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Sun Mar 22 19:17:51 GMT 2009

The EMS is handled by GPs (+ 1 year EM speciality)

The EMS system is so immature
On the one hand we have absolutely no Paramedics... so not much hands on to do
On the other hand we had in Montral EMS and still have on our Medevac plane some MDs
That can do much more... but really do not have too listen to the surgeons
I am repeating myself... these doctors do not much care about what pediatric intensivist have to say
As they keep botching neonatal transfers (X 20 years) despite the availability of specialised pediatric medevac service

Not much sign of leadership
Not many signs of a "system"

Not an atmosphere conducive to intelligent amelioration

Charles

 Sunday » March 22 » 2009 

Trauma team resignations worry Quebec
Charles Lemoyne downplays impact. Seven surgeons' departure is believed to be a protest against lack of resources

AARON DERFEL 
The Gazette 

Thursday, January 18, 2007

The Quebec government is deeply worried about the resignations of seven surgeons from the trauma team at Charles LeMoyne Hospital and the impact they could have on patient care, an aide to Health Minister Philippe Couillard said yesterday.
Although the surgeons will continue working in the Longueuil hospital, they will no longer coordinate trauma care.
Their resignations are a protest against what they believe to be a lack of resources.
Charles LeMoyne is one of four hospitals in Quebec that specialize in saving the lives of victims of car crashes, shootings and other traumas.
The province is following the situation at Charles LeMoyne closely, said Isabelle Merizzi, Couillard's press attache.
"For us, in the last few months (Charles LeMoyne) no longer responds to the norms of a tertiary trauma centre," Merizzi said, explaining the hospital is not able to carry out neurosurgery.
The resignations "leave a hole" and "we have some worries," she added.
"Neurosurgery and trauma care are inextricably linked. We have asked the hospital to sit down with the director of professional services and the doctors to try to resolve the situation."
The province has boosted health funding to the Monteregie region by 25 per cent, Merizzi noted. Therefore, if there is a lack of resources for trauma care, the government is not to blame, she suggested.
The trauma surgeons were unavailable for comment yesterday. They are to hold a news conference today at a Longueuil hotel.
Louis Couture, director of professional services at Charles LeMoyne, played down the impact of the resignations.
"Trauma patients will continue to be taken care of at Charles LeMoyne Hospital," he said.
"The quality of care will be just as good and just as safe. We have emergency-room doctors who will take over and ensure the coordination of trauma care.
"The hospital is under exceptional pressure," he added. "The doctors work very hard here. We have to look at all our resources, not just trauma care."
Luc Boileau, executive director of the Monteregie Health and Social Services Agency, which oversees the hospital, criticized the doctors for resigning while all sides were examining the issue of resources.
"Certainly, there is a communication problem between the surgeons and the administrative team," Boileau said, adding that "patient care has not been compromised so far."
Charles LeMoyne handles an average of 1,200 trauma cases a year, of which 250 are considered very severe.
This is not the first time questions have been raised about the quality of trauma care at the South Shore hospital. In 2000, a government report found the trauma centre lacked "appropriate medical and surgical teams" - resulting in a statistically high number of deaths among severely injured patients.
John Sampalis, an epidemiologist who wrote the report, said at the time: "My first instinct would be to recommend that (trauma patients) cross the bridge and come over to the Montreal General Hospital.
"Charles LeMoyne is significantly worse than the three other trauma centres," he added.
Seven years later, the hospital still does not have a designated trauma operating bay.
aderfel at thegazette.canwest.com
© The Gazette (Montreal) 2007

Copyright © 2009 CanWest Interactive, a division of CanWest MediaWorks Publications, Inc.. All rights reserved.
  CanWest Interactive, a division of CanWest MediaWorks Publications, Inc.. All rights reserved.

