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Wed Jun 13 20:35:40 BST 2012

GEEZ - you are typing faster than I think!!!!!!

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Zsolt J. Balogh
Sent: Wednesday, June 13, 2012 3:29 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Landstuhl

I think we are talking about the same thing. I just disagree when people accept everything and attribute any development to wars. 

________________________________________
From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald [Ronald.Gross at baystatehealth.org]
Sent: Thursday, 14 June 2012 5:22 AM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Landstuhl

" The direct translation of military practice resulted some lost limbs due to the use of tourniquets in inapproprite settings/indications."

I don't believe that anyone ever said that direct translation of any practice from one forum to another is appropriate; before implimenting anything, regardless of what the "anything" is and where it is to be used, one would always make sure that the circumstances, situations and appropriate applications have been examined, tested and proven to be appropriate.  We do this with new medications as well as with new and innovative procedures.

Truth be told,1:1:1 resuscitation is nothing new.  It has been used for decades - in the form of whole blood transfusions (before the Red Cross figured out how to make a whole lot of money fractionating whole blood).  Tourniqueets have been used for centuries and yes indeed resulted in the loss of many salvagable limbs because they were used wrong and used by the uneducated.  Temporary shunts are also nothing new, but oncce again their utility has been resurrected by the experiences gained over the last 10 years.

" that if one wanted to learn surgery one needed to go to war."  Notice the key word is learn.  Ours is a profession where when we cease to learn we cease to be of use to our patients.  Ours is, therefore, a profession that can benefit from the experience gained in wartime by translating that experience - and the lessons learned under the most hostile and devastating of circumstances -  into the appropriate applications in civilian trauma care.

Direct translation?  Hardly!  Appropriate translation with appropriate education - priceless!

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Zsolt J. Balogh
Sent: Wednesday, June 13, 2012 2:11 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Landstuhl

Neither of them are military inventions. But the current pattern of war injuries makes it possible to utilize these techniques in large number of cases. Tourniquets in civilian setting very are infrequently needed. The direct translation of military practice resulted some lost limbs due to the use of tourniquets in inapproprite settings/indications.

________________________________________
From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald [Ronald.Gross at baystatehealth.org]
Sent: Wednesday, 13 June 2012 10:57 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Landstuhl

Agreed. And let's not forget the reintroduction of tourniquets and temporary vascular shunts, limb and life saving adjuncts that appeared to have been left by the wayside for a good long while.

Hippocrates had said (very loosely paraphrased) that if one wanted to learn surgery one needed to go to war. Seems to me that the man was pretty smart......and we need to bring as much  home from down range as we possibly can.

Sent from my iPhone

On Jun 12, 2012, at 5:11 PM, "William Bromberg" <brombwi1 at memorialhealth.com> wrote:

> I'm with you Ron 1:1 resus is already saving lives IMO.
>
> Sent from my iPad
>
> On Jun 12, 2012, at 13:49, "Gross, Ronald" <Ronald.Gross at baystatehealth.org> wrote:
>
>> Sorry, but I cannot agree with that - not even close!
>>
>> Ron
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Zsolt J. Balogh
>> Sent: Tuesday, June 12, 2012 12:27 PM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: RE: Landstuhl
>>
>> Trauma care does not improve from the war. Only if you are able to identify from war experience how not to do it. Any overenthusiastic direct applications from war experience led to disasters in civilian arena.
>>
>> --------
>> Sent from my HP iPAQ
>>
>> -----Original Message-----
>> From: Charlene M Morris <cvmmorris at gmail.com>
>> Sent: Tuesday, June 12, 2012 1:43 PM
>> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
>> Subject: =?utf-8?B?UmU6IExhbmRzdHVobA====?>
>>
>> The other MAJOR consideration for our lawmakers and funding for US troops,
>> is that trauma medicine has EXPONENTIALLY improved because of military
>> knowledge and experience. I would nopt wish that their family needs such
>> care, but we all know of a family member or friend who required ememrgency
>> care-- that most likely saved their life.
>>
>> keep squawking! squeaky wheel and all that..
>>
>> cmm
>>
>> On Tue, Jun 12, 2012 at 8:18 AM, Bjorn, Pret <pbjorn at emh.org> wrote:
>>
>>> Setting aside our leaders' sad habit of neatly segregating our foreign
>>> policy decisions from their aftermath, it's just fascinating to me how much
>>> easier it is to fund a war than a hospital.
>>>
>>> ANY hospital.
>>>
>>> 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 Robert Smith
>>> Sent: Monday, June 11, 2012 9:54 PM
>>> To: Trauma-List [TRAUMA.ORG]
>>> Subject: =?utf-8?B?UmU6IExhbmRzdHVobA====?>>
>>> No, you'd better not.
>>>
>>> Sent from my iPad
>>>
>>> On Jun 11, 2012, at 5:48 PM, "Gross, Ronald" <
>>> Ronald.Gross at baystatehealth.org> wrote:
>>>
>>>> As I see it, this is just one more example of how terribly short-sighted
>>> the government bean counters are, and just how spineless our elected
>>> officials continue to be.  LRMC has proved to be the best example of the
>>> best that military medicine has to offer.  This hospital has earned the
>>> distinction of being a ACS COT verified Level I Trauma Center - the only
>>> one outside of CONUS (the continental United States) and the only one in
>>> the military.  The care they have given to so many of our heroes is
>>> mind-boggling, and aging or not, white elephant or not, this medical
>>> .facility has done so much with so little and done it well.
>>>>
>>>> I am perhaps reacting emotionally, and I will admit that, but I am also
>>> reacting as one who has seen first-hand what has been done by the LRMC
>>> staff.  Closing this medical center with no alternative IN PLACE is, in my
>>> mind, criminal - and there is no other word for it.
>>>>
>>>>
>>>> Have we no heart?  Have we no conscience?  It appears that our elected
>>> officials forgot that the best way to demoralize an amry is to inject the
>>> threat that their medical care won't be there when they really need it
>>> most!  I wonder what would happen to the decision if a half dozen Senators
>>> and Congressmen had kids wounded and needed care..........
>>>>
>>>> I better shut up -
>>>>
>>>> Ron
>>>>
>>>>
>>>> -----Original Message-----
>>>> From: trauma-list-bounces at trauma.org [mailto:
>>> trauma-list-bounces at trauma.org] On Behalf Of Robert Smith
>>>> Sent: Monday, June 11, 2012 4:45 PM
>>>> To: Trauma-List [TRAUMA.ORG]
>>>> Subject: =?utf-8?B?UmU6IExhbmRzdHVobA====?>>>
>>>>
>>> http://www.nytimes.com/2012/06/11/world/europe/landstuhl-hospital-to-be-replaced-but-with-what.html
>>>>
>>>> Curious what Ron and others having to do with these decisions think.
>>>>
>>>> Rob
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>>
>>
>>
>> --
>> "There are three classes of people in the world: those who make things
>> happen, those who watch things happen, and the vast majority who are not
>> aware that anything is happening." -- Unknown
>>
>> **
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