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Sun Mar 22 15:16:55 GMT 2009

I remember taking part in meetings about how to arrange trauma better,  
bypass hospitals within 20 mins of the trauma centre, etc etc. Died a  
death.
Triage seems to be "take the patient to the nearest hospital". The  
exception is in cardiology, where they bypass to get to a hospital  
that can do emergency PCI.
I would suggest that this has happened because the cardiologists have  
demanded it. I have never seen any sign of neurosurgeons in this area  
demanding transfer to them. In fact, they are happy to say they are  
full - goodbye.
Nick Macartney
On 22 Mar 2009, at 14:21, Robert Smith wrote:

> 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
>>
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>
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> trauma-list : TRAUMA.ORG
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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 ?