 Sunday » March 22 » 2009 

Quebec curtails hospital
Children's squeezed out. New policy sends most injured kids to Ste. Justine, documents show

CHARLIE FIDELMAN 
The Gazette 

Friday, December 07, 2007

Montreal Children's Hospital is being squeezed out of pediatric trauma care, despite blunt assurances to the contrary from the province's top health official.
Internal Quebec Health Department documents obtained yesterday show government policy has sharply curtailed the Children's function as a pediatric trauma centre.
Since July, most pediatric and adolescent trauma patients from across Quebec have been systematically sent to Ste. Justine Hospital.   

Traditionally, children living in outlying regions (for example, the Montérégie, the Laurentians, Lanaudière and the Mauricie) who suffer a severe traumatic injury could be transferred to either Montreal pediatric hospital.
Under the new policy, the Children's is limited to caring for trauma victims from four hospitals while Ste. Justine gets the lion's share of ambulances coming from a total of 24 institutions.
The new policy has reduced the Children's role to caring for "overflow" cases from other ERs and intensive-care units, critics said.
That will translate to delays in care and lead to higher death rates from trauma injuries, McGill University Health Centre officials warned in a statement.
At least eight critically ill children have had to be treated at the Children's because Ste. Justine refused to take them, the MUHC says.
In the meantime, a Ste. Justine executive has called for concentrating severe trauma cases at one institution: his.
Put the typical year's 150 or so cases of severe trauma in one place - Ste. Justine - "and they'll have better care," said Dickens Saint-Vil, chief of trauma at Ste. Justine Hospital.
Quebec Health Minister Philippe Couillard dismissed the MUHC's concerns as unfounded.
The Children's has nothing to worry about, Couillard told The Gazette this week.
"There's absolutely no intention from my part, from the government's part, to reduce the Montreal Children's activity in trauma," he stressed.
He chastised officials at both pediatric institutions for reigniting old conflicts by bickering over who gets to treat severely injured children.
But documents from Couillard's department suggest a different scenario.
The distribution of trauma care clearly favours Ste. Justine.
The four institutions allowed to send patients to the Children's are Anna Laberge Hospital (Montérégie), Santa Cabrini Hospital (Montreal North), the Centre de santé de Chibougamau (James Bay) and Suroît Hospital (Valleyfield).
Ste. Justine is to receive patients from 24 facilities - from Sorel to Témiscamingue, Trois Rivières to Abitibi - including Fleurimont Hospital (Sherbrooke), and Honoré Mercier, Charles LeMoyne and Granby hospitals (the Montérégie).
Couillard was not available for comment yesterday.
"Everything Mr. Couillard said (earlier) remains true, documents or no documents," said Isabelle Merizzi, his aide.
"There's no question of neglecting the Children's. It's not because Ste. Justine has evolved that the Children's cannot."
The government is re-evaluating its distribution of trauma care to pediatric and adult hospitals, Merizzi said, "despite the existence of these documents."
"But in an emergency, and this is paramount, the treating physician must make the right decision," she said on the issue of where to transfer a patient.
The decision depends on trauma severity and health resources available, she explained.
Officials at both pediatric hospitals refused to comment.
Nicolas Steinmetz, a pediatrician and a former executive director of the Children's, said government policy is strangling the Children's.
"This is complementarity by stealth," he said, referring to a government-proposed reorganization of services that called for a transfer of cardiac surgery, cancer care and trauma units to Ste. Justine from the Children's. The plan was shelved last summer.
cfidelman at thegazette.canwest.com
© The Gazette (Montreal) 2007

Copyright © 2009 CanWest Interactive, a division of CanWest MediaWorks Publications, Inc.. All rights reserved.
  CanWest Interactive, a division of CanWest MediaWorks Publications, Inc.. All rights reserved.

----- Original Message ----
From: "KMATTOX at aol.com" <KMATTOX at aol.com>
To: trauma-list at trauma.org
Sent: Sunday, March 22, 2009 9:02:37 AM
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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Where are the SURGEONS?