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Thu Jun 4 23:46:44 BST 2009

We screen every patient with CAGE. Any positives get follow up next  
day (during weekdays) with substance abuse counselor for more detailed  
interview. If an intervention is needed they arrange for them to be  
discharged directly into that setting. If the patients have to wait to  
get in or follow up themselves, the follow up rate approaches zero.

Rob
On Jun 4, 2009, at 6:49 AM, Gross, Ronald wrote:

> 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 that law repealed.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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