List Archives

Sat May 23 13:05:02 BST 2009

I think we're actually agreeing.  I'm just not explaining it well enough.
Another try, then:

Modern trauma systems are, for the most part and quite necessarily,
centralized.  No matter how big the map, the trajectory of the patient
should favor the closest trauma center, and the system should strive to keep
the patient moving forward.  

There will be times when such is not possible -- and even rare cases where
it is not ADVISABLE.  Thus there will be appropriate (even occasionally
laudable) departures from the trajectory, like this one.  The system owns
them, and must review and control them very carefully.  Just like you
describe.  The system should look at the records and the times and the
circumstances, analyze them meticulously, and then award Dr. Carson a hearty
congratulations and a beautiful wall plaque.

Nonetheless, such incidents are conspicuous VARIANCES, and should not be
allowed to confuse the day-to-day operation of the system.  Else we risk
local responders pointing critically-wounded NON-subdurals at community
clinics in search of domestic power tools.  It worked, after all, on TV.

You're right: this was not mis-directed heroism, nor did I say that it was;
but it may serve to INSPIRE plenty of it, unless we maintain our objectivity
and steadfastly defend and protect the system.

Pret 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Jenny Moncur
Sent: Friday, May 22, 2009 6:41 PM
To: Trauma and Critical Care mailing list
Subject: Re: Congrats. - Re: Australian doctor uses household drill to save
boy

Pret,
I normally fully share your sentiments and enjoy your posts immensley.
This time I must disagree.

I DO think that this type of outcome is exactly what our State Trauma System

was set up to achieve.
There was no departure from the system - this was not 'mis-directed 
heroism'.

Dr Carson recognised the childs situation as being immediately life 
threatening and correctly diagnosed the problem. I am not sure if imaging 
was used but knowing the hospital I do not believe they have a CT scanner.

He then did what he should do under the state trauma system framework,  and 
this is contact the major trauma centre - in this case the Royal Childrens 
Hospital.
As Julie said, one of their neuro-surgeons talked Dr Carson through the 
procedure.

This child would not have survived a transfer to the RCH - even by chopper. 
If he did he would have been a 'parts only' prospect on survival.
As it is he was discharged three days later, and is well enough to receive a

lecture from his father about wearing a helmet whenever he rides his bike!

If there had been an adverse outcome it would have been subjected to 
scrutiny through the trauma system review process, and measure taken to 
adress the problems.

I have seen this type of action many times before, although not on such a 
dramatic scale, where expert advice over the phone has allowed prompt and 
appropriate interventions whilst preparing a patient for transfer to a major

trauma centre, if they are unable to be delivered there directly.

Respectfully

jenny Moncur
IC Paramedic, Victoria, australia
----- Original Message ----- 
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
Sent: Saturday, May 23, 2009 1:36 AM
Subject: RE: Congrats. - Re: Australian doctor uses household drill to save 
boy

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

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

____________________________________________________________
Westwood College offers a wide selection of degrees and programs.
http://thirdpartyoffers.netzero.net/TGL2241/fc/jZBdzA5v8EjklCrwXCXYK929lkkD2ptkgCA6XFiQM1YgZ5k1ri1mRry/

List Archives

For your convenience, find the Trauma List Archive Below

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