACS
Chief of Trauma & Emergency Surgery Services
Baystate Medical Center
Assistant Professor of Surgery
Tufts University School of Medicine
759 Chestnut Street
Springfield, MA  01199
413-794-4022  phone
413-794-0142  fax
ronald.gross at baystatehealth.org
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of nappio at aol.com
Sent: Wednesday, June 03, 2009 5:50 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Air France Flight Disappearance - THEORY

Ps - check your records...probably 1% of the positive etoh screens ever get 
a summons. Dn

Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>

Date: Wed, 3 Jun 2009 17:11:34
To: 'Trauma-List [TRAUMA.ORG]'<trauma-list at trauma.org>
Subject: RE: Air France Flight Disappearance - THEORY

Reducing the penalty??  Hell, Norman, up here the lawyers DEFEND these guys. 
There is a huge billboard in Bridgeport on I-95 by a lawyer who does nothing 
else but defend the guys up for DUI cases.  And last week I took care of a 
patient driving his motorcycle without a helmet who lost his leg and remains 
comatose after being taken out by a guy with a suspended license and FOUR 
prior CONVICTIONS for DUI.  Stupidity is our job security - and the 
legal/legislative system merely acts to perpetuate and reward stupidity.

Yeah, I guess I'm a bit frustrated..........today has been a long week.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of McSwain, Norman E Jr.
Sent: Wednesday, June 03, 2009 1:52 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Air France Flight Disappearance - THEORY

Sorry but mandatory continuing education and retesting will not work if the 
lawmakers continue to do as the Louisiana is doing this week: reducing the 
penalty for DWI and removing the motor cycle helmet law

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of John Annen
Sent: Wednesday, June 03, 2009 12:22 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Air France Flight Disappearance - THEORY

Dear Dr. Gross

You are too right about our (and our policy makers') lack of attention to 
road safety. A lot of money has been spent over the past few decades on 
improved safety technologies for cars and roads, but IMO far too little has 
been done to improve attitudes and awareness among drivers.

I would like to see mandatory continuing education and periodic retesting 
for all drivers. Surely the additional cost and inconvenience would be 
justified by the lives saved (and if it weren't, the measures could be 
removed), and we as a society readily accept such measures in the workplace 
in order to operate machinery and perform other tasks which are 
substantially less risky to ourselves and others than driving a car, but our 
"right" to drive seems to be sacred, and the law makers seem afraid to do 
what needs to be done to get highway deaths and injuries down.

John Annen

________________________________
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Sent: Wednesday, June 3, 2009 3:12:35 PM
Subject: RE: Air France Flight Disappearance - THEORY

>A faulty maintenance,  a leak in the fuel system + static= explosion, a 
>suicide attack to the pilot cabin, an explosive bomb, a air plane to plane 
>crash and an astray missile are other common explanations<

Common explanations?  When is the last time you saw any of these common 
events?  Lest we forget, air travel is still the safest mode of 
transportation available to mankind.  Case in point - just for the US, how 
many traffic deaths were there, and how many deaths due to plane crashes 
were there?  Yes, there was the pilot error in Buffalo, NY, but how many 
crashes on US roadways did we see due to "pilot" aka driver error?  Like 
drunk drivers, drivers talking on cell phones, etc, etc, etc.

Too bad we don't pay as much attention to the carnage on the world's 
roadways as we do to the deaths caused by airplane crashes.  Yes a sudden 
massive loss of live is very visible - but the effects are the same whether 
that loss of life happens all at once or over the course of 365 
days..........

And while I am at it - we might never know what happened on the doomed Air 
France plane, and so all this speculation by all of our self-proclaimed 
experts and a token will get me mugged on a subway - and will cast unproved 
and therefore undeserved blame on pilots who might not deserve it.  How 
about we all look to cast blame and hold accountable all of the people who 
are responsible for all of those deaths on the worlds' roadways because they 
can't seem to stay sober when they have to drive?

Just my 2 cents.

Ron
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Bjorn, Pret
Sent: Wednesday, June 03, 2009 8:42 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Air France Flight Disappearance - THEORY

I'm guessing that nobody "forgot" to blame the suddenly dead and thus 
defenseless crew on zero evidence.

Some people just prefer to keep their speculations respectful and harmless. 
Some would rather not speculate at all.  The truth will out; no sense or use 
in rushing it.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of listasmsd
Sent: Wednesday, June 03, 2009 7:04 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Air France Flight Disappearance - THEORY

Every one forgot the common cause of airplanes crashes: pilot error ... seek 
the Occams´razor. In very bad weather there is safe way out. At the end, 
like in most cases the pilots poor judgment will be the main reason of the 
plane lost.
I will always praise an anonymous Captain from A.A. that stopped the flight 
I was in because the gadget-meter for fuel was faulty (a 3 hours flight, 
fuel for 6 hours). We were ready for take off and the Captain said the 
reason in the plane´s loud speaker: ......the replacement sent by the 
company was broken also... even with the A.A. land people pressure he is not 
taken off......... It took me 14 hour to get to Miami
The companies pressure the air crew often over "minor" problems so the show 
will go on.
Regards
Manuel Sotelo
Caracas D.C.
PS A faulty maintenance,  a leak in the fuel system + static= explosion, a 
suicide attack to the pilot cabin, an explosive bomb, a air plane to plane 
crash and an astray missile are other common explanations

(Cross post from CCM-L)

Unfortunately, although there may be various variations (if they ever find 
the flight data recorder), the cause of this crash is likely to be pretty 
simple:  Airplanes and thunderstorms don't mix.
There is no airplane that is turbulence and ice proof at the levels 
thunderstorms achieve.
The tops of the storms were reported at or above the cruising altitude of 
the aircraft.
Airborne radar only shows what is in front of the aircraft so you can't look 
at the big picture in the Atlantic real time.
In the US, I can ask the weather folks (and ATC if they turn off the filters 
that remove weather from their radar scopes) for additional information.
I don't believe that option is available in the middle of the Atlantic.

If you have nowhere to go as you try to thread through storms that doesn't 
contain a cell, you lose.
The space you came through may now contain another storm, so you can't even 
turn back.  Generally, turning back is a bad idea once you are in the 
turbulence because of the greater forces on the aircraft in a turn..

I flew (on instruments) through a cold front once in a Cessna 182.  Normally 
I would never do so, but we were looking for two missing students who had 
flown back to their base from a trip and never got there.
Their Emergency Locator beacon (ELT) had been heard.
We were the only aircraft/crew able to do ELT search in instrument 
conditions that could be there in a prompt time frame and we had no idea if 
they were alive.
Survival drops > 75% (some say 90%) after 24 hours.
After talking with Flight Service meteorologist and the ATC controller for 
the area, we decided we could make the flight with an acceptable level of 
safety.
For about a minute, I couldn't maintain the aircraft altitude within 1000' 
(i.e. we were pushed up and down by turbulence > 3000' total),  Usual 
tolerance is +/- 100'.
That was a cold front, not a thunderstorm, with the penetration selected 
based on expert guidance, real time. Admittedly, a tiny airplane compared to 
an airliner.
It is amazing what ATC will do when you have "Rescue" on the front of your 
call sign.
(We found them on the side of a mountain, night and still on instruments. 
Ground team went in, no survivors.)

Lorick

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