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Whole-body CT

Krin135 at aol.com Krin135 at aol.com
Tue Jan 31 02:47:46 GMT 2012


Pret:
 
At least as late as 2005, there was a problem with certain receiving  
programs where PGIII docs were the initial point of contact, and *EVEN* in the  
face of quoting Mattox, McSwain, Bromberg et  al, and the latest (then  the 
7th, IIRC) edition of ATLS, the residents were insisting on having full work  
ups before accepting patients for transfer.....and then proceeded to repeat 
all  the tests when the patient arrived....to the point where I 
occasionally had to  contact the surgical attending....several of whom I had served 
with during  residency...to get the patient on the road in a reasonable amount 
of time.
 
I understand that Dr. Wigle has solved at least part of the  problem....
 
Oh, and as a FP doc, I qualified as an ATLS instructor along the way, so  
not all FPs are/were high turnover moving targets. 
 
I have maintained for years that it would help if the ACS/COT, the ACEP and 
 the AAFP would co-ordinate things better....The Comprehensive Advanced 
Life  Support Course started by the Minnesota Academy of Family Physicians and 
the  Minn. College of Surgeons back in the 1990s was an attempt to reduce 
the 'merit  badge courses' from four or five (ACLS, ATLS, PALS/APLS and ALSO, 
along with  special packages on burns and chemical injuries) by combining 
all of the  anatomy, physio, pathophysio and pharm sections, and emphasizing 
the team  work (Ideally, rural facilities would send a doc, a couple of 
nurses and a  couple of paramedics as a team to go through the course together) 
needed in  smaller facilities.
 
I don't see where CALS has had much penetration outside of the North  
Central Tier.
 
ck
 
 
In a message dated 01/30/12 14:52:59 Central Standard Time, pbjorn at emh.org  
writes:

Honestly, I don't think ATLS deserves much credit OR blame for  the
over-use of CT's in rural systems.  The "Transfer to Definitive  Care"
lecture is short and soft-edged -- and follows several hours  of
slideshows and skills stations which feature CT's as a common  diagnostic
modality.  Moreover, the ATLS certification rate in many  rural systems
is far from ideal: courses are rare and expensive and  distant, and
providers (often moonlighting family practitioners or  mid-levels or
locums) are a high-turnover moving target.

The College  has produced a "Rural Trauma Team Development Course," which
does an  excellent job of examining various diagnostic yields in the
context of  inevitable transfer, and wisely brings nurses and medics and
other staff  into the conversation; but in its most recent iteration it
is  discouragingly expensive to disseminate.  (We're exploring  our
options; but jeez, they went from FREE to fifty bucks a  head,
practically overnight.)

And so, regular outreach and published  guidelines may be our best hope
of modifying behaviors.  One can  hope.

Pret





-----Original Message-----
From:  trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On  Behalf Of Doc Holiday
Sent: Sunday, January 29, 2012 5:05 PM
To: .Trauma  List
Subject: RE: Whole-body CT


From: pbjorn at emh.org
>...  EMS Trauma Advisory Committee is preparing this guideline
(attached,  currently in draft) for addition to our other online advice
to trauma  system providers.  Comments or suggestions welcome.

--> Good  ol' ATLS. Nice.                   
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