List Archives

Tue Jan 31 13:22:33 GMT 2012

From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
To: 'Trauma-List [TRAUMA.ORG]' <trauma-list at trauma.org> 
Sent: Tuesday, January 31, 2012 6:49 AM
Subject: RE: Whole-body CT

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 hit...
******************
N O P E

Here in Canuck land
Where monetary concerns are definitely not on the radar
If only in a negative way (May cost additional OverTime, supply, hassle)
The Dx trap still kills many an unsuspecting (mostly trauma) Patients

Natasha Richardson spent 2 hours in a small hosp

For What ?

Charles
-----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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Whole-body CT