Prevetable death? from a Qc MD

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----- Original Message ----
From: "Thomson, Dave" <dthomson at phihelico.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, March 31, 2009 8:39:46 AM
Subject: RE: Prevetable death? from a Qc MD

The question is: what are the alternatives?  Stay (for a little while) and play can work if there is some way to get the information on the basic procedure to the small hospital physician in a timely fashion.  The only way I know of is telemedicine.  For years the technology limited this, but now the limitation is reimbursement policy.  How will the University / University surgeon get paid for mentoring the procedure over the telemedicine system, and what will his / her liability be?  What if the mentor-surgeon is in another state, or another country? Are there licensure issues?
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The TRAUMA SYSTEM
Should be able to pay for this service and shoulder the medical responsibility
As it does with the Paramedics
In Quebec our Provincial No-Fault care insurance subsidizes many of these key services
Or through direct taxation (Speeding tickets, Drunk driving fines, etc.) (Much more easily accepted by even the most tax avert population)




Scoop and run can work if there is an integrated, truly functional transport system that can also work across political boundaries.  Unfortunately we have too much collegial distrust at the present time to make that work.  If it's not "my helicopter" or "my ambulance" then we don't want them bringing patients to "my hospital."  It's time that we started to have systems and teams to care for patients.
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Very same problem with Socialised medecine
With a very much different taste and texture but with
... often worse (Quebec)

... or much better results (Ontario)

A (provincial) structure needs to be created
It will be able to measure, document and rationalise it's need
It should be given some resources (see above) and gvent the RESPONSABILITY of the measured ``outcomes``




Finally, we need to educate the public.  We have to be vocal about the idea that helmets save lives.  We need to have them understand that although some medical care may be close by, it may not be the sort of definitive medical care they need.  They need to be an active part of any system, not just a victim.
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Indeed
This principle is very much advocated by this list
But for all of us
It has been easier to pop some Medevac Helicopters here and there (I am being facetious... again)
Than improve the educational and support environement of the society in wich they live in

Which is much harder
But evidently more fruitful



Charles

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