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Sun Mar 22 14:21:32 GMT 2009

Nick,

We were recently in London for international trauma conference that  
Karim helped host. I know London was working toward implementation of  
a full trauma system but had not achieved this yet. I'm unclear as to  
who oversees triage and how it is done. But if someone had LOC, was  
lucid, and then was unconscious, I assume that would imply a low GCS  
currently. Why wouldn't such a person be taken to a trauma center?

Rob Smith
On Mar 22, 2009, at 9:23 AM, Nicholas Macartney wrote:

> 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 ?