ATLS training

Wed Oct 11 14:27:14 BST 2006

CAVEAT * I'm talking about the US now.=20

The likelihood that you could prove that having the orthopods and =
neurosurgeons take ATLS (esp. at a mature trauma center) improves outcome =
is infinitesimally small. The likelihood that you could GET the orthopods =
and neurosurgeons to take ATLS (at my institution at least) is only =
marginally smaller than that. In an era that is seeing ever more hospitals =
being forced/blackmailed into sub-specialist call pay to get them to cover =
trauma, adding requirements, particularly those that you can't prove =
impacts outcome (no data) is unrealistic. AFAIC it's not a hill to die on =
* just make sure that you don't have orthopods/neurosurgeons do the =
resuscitation, and that you check on the patient when they go to the OR =
for early operation with non-trauma-trained surgeons to avoid the =
all-to-common phenomenon of a PACU phone call b/c the patient is cold, =
coagulopathic, acidotic, hypotensive, anemic, and hypoxic.

Bill Bromberg

William J. Bromberg
Savannah Surgical Group
912 350-7412

>>> cvmmorris at gmail.com 10/11/06 8:06 AM >>>
As I have mentioned, ATLS is a bastion, albeit unnecessarily so!

Perhaps a good 1st step would be for the ACS to *allow* other useful team
members to take the course and *receive certification*. I liken it to =
being
invited to dinner, but then told I am relegated to the children's table.

Please understand, I respect the physician's role in the team concept, but
unless I am included in the process, I am indeed ancillary and as such--
dispensible.

