Where are the SURGEONS?

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Greetings,
I’m new to this site and not an MD but I’d like to put in two cents.
There are obviously many unfavorable factors leading to this unfortunate event. I believe that the first critical failure may have been  on the part of the EMS personnel involved. Whether a patient is refusing care in a facility or in the field, it is the medical professional’s duty to ensure that the patient is fully informed of the consequences of refusal and that they exhaust every means and method to encourage the patient to consent to evaluation and treatment.
 It is my observation that many providers, be it pre hospital or even in an Emergency Department go directly into “CYA” mode at this point with patient advocacy a distant second consideration. In an area such as this where timely transport is crucial, this responsibility becomes all the more imperative. 
 
Thanks.
 
Guy E. Howd, EMT-P, I/C
Lieutenant, Professional Development
EMS Educator – SETEC
 
__________________________________
STAT Emergency Medical Services, Inc
Central District Headquarters 
520 West Third Street
Flint, MI 48503
 
From: McSwain, Norman E Jr. [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr.
Sent: Sunday, March 22, 2009 12:06 PM
To: Trauma &amp
Subject: RE: Where are the SURGEONS?
 
Ken  may have other observations but I think there are many reasons some the fault of surgeons themselves and some the fault of others. below are listed some of my thoughts. 
 
* the desire of those other than surgeons to run the care of the acute patient, so the surgeon is not invited to the discussions. Unfortunately many of these folks do not understand to complexities of care in the OR, in the ICU and the follow up after the hospitalization to assure that the treatments provided did, in fact, provide improvement. Many of these directors of care,  never see the patient after the first few hours of the emergency. They do not have clinics and are not involved in the results of inappropriate management in the initial hour or two of patient care.  (or are non clinicians who do not take care of patients at all). In one of the hospitals that I practice, the emergency and disaster program is run by non physicians who do not take care of patients at all,  yet believe themselves to be experts in all aspects disaster and emergency care. Many of these people are frightened of the aggressive approach of the surgeon who believe in the need for immediate decisions. The want to have multiple committee meetings over the next several months rather than make a decision of any sorts.
* The perceived need of the surgeon to become specialized to have a more enjoyable life and to get more referrals
* the more relaxed life style desired by many surgeons
* many surgeons have abandoned the acutely ill or injured patient because of not wanting to get up in the middle of the night, the reduces payment from the indigent patient (the most commonly injured) and the loss of need for the epinephrine stimulation when caring for a really sick patient.
 
It is for these reasons, and others, that the specialty of the Acute Care Surgeon is taking hold in the United States.
 
By the way, none of the above comments in the first point are aimed at any specialty but are aimed at the general personality who migrate to directing of emergency care. Surgeons are unfortunately part of this group in some hospitals.
 
Norman
 
Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu
 



From: trauma-list-bounces at trauma.org on behalf of Robert Smith
Sent: Sun 3/22/2009 9:26 AM
To: Trauma & Critical Care mailing list
Subject: Re: Where are the SURGEONS?
I'm stunned in one sense, but perhaps not totally surprised I guess, 
to read that surgeons are being systematically excluded from planning 
of EMS and disaster management. It's also sad that you would even feel 
a need to defend the surgeon's current and historic role. I would have 
liked to think that everyone was aware of those by now.

Why do you think this has come about?

Rob
On Mar 22, 2009, at 9:30 AM, McSwain, Norman E Jr. wrote:

> This is the old story of when the elevator door closes with the 
> patient  headed to the OR from the ED, that the emergency is over. 
> No one thinks of the continued care that the patient needs and the 
> importance of how the planning of the initial care impacts the later 
> care. Ken is correct. of late there has been a "purposeful EXCLUSION 
> of surgeons in many  areas" from the planning of EMS, disaster 
> management both outside the hospital and in the hospital.
>
> This is interesting because surgeons have been actively involved in 
> the starting of all emergency care and EMS. Starting from Larrey 
> with Napoleon in 1699, to Farrington starting EMS in the US in the 
> 1950's, the start of ATLS in the late 1970's, the start of PHTLS in 
> the early 1980's and yes  even emergency medicine was started by 
> surgeons in the US.
>
> Norman
>
> Norman McSwain MD
> Trauma Director, Charity Hospital
> Professor of Surgery, Tulane University
> New Orleans LA
> 504 988 5111
> norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of KMATTOX at aol.com
> Sent: Sun 3/22/2009 8:02 AM
> To: trauma-list at trauma.org
> Subject: Where are the SURGEONS?
>
>
>
> Pret:   My question about "where are the surgeons" related to the  
> discussion
> as it entered into the regional trauma system and  EMS/EM system  
> development
> (in general).   The post at that point talked about  emergency 
> medicine and
> EMS, but nothing about surgical involvement in a  regional, area 
> wide, or even
> city trauma system.   It was surgeons,  working with all others in 
> health care
> (EMS, nursing, EM, administrators,  politicians, and yes, YOU, with 
> your many
> hats) that developed and grew the  Trauma System in Maine.     I can 
> tell you
> 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.
>
> k
>
>
>
>
> 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
>
> **************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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