Prevetable death? from a Qc MD

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Any chance someone has put these threads into digest form.


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________________________

On 2009-03-31 14:24:15 -0400 Charles Brault <c_brault at yahoo.com> wrote:

> 
> My comment to this last Editorial :
> 
> Charles GL writes : To Forrest G - it took 8 minutes to get Natasha 
> Richardson to Ste.-Agathe, and 40 minutes to Sacre-Coeur. A helicopter would 
> not have been quicker. ***************** Yes; but the real killer numbers are 
> : 50 min scene time for the second ambulance and  
> AND 1:50 min at the Centre Laurentien Factor this by the actual beneficial 
> interventions : Ambulance - Basic EMT = Oxygen (that's it) Local Hospital - 
> IV access, Artificial coma & intubation, perhaps hypertonic saline) and  
> AND a CAT-Scan Note Diagnostic (CAT-Scan) Is useless if does not result in a 
> treatment (Cranial decompression/drainage)(Not available in the small 
> hospital)
> It serves only to orient and support the Trauma referral
>  
> ... But We knew this patient needed a Trauma center upon the arrival of the 
> second ambulance ... clinically (Did not need a Scan... she needed 
> specialised care) In Trauma;  
> TRANSPORT is 80% of the care Transport to a Medical Center with the 
> appropriate level of care (Avoiding the deadly “Pitt Stop” of limited 
> medical value on Patient outcome The Helicopter is a mere tool (one of many) 
> of a Trauma SYSTEM It is one (very technological) way to bond all the medical 
> elements and have the medical actors work and think on the same level : The 
> best survival of the prehospital patients  
> A SYSTEM is best placed to evaluate, direct and attribute resources. Then 
> come back, RE-evaluate, do Quality Assurance and tweak the system accordingly 
>  
> Years of that guarantees best care and base care in relation to available 
> resources (Human AND Monetary)  
> At this time the Quebec Trauma system follows a pretty loose and hope base 
> system.  
> As for the American health system (which I know intimately) It's failures 
> Does not justify our own failures i.e. We save so many... we can allow to 
> lets SOME die in prehospital with the minimum of effectual intervention or 
> concerns on our part  
> American can DEFINITELY learn from us (and they are)  
> We, on the other hand can learn from all It's when we do that that WE improve 
> We... Being more important than Americans, You will agree  
> Charles  
> 
> 
> 
> ----- Original Message ----
>  From: Charles Brault <c_brault at yahoo.com>
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Tuesday, March 31, 2009 12:10:06 PM
> Subject: Re: Prevetable death? from a Qc MD
> 
> 
> Most recent infromation :
> Mrs Richardson, herself, phoned back the local clinic to cancel a follow-up 
> clinic visit
> Probably at the local ski hill clinic
>  
> (Reasonble)Prevention, Education, remains the best tools at death and injury 
> reduction
> This approach is allowed to dominate in an "organised" Health System (Canada)
>  
> That should be a good reason for Quebec to "Organise" it's prehospital and 
> trauma system (In the same "Social" way that Ontario, British Columbia, 
> Alberta, Nova Scotia, New Brunswic, etc.)
>  
> Charles
>  
>  
>  
> Don't blame Canada: doctor
> 
> U.S. media finger 'socialized medicine' in actress's death
> 
> By MAX HARROLD, The Gazette
> Some Montreal doctors added a dose of caution yesterday to the fierce debate 
> south of the border that asked if Canada's "socialized medicine" killed 
> actress Natasha Richardson after she hit her head skiing on Mont Tremblant 
> March 16.
> "Canadacare may have killed Natasha," screamed a headline in the New York 
> Post. "Was Canada's health care the problem?"asked another in the Chicago 
> Tribune.
>  
> The implication "is totally unjustified," said Paul Saba, an emergency room 
> doctor at Lachine Hospital and co-president of the Coalition of Physicians 
> for Social Justice. He flatly rejected the notion that a lack of funding for 
> overall public health care contributes to fatalities from head injuries like 
> the one that claimed the life of Richardson, the wife of actor Liam Neeson 
> and the daughter of actress Vanessa Redgrave.
> Saba stressed he was not commenting specifically about Richardson, but "any 
> patient's refusal of treatment is crucial" to the outcome. So is not wearing 
> a ski helmet, he added.
>  
> Richardson, 45, wasn't wearing a ski helmet when she fell about noon and was 
> walking and talking afterward. She also refused an ambulance that came for 
> her about 45 minutes later.
> Another ambulance was called at about 3 p.m. and she arrived at the Centre 
> Hospitalier Laurentien in Ste. Agathe, 42 kilometres away, nearly four hours 
> after her fall.
>  