JMO--

C M Morris

On 10/11/06, stefmazur at ausdoctors.net <stefmazur at ausdoctors.net> wrote:
>
> Juan,
> while it would appear ATLS is a useful course in that it helps train
> people who manage trauma to think in a systematic fashion and deal with
> immediate life threats in such a way that everyone involved knows what =
is
> happening (i.e. the "all singing from the same song sheet" analogy), =
there
> is a paucity of evidence suggesting it saves lives.  The following is =
about
> the best evidence about that it may be of benefit, but wouldn't call it
> "Gold Standard."
>
> J Trauma. 1993 Jun;34(6):890-8; discussion 898-9.
> Trauma outcome improves following the advanced trauma life support =
program
> in a developing country.
>
> Ali J, Adam R, Butler AK, Chang H, Howard M, Gonsalves D, Pitt-Miller P,
> Stedman M, Winn J, Williams JI.
>
> So the discussion is probably worth having and should
> continue.........maybe someone clever needs to look at the evidence
> supporting it.......maybe there is an even better way.......!
>
> Stefan Mazur
> Emergency Physician
>
> By the way your Caps Lock key seems to be stuck
>
> >ATLS save lives.......end of discussion guys!......this is not about a
> >certificate, audit, CME or waste of time.....this is about personal
> >commitment in doing what is best for patient care.......We need to stop
> >this attitude about what ATLS really means.........I will like to read
> >any LEVEL I EVIDENCE THAT ANY residency ED,SURGERY..... IS EQUAL OR
> >BETTER THAN ATLS TRAINING........if any question place YOURSELF OR YOUR
> >FAMILY in a rural environment where your first responder is not ATLS
> >trained.......I HAVE BEEN THERE!!!.....AND IS NOT FUN OR
> >FAIR!........END OF DISCUSSION!
> >Let's move on.
> >juan
> >
> >Juan C Duchesne, M.D.
> >University of Mississippi Medical Center
> >Assistant Professor of Surgery/Trauma and Critical Care
> >Louisiana ATLS State Faculty
> >2500 North State Street
> >Jackson MS 39216
> >>>> Rick.Moore at TriadHospitals.com 10/10/06 12:55 PM >>>
> >Since when is an off-duty physician who happens to be driving by or
> >otherwise in the neighborhood "duty bound" to respond and assist?
> >REM
> >
> >-----Original Message-----
> >From: trauma-list-bounces at trauma.org=20
> >[mailto:trauma-list-bounces at trauma.org] On Behalf Of Patrick
> >Greiffenstein
> >Sent: Tuesday, October 10, 2006 12:42 PM
> >To: trauma-list at trauma.org=20
> >Subject: Re: ATLS training
> >
> >I agree with Dr Duchesne.  ATLS is a basic skills course that is not
> >very demanding to take and would benefit ANYONE being involved with any
> >patient.
> >Given the fact that we might come accross a trauma scene outside of the
> >hospital (I've counted three since I graduated med school four years
> >ago!) and the fact that we as physicians are duty-bound to respond, it
> >is a course that every physician should take in an ideal world.  One
> >would think that practicing MDs would be well acquainted with most of
> >the basics covered by ATLS.  As an ATLS instructor I can tell you that
> >it is absolutely frightening how many general surgeons and ED-program
> >graduates, not to mention orthopods, FP's, internists and others who
> >have opted to take our course that have clearly no clue what the basics
> >are (this is AFTER several hours of lecture on the subject).
> >
> >I believe that too much rides on a smoothly-working trauma team and =
that
> >redundancy, when feasible, can avert disaster.  If everyone knows what
> >everyone else is supposed to be doing, things might be missed or
> >overlooked less often.  Given the stakes and the time-constraints, I
> >think a little weekend course twice every decade is a miniscule price =
to
> >pay.
> >
> >my 1.5 cent's worth
> >
> >-Patrick Greiffenstein
> >Resident, General Surgery
> >LSUHSC, New Orleans
> >pgreif at lsuhsc.edu=20
> >
> >
> >
> >
> >On 10/6/06, trauma-list-request at trauma.org=20
> ><trauma-list-request at trauma.org >
> >wrote:
> >>
> >> Send trauma-list mailing list submissions to
> >>        trauma-list at trauma.org=20
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> >>
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> >>
> >> When replying, please edit your Subject line so it is more specific
> >> than "Re: Contents of trauma-list digest..."
> >>
> >>
> >> Today's Topics:
> >>
> >>   1. Re: ATLS for consultants... (Juan Duchesne)
> >>   2. Re: ATLS for consultants... (Ronald Simon)
> >>   3. Re: ATLS for consultants... (Jago Miloguz)
