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Fri May 22 16:36:10 BST 2009

I would disagree that this has much at all to do with systematized care, or that it should.  Rather, it probably (at least in most cases) represents a complete and wholly situational DEPARTURE from the system.  

There's nothing at all wrong with this sort of just-in-time problem solving, so long as it is subject as such to conventional performance review.  In this case, congratulations seem well-deserved; but if a different departure results in tragedy -- as with any of the myriad hypotheticals we touched on during the Natasha Richardson thread -- then the system should be as willing to criticize and correct.  

There is perhaps nothing so dangerous as mis-directed or poorly-executed heroism.  Part of the purpose of proper systems is to protect us from our best intentions.

I once watched Radar O'Reilly and Father Mulcahey improvise a surgical airway with a fountain pen.  But we don't contort our systems to endorse or disseminate that sort of thing.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
Sent: Friday, May 22, 2009 2:34 AM
To: Trauma and Critical Care mailing list
Subject: Congrats. - Re: Australian doctor uses household drill to save boy

Congratulations.   This is what our maturing trauma and emergency surgery systems should and can be accomplishing.  Great examples.   Julie, please accumulate the cases and write it up.  

K

Sent via BlackBerry by AT&T

-----Original Message-----
From: julie miller <jamiller444 at yahoo.com>

Date: Thu, 21 May 2009 23:17:02 
To: Trauma and Critical Care mailing list<trauma-list at trauma.org>
Subject: Re: Australian doctor uses household drill to save boy

Yes, it was one of our neurosurgeons who talked him through it. The boy was then flown to the Royal Childen's Hospital.

I had a similar opportunity last year with a GSW to the liver, small bowel, and rectum in an hypotensive adult - talked a country doctor through a damage control laparatomy, then he sent the patient with packs in down to us.  It made me feel all warm and fuzzy.

Julie Miller
Royal Melbourne Hospital

________________________________
From: Jenny Moncur <jmoncur at netspace.net.au>
To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Sent: Thursday, May 21, 2009 12:32:03 PM
Subject: Re: Australian doctor uses household drill to save boy

Yep - he did have a critical lesion.
The child rapidly became unconscious, started fitting and then blew a pupil.
Family took him to local hospital.

The local doctor evacuated a clot and 400ml of blood from the epidural space by drilling just above the right ear.

He was in phone contact with a neurosurgeon at the major trauma centre in Melbourne who talked him through the procedure.
This was in part facilitated by our State Trauma system which fast tracks communications between regional and remote medical facilities with the major trauma centres.
The surgeons can give advise to the remote doctor or paramedics over the phone for immediate care needs of the patient meanwhile arranging for transfer to the appropriate centre.

This kid also had a pretty level headed and gutsy local doctor and anaesthetist at the regional hospital.

He looks well.

Jen
IC Paramedic
Victoria, Oz
----- Original Message ----- From: "Rob Ojala" <Rob.Ojala at cdhb.govt.nz>
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
Sent: Thursday, May 21, 2009 12:07 PM
Subject: RE: Australian doctor uses household drill to save boy

based on recent opinions expressed on this list....[and assuming this child really did have a critical lesion]...i suspect he was lucky to be living in Australia :-(

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Congrats. - Re: Australian doctor uses household drill to save boy