> Two hours later, she was transferred by ambulance to the trauma centre at 
> Montreal's Hôpital du Sacré-Coeur, 83 kilometres southeast of Ste. Agathe.
>  
> An article in U.S. newspapers by Cory Franklin, a physician who lives in 
> Wilmette, Ill., took sharp aim at the lack of CT brain scanners in some 
> Quebec hospitals and the lack of helicopter ambulances.
> "With prompt diagnosis by CT scan, and surgery to drain the blood, most 
> patients survive," Franklin wrote. "Could Richardson have received this care? 
> Where it happened in Canada, no. In many American resorts, yes."
> But a simple telephone call yesterday by The Gazette to the radiology 
> department at the Centre Hospitalier Laurentien revealed that the hospital is 
> in fact equipped with a CT scanner.
>  
> It was not known, however, whether the device, which can cost $1 million, was 
> used on Richardson.
> As for the need for a medical helicopter, Saba said that while it would be 
> helpful in longer-range cases, it might not have saved the actress.
> Mont Tremblant is relatively close by road to Montreal's trauma hospitals, he 
> noted.
>  
> "You have to do a cost-benefit analysis," Saba said. "It takes time to get 
> the helicopter's medical team assembled, get the helicopter to the location 
> of the patient, pack in the patient and fly the helicopter to Montreal."
>  
> But Michel Garner, head of the emergency department at Sacré-Coeur, said 
> Mont Tremblant is a two to 21/2 hour drive from Montreal. Ste. Agathe can be 
> an hour's drive away, he noted.
>  
> "I'm certain some patients would benefit" from a helicopter system, he said.
> André Lizotte, Quebec's chief co-ordinator of air ambulance services for the 
> Ministry of Health, said March 20 that "a serious analysis is under way" 
> regarding implementing a provincial helicopter ambulance service.
>  
> Lizotte said Quebec is served by two airplane ambulance services - a 
> government-run service in eastern Quebec, and a private-contract service in 
> the western part of the province. But these airplanes need airport landing 
> strips and can't land right beside hospitals, like helicopters can.
> Paul Brunet, president of the Council for the Protection of Patients, said 
> the question of whether a helicopter ambulance would have made a difference 
> was moot.
>  
> "If she had worn a helmet and accepted to see a doctor, would there be any 
> talk of this need for a helicopter?
> "And with all due to respect to the Americans, we don't need any lessons from 
> them about health care," Brunet added. Canada doesn't "have 50 million people 
> without health care like they do."
>  
> mharrold at thegazette.canwest.com
>  
> © Copyright (c) The Montreal Gazette
> 
> 
>  http://www.montrealgazette.com/Health/blame+Canada+doctor/1441074/story.html 
>  
>  
>  
>  
> We need helicopter ambulances
>  
> The GazetteMarch 31, 2009
>  
> Re: "Don't blame Canada: doctors" (Gazette, March 29).
>  
> This article, based on the opinion of one physician who is not an expert in 
> trauma care,  jeopardizes an attempt to address a critical problem in our 
> region that seriously affects public safety - the lack of a proper helicopter 
> ambulance service.
> The claim that such a service would have had no impact on the outcome of the 
> Natasha Richardson tragedy contradicts the opinion of most experts in the 
> field. All agree that time is critical. In light of the details described in 
> Saturday's Globe and Mail, it is clear that using helicopter transport would 
> have saved precious hours.
>  
> Yes, people should seek help when it is recommended; yes, a helmet is 
> recommended; and yes, a helicopter would have saved time and possibly her 
> life no matter when a decision to transport was made.
>  
> Our failure to ensure public safety to a minimum standard is indeed shameful, 
> but it is not a failure of Canadian health care, as this service exists in 
> most of Canada. Rather, it is a failure of Quebec health care.
>  
> Since Richardson's tragic death we have received several unfortunate victims 
> of trauma at our centre who have had consequences due to a lack of helicopter 
> transport.
>  
> I'd be very interested to know what Dr. Paul Saba would choose if a member of 
> his family were found unconscious at Mont Tremblant or Mont Sutton - a 3 
> 1/2-hour transit to a trauma centre or a 25-minute flight to the roof of a 
> trauma centre?
> What do you want? I know what I want. It's also what most Canadians want and 
> get, except here. And that demands an immediate explanation and solutions, 
> not excuses.
>  
> Tarek Razek
> Chief of trauma
> McGill University Health Centre
> © Copyright (c) The Montreal Gazette
> 
>  
>  
>  
> http://www.montrealgazette.com/opinion/need+helicopter+ambulances/1446231/story.html
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