> >>   4. RE: ATLS for consultants... (Hotz, Heidi, RN)
> >>   5. Re: ATLS for consultants... (Ronald Gross)
> >>   6. Re: ATLS for consultants... (Ronald Gross)
> >>   7. NoM Spleen Returns (Bjorn, Pret)
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Juan Duchesne" <JDuchesne at surgery.umsmed.edu><~!B*+R^&>> To:
> ><rfsmithmd at comcast.net>, <trauma-list at trauma.org><~!B*+R^&>> Date: Fri,
> >06 Oct 2006 08:59:51 -0500
> >> Subject: Re: ATLS for consultants...
> >> I strongly disagree with your statement  Dr. Smith. I work in that
> >> same enviroment you are describing were our ED staff refuse to do
> >> ATLS, their explanation is that ED training (3-4 years) and recert (q
> >> 10 years) equalls ATLS (2 days q 4 years)......we are just asking 2
> >DAYS for cert.
> >> and one day for recert.!!!! how bad can that be for GOD
> >> sake!!!.............. This is not about MD ego's Dr Smith........this
> >> is very simple and clinically demostrated: ATLS DEFINITIVELY IMPACT
> >> PATIENT CARE!!....let all jump on the boat and work as a
> >> team!........As for consultants even if they are not first responders
> >> to activation we still mandate they get their ATLS.
> >> juan
> >>
> >> Juan C Duchesne, M.D.
> >> University of Mississippi Medical Center Assistant Professor of
> >> Surgery/Trauma and Critical Care 2500 North State Street Jackson MS
> >> 39216
> >> >>> rfsmithmd at comcast.net 10/06/06 2:32 AM >>>
> >> I am a huge fan of ATLS but I am curious as to the rational for
> >> requiring consultants OR primary trauma providers to have taken ATLS.
> >> How will this positively impact the care of the injured patient?
> >> Hopefully the consultants will not be directing the resuscitation or
> >> initial evaluation of the patient. Conversely ATLS will not have a
> >> meaningful impact on the experience of trauma providers compared to a
> >> full residency in either surgery or emergency medicine.
> >>
> >> R. Smith MD
> >>
> >> -------------- Original message --------------
> >> From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>><~!B*+R^&>> > We
> >are currently having a debate in our State Trauma Advisory
> >> Committee
> >> > about whether trauma related consultants (neurosurg, ortho, ent,
> >> > etc) should be required to have taken ATLS to care for a trauma pt.
> >> > The question is whether this should be part of the requirements for
> >> > trauma
> >>
> >> > center designation. No question that members of the trauma service
> >> > and
> >>
> >> > the ED should but what about the subspecialists? Sure its a good
> >> concept
> >> > but actually getting them to take it is another thing. What is the
> >> > practice of other trauma systems?
> >> > Thanks
> >> > Ron Simon, MD
> >> > Jacobi Medical Center
> >> > Bronx, NY
> >> >
> >> > --
> >> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > settings or unsubscribe visit:
> >> > http://www.trauma.org/traumalist.html=20
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html=20
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> To: "Trauma &
> >Critical Care mailing list" <
> >> trauma-list at trauma.org>
> >> Date: Fri, 06 Oct 2006 11:15:20 -0400
> >> Subject: Re: ATLS for consultants...
> >> The thoughts behind requiring consultants to take the course is for
> >> them to understand how we prioritize and why we may ask them to go
> >> away and come back later.
> >> ron simon
> >>
> >> rfsmithmd at comcast.net wrote:
> >>
> >> >I am a huge fan of ATLS but I am curious as to the rational for
> >> >requiring
> >> consultants OR primary trauma providers to have taken ATLS. How will
> >> this positively impact the care of the injured patient? Hopefully the
> >> consultants will not be directing the resuscitation or initial
> >> evaluation of the patient. Conversely ATLS will not have a meaningful
> >> impact on the experience of trauma providers compared to a full
> >> residency in either surgery or emergency medicine.
> >> >
> >> >R. Smith MD
> >> >
> >> >-------------- Original message --------------
> >> >From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> >
> >> >
> >> >
> >> >>We are currently having a debate in our State Trauma Advisory
> >> >>Committee about whether trauma related consultants (neurosurg,
> >> >>ortho, ent, etc) should be required to have taken ATLS to care for =
a
> >
> >> >>trauma pt. The question is whether this should be part of the
> >> >>requirements for trauma center designation. No question that =
members
> >
> >> >>of the trauma service and the ED should but what about the
