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Sun Mar 22 13:23:11 GMT 2009

Dear Pret,
While I know that I live in a third world country, in London, England  
at least a head bump with short term loss of consciousness would not  
go to a neurosurgeon. It would go to the nearest hospital. And a head  
bump, followed by a lucid interval, followed by loss of consciousness  
would go to the nearest hospital too.
Bear in mind that in London, there are 6 hospitals with neurosurgeons  
I can think of. One ( National Hospital for Neurology and  
Neurosurgery ) does not have an ER, so never accepts patients that  
have not gone via another hospital.
With the notable exception of the Royal London ( where the trauma  
listowner works ) one has to think that some neurosurgeons do not want  
to get all the emergencies, as it would impede the elective work/ 
private work.

Nick Macartne
On 22 Mar 2009, at 12:46, Pret Bjorn wrote:

> Let's start from the ground up, an decompress this conversation a  
> bit by
> admitting that (from all that the public has been allowed to know) Ms.
> Richardson herself played a huge part in her own trajectory.  She  
> was both
> exceedingly unlucky and tragically unwise.
>
> She was unlucky, not for cratering on a bunny slope, or even  
> incurring a
> mortal head injury in the mix; but rather, for (apparently) showing  
> little
> or no loss of consciousness followed by a truly world-class lucid  
> interval.
> Bright lucidity, we must admit, can occasionally be wasted on the  
> owner.
>
> As for that, her un-wisdom traces to at least two bad decisions:  
> first, to
> not spend eight bucks renting a helmet (though why a ski school  
> wouldn't
> provide this free of charge is beyond me); and second, to decline  
> medical
> treatment in the immediate aftermath of her crash -- presumably  
> because she
> felt largely uninjured, at least moderately embarrassed, and didn't  
> want to
> dampen her vacation over a bump on the head.  Here, a show of hands:  
> who
> among us would have done otherwise?
>
> So.  Four hours later, as her brainstem squeezes out the bottom of her
> skull... WHERE are the SURGEONS?
>
> Forgive me when I suggest that this is at least an unnecessarily  
> obtuse, if
> not altogether silly, question.  There is zero assurance that her  
> outcome
> would be any better had she been injured in any resort in Montana,  
> Utah,
> Colorado, or Maine.  Speaking only for Maine, I'm confident that she  
> would
> have been at a trauma center in well under an hour (probably half of  
> that)
> from the time of the second EMS call.  (Sorry, Ken, but I base this
> exclusively on the integration and efficiency of our HELICOPTER  
> program.)
> Yet I think we're all flattering ourselves if we think that would  
> have made
> much difference so late in the game.  There are indeed miracle  
> recoveries in
> such stories; but there are also fates worse than death.
>
> I'm less willing to criticize the Quebec EMS system because I'm more  
> than
> 90% ignorant of its architecture.  Generally speaking, though, I  
> hope that a
> mechanical fall with objective and isolated loss of consciousness --
> anywhere in the world -- would be triaged in favor of the closest  
> hospital
> with a neurosurgeon.  (Practically anybody can do a head CT these  
> days; but
> that's the problem.)  I'd prefer the destination be a trauma center;  
> but if
> that's gonna add hours to the trip, she can be out-transferred after  
> the
> burr holes.  And all this admits that I have no idea whether or to  
> what
> extent the Canadian healthcare system has centralized the neurosurgery
> resources of one of the largest nations on the face of the earth...
>
> These are generalizations, of course, and defy systematization in the
> absence of a broad enthusiasm from local, regional, and provincial
> government; prehospital and EM providers; and yes, SURGEONS.  But I  
> should
> think they'd all have significant and very useful input.
>
> Pret Bjorn, RN
> Bangor, ME USA
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org 
> ]
> On Behalf Of KMATTOX at aol.com
> Sent: Saturday, March 21, 2009 10:50 PM
> To: trauma-list at trauma.org
> Subject: Re: Lack of INTEGRATED TRAUMA SYSTEM cost Richardson her  
> life ?
>
> WHERE are the SURGEONS ???
>
>
> In a message dated 3/21/2009 12:45:42 P.M. Central Daylight Time,
> c_brault at yahoo.com writes:
>
> Once in  a while you hear stories through the EMS grapevine that EMS  
> crews
> were  sanctions for bypassing local regional hospital and taking the  
> wild
> risk
> of  doing diret transport to the Level 1 Trauma Center (this can  
> only happen
> in
> certain regions near Montreal and Quebec city)
>
>
> When I  came back from the States 1988
> Their were no Board recognised Emergency  Physicians that were  
> allowed to
> exercise as such (McGill Univ has the 2nd  oldest EM program through)
> Basicaly, I found that the GPs did not trust  themselves and there  
> emergency
>
> medicine very much (and rightly  so)
>
> They
> Therefore
>
> Did not trust their nurses  either (French Quebec nurses have  
> clearly less
> autonomy than their Anglo  counterparts)
>
> And
>
> They absolutely did not trust the  "Ambulance Drivers"
>
>
> **************Feeling the pinch at the grocery store?  Make dinner  
> for $10
> or
> less. (http://food.aol.com/frugal-feasts?ncid=emlcntusfood00000001)
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Dr NJD Macartney
ICU Director
Chase Farm Hospital
The Ridgeway
Enfield
EN2 8JL
+4420 8375 1074

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Lack of INTEGRATED TRAUMA SYSTEM cost Richardson her life ?