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Where are the SURGEONS?

Pret Bjorn p.bjorn at netzero.net
Sun Mar 22 15:23:41 GMT 2009

Dr. Mattox,

I think it's unfair to suggest that surgeons are typically or unilaterally
marginalized from system development without noting that many
surgically-oriented trauma systems suffer a lack of cooperation or
enthusiasm from the surgeons on the front lines.  

Especially in rural systems (read: disproportionately blunt, hugely
non-operative, far more aged and comorbid), it has been my experience that
getting skilled surgeons to rise to the expectations of their peers who've
described a workable system (or their colleagues in EM, nursing, and
prehospital care who inhabit it) is more difficult than you're letting on. 

My personal history with "SURGEONS" includes a whole lot of people you don't
seem to have encountered.  We've spent millions in Bangor to put the right
people on our team, and conspicuously none of them came from the local pool
of very talented private practitioners.  

It's worth repeating: these are fine doctors; good people -- but not
generally interested or invested in the necessary hardships of excellent
trauma care.   

The trauma surgeons you're most familiar with are not evenly distributed,
and many systems -- including those designed with Mattox-level surgeons in
charge -- struggle to compensate for that hard reality.  Until we know more
about Quebec, I'm tempted to give them the benefit of the doubt.


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Sunday, March 22, 2009 9:03 AM
To: trauma-list at trauma.org
Subject: Where are the SURGEONS?

Pret:   My question about "where are the surgeons" related to the
as it entered into the regional trauma system and  EMS/EM system
(in general).   The post at that point talked about  emergency medicine and 
EMS, but nothing about surgical involvement in a  regional, area wide, or
city trauma system.   It was surgeons,  working with all others in health
(EMS, nursing, EM, administrators,  politicians, and yes, YOU, with your
hats) that developed and grew the  Trauma System in Maine.     I can tell
from first  experience in talking to people around the world, and including 
medical disaster  planning and response, there is a purposeful EXCLUSION of 
surgeons in many  areas, thinking trauma care is in the arena of emergency 
medicine and ems  only.    We are all in this together.     
In a message dated 3/22/2009 7:48:05 A.M. Central Daylight Time,  
p.bjorn at netzero.net writes:

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

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