> >> >>subspecialists? Sure its a good concept but actually getting them =
to
> >
> >> >>take it is another thing. What is the practice of other trauma
> >systems?
> >> >>Thanks
> >> >>Ron Simon, MD
> >> >>Jacobi Medical Center
> >> >>Bronx, NY
> >> >>
> >> >>--
> >> >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> >>settings or unsubscribe visit:
> >> >>http://www.trauma.org/traumalist.html=20
> >> >>
> >> >>
> >> >--
> >> >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your =
settings
> >
> >> >or unsubscribe visit:
> >> >http://www.trauma.org/traumalist.html=20
> >> >
> >> >
> >> >
> >>
> >> --
> >> Ronald Simon, MD
> >> Dir of Trauma/SICU
> >> Jacobi Medical Center, Rm 1213
> >> Bronx, NY 10461
> >> 718 918 5598 phone
> >> 718 918 5593 fax
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Jago Miloguz" < japrak at gmail.com>
> >> To: "Trauma &, Critical Care mailing list"
> ><trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 6 Oct 2006 17:58:49 =
+0200
> >> Subject: Re: ATLS for consultants...
> >> well it would be ideal to have everybody who gets in touch with =
trauma
> >
> >> patient pass the ATLS but obviously it is quite irrational to wish,
> >> but l think it should be officialy mandatory for all personal dealing
> >> with to intiative managment of trauma patients to pass ATLS(EM docs
> >> and acute care and trauma surgeons).if every hospital has those docs
> >> with passed ATLS then patients would probably do just fine with
> >> consultants not passing ATLS.
> >> just my opinion
> >> ante
> >>
> >>
> >> 2006/10/6, Ronald Simon <Traumamd at nyc.rr.com>:<~!B*+R^&>> >
> >> > The thoughts behind requiring consultants to take the course is for
> >> > them
> >>
> >> > to understand how we prioritize and why we may ask them to go away
> >> > and come back later.
> >> > ron simon
> >> >
> >> > rfsmithmd at comcast.net wrote:
> >> >
> >> > >I am a huge fan of ATLS but I am curious as to the rational for
> >> requiring
> >> > consultants OR primary trauma providers to have taken ATLS. How =
will
> >> this
> >> > positively impact the care of the injured patient? Hopefully the
> >> consultants
> >> > will not be directing the resuscitation or initial evaluation of =
the
> >
> >> > patient. Conversely ATLS will not have a meaningful impact on the
> >> experience
> >> > of trauma providers compared to a full residency in either surgery
> >> > or emergency medicine.
> >> > >
> >> > >R. Smith MD
> >> > >
> >> > >-------------- Original message --------------
> >> > >From: Ronald Simon <Traumamd at nyc.rr.com >
> >> > >
> >> > >
> >> > >
> >> > >>We are currently having a debate in our State Trauma Advisory
> >> Committee
> >> > >>about whether trauma related consultants (neurosurg, ortho, ent,
> >> > >>etc) should be required to have taken ATLS to care for a trauma
> >> > >>pt. The question is whether this should be part of the
> >> > >>requirements for trauma center designation. No question that
> >> > >>members of the trauma service and
> >>
> >> > >>the ED should but what about the subspecialists? Sure its a good
> >> concept
> >> > >>but actually getting them to take it is another thing. What is =
the
> >
> >> > >>practice of other trauma systems?
> >> > >>Thanks
> >> > >>Ron Simon, MD
> >> > >>Jacobi Medical Center
> >> > >>Bronx, NY
> >> > >>
> >> > >>--
> >> > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > >>settings or unsubscribe visit:
> >> > >>http://www.trauma.org/traumalist.html=20
> >> > >>
> >> > >>
> >> > >--
> >> > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > >settings or unsubscribe visit:
> >> > >http://www.trauma.org/traumalist.html=20
> >> > >
> >> > >
> >> > >
> >> >
> >> > --
> >> > Ronald Simon, MD
> >> > Dir of Trauma/SICU
> >> > Jacobi Medical Center, Rm 1213
> >> > Bronx, NY 10461
> >> > 718 918 5598 phone
> >> > 718 918 5593 fax
> >> >
> >> > --
> >> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > settings or unsubscribe visit:
> >> > http://www.trauma.org/traumalist.html=20
> >> >
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Hotz, Heidi, RN" <Heidi.Hotz at cshs.org><~!B*+R^&>> To: 'Trauma
> >&' < trauma-list at trauma.org>
> >> Date: Fri, 6 Oct 2006 09:11:36 -0700
> >> Subject: RE: ATLS for consultants...
> >> Ron,
> >>
> >> All of our EM physicians have completed ATLS once in their lifetime
> >> (thus, we adhere to the ACS Gold Book criteria.) With regards to our
> >> consultants from Ortho and Neurosurgery, it is not a formal
> >> requirement, but we have some of them become ATLS Instructors because
