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Whole-body CT

Gross, Ronald Ronald.Gross at baystatehealth.org
Tue Jan 31 12:00:29 GMT 2012


Ay, cynical I am, my friend.  But that cynicism has come at a hard price and is resisted daily.......but so too is my idealism beaten daily as well!  :-(



-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Tuesday, January 31, 2012 6:57 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Whole-body CT

Cynics of the world UNITE!
(... as if THAT'll do any good.)

Sent from my iPhone.

On Jan 30, 2012, at 11:49 PM, "Gross, Ronald" <Ronald.Gross at baystatehealth.org> wrote:

> Norman,
> We also ask that the patients be stabilized and sent without imaging.  Sadly, however, imaging is a very good way for our referring hospitals to make money on the patients that they send to us so that we can take the morbidity/mortality hits, while they keep their numbers pristine and their books in the black.  No matter how much we ask, the outcome is always the same.  I guess it is the "low lying fruit" concept...........
> Ron
> 
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
> Sent: Monday, January 30, 2012 11:38 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Whole-body CT
> 
> Currently we do NOT request assessment using CT before transport from an
> outlying hospital. This just delays the needed transport. If the
> referring physician believes that the patients meets either anatomic or
> physiologic triage, we say to send the patient immediately.  Since we do
> not use Mechanism of Iinjury only for destination protocols, this would
> be a physician to physician discussion. If the patient needs to be in a
> trauma center we do not request further workup using CT or anything else
> 
> Norman
> 
> Norman McSwain MD, FACS
> Professor of Surgery, Tulane University
> Trauma director, Spirit of Charity Trauma Center, ILH
> 504 988 5111
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com
> Sent: Monday, January 30, 2012 8:48 PM
> To: trauma-list at trauma.org
> Subject: Re: Whole-body CT
> 
> 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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