Where are the SURGEONS?

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Indiana has 2 Level I trauma centers, Methodist and Wishard, both centrally 
located in Indianapolis. But...not all trauma needs level I care and so a 
few Level II's have sprung up and hopefully a few more will develop under 
the plan so that there will be regional Level II centers to take the 
majority of trauma saving the level I's for the really need a level I stuff.

We are looking at protocol development from pre-hospital on up to help guide 
destination of trauma patients so that the right person gets to the right 
facility the majority of the time (there will always be a number of over and 
under triages, key is to keep those numbers "acceptable" whatever that is).

Right now most EMS do a good job of patient destination decisions. But there 
is great over-use of air EMS and we now have 21 helicopters in 
Indiana!!!!!!! Plus, some hospitals that could easily be level II's are not 
seeking that designation and so patients get sent out to Indianapolis.

And in Lafayette, major trauma patients are still being taken to a hospital 
that does not offer general surgery (only CV and one day of elective ortho) 
when there are 2 other hospitals in town available that do offer general 
surgery 24/7. Why??? Politics!!!!!!


Andrew Bowman


----- Original Message ----- 
From: "Stephen Richey" <stephen.richey at gmail.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Sunday, March 22, 2009 2:07 PM
Subject: Re: Where are the SURGEONS?


> So, that probably means it's going to be all Wishard, all the time.
> Great.....any EMS providers in the Indy area, please remember, I want to 
> go
> to St. Vincent's 86th street campus rather than anything in the Clarian
> network.
>
> On Sun, Mar 22, 2009 at 12:45 PM, Andrew J Bowman
> <andrewj.bowman at gmail.com>wrote:
>
>> Indiana is currently working to put together a statewidetrauma plan.
>> Meetings include surgeons ER physicians and nurses and prehospital care
>> providers.
>>
>> Typed by my index finger and sent from my iPhone.
>>
>> Andrew J Bowman
>> Acute Care Nurse Practitioner
>> Trauma Nurse Specialist
>> Paramedic
>>
>> Witham Health Services
>> Emergency Department
>> Lebanon, Indiana
>> 765-485-8500 Work
>> 765-426-4189 Cell
>> 765-485-8509 Fax
>>
>>
>> On Mar 22, 2009, at 10:26, Robert Smith <rfsmithmd at comcast.net> wrote:
>>
>>  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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>>>>
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>>>
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>
>
>
> -- 
> Stephen L. Richey
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
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