> >> they want to; believe it is their duty working at a Level I trauma
> >> hospital; etc, etc. We have two orthopedic trauma surgeons that are
> >> Instructors. We run two ATLS courses per year, so they only need to
> >> teach once yearly.
> >>
> >> Our County trauma contract and State Regs do not require them to have
> >> ATLS.
> >>
> >> Hope this helps.
> >>
> >> Best of luck.
> >>
> >> Heidi
> >>
> >> Heidi A. Hotz, RN, Trauma Program Manager Department of Surgery
> >> Cedars-Sinai Medical Center 8700 Beverly Blvd.
> >> Los Angeles, CA 90048
> >>
> >> Office: 310-423-8732
> >> Cell: 310-430-2649
> >> Pager: 310-960-6341
> >> Fax: 310-423-0139
> >>
> >> -----Original Message-----
> >> From: trauma-list-bounces at trauma.org=20
> >> [mailto:trauma-list-bounces at trauma.org=20
> >> ]
> >> On Behalf Of Ronald Simon
> >> Sent: Thursday, October 05, 2006 6:16 PM
> >> To: trauma-list at trauma.org=20
> >> Subject: ATLS for consultants...
> >>
> >> We are currently having a debate in our State Trauma Advisory
> >> Committee about whether trauma related consultants (neurosurg, ortho,
> >> ent, etc) should be required to have taken ATLS to care for a trauma
> >> pt. The question is whether this should be part of the requirements
> >> for trauma center designation. No question that members of the trauma
> >> service and the ED should but what about the subspecialists? Sure its
> >> a good concept but actually getting them to take it is another thing.
> >> What is the practice of other trauma systems?
> >> Thanks
> >> Ron Simon, MD
> >> Jacobi Medical Center
> >> Bronx, NY
> >>
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html=20
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Ronald Gross" < Rgross at harthosp.org>
> >> To: <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006
> >12:20:12 -0400
> >> Subject: Re: ATLS for consultants...
> >> Ron,
> >>
> >> We require that ortho and neurosurgeons take ATLS at least once.
> >>
> >> Please note that the ACS COT "Optimal Resourses" document states =
that,
> >
> >> "At a minimum, orthopaedic surgeons on the trauma team should be
> >> encouraged to successfully complete an ATLS Student Course."  The =
same
> >
> >> statement is repeated in the neurosurgical chapter: "At a minimum,
> >> neurosurgeons on the trauma team should be encouraged to successfully
> >> complete an ATLS Student Course."
> >>
> >> Best wishes,
> >> Ron
> >>
> >> >>> Ronald Simon <Traumamd at nyc.rr.com> 10/5/2006 9:16 PM >>>
> >> We are currently having a debate in our State Trauma Advisory
> >> Committee
> >>
> >> about whether trauma related consultants (neurosurg, ortho, ent, etc)
> >> should be required to have taken ATLS to care for a trauma pt. The
> >> question is whether this should be part of the requirements for =
trauma
> >>
> >> center designation. No question that members of the trauma service =
and
> >>
> >> the ED should but what about the subspecialists? Sure its a good
> >> concept but actually getting them to take it is another thing. What =
is
> >
> >> the practice of other trauma systems?
> >> Thanks
> >> Ron Simon, MD
> >> Jacobi Medical Center
> >> Bronx, NY
> >>
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html=20
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Ronald Gross" < Rgross at harthosp.org>
> >> To: "Trauma & Critical Care mailing list"
> ><trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006 12:25:41
> >-0400
> >> Subject: Re: ATLS for consultants...
> >> The concept is to ensure that the subspecialists see, learn about and
> >> understand the overall picture of trauma care, how the concept of a
> >> systems/team approach to trauma care actually includes them, and that
> >> they should incorporate it into their lexicon.......
> >>
> >> >>> <rfsmithmd at comcast.net> 10/6/2006 3:32 AM >>>
> >> I am a huge fan of ATLS but I am curious as to the rational for
> >> requiring consultants OR primary trauma providers to have taken ATLS.
> >> How will this positively impact the care of the injured patient?
> >> Hopefully the consultants will not be directing the resuscitation or
> >> initial evaluation of the patient. Conversely ATLS will not have a
> >> meaningful impact on the experience of trauma providers compared to a
> >> full residency in either surgery or emergency medicine.
> >>
> >> R. Smith MD
> >>
> >> -------------- Original message --------------
> >> From: Ronald Simon < Traumamd at nyc.rr.com>
> >>
> >> > We are currently having a debate in our State Trauma Advisory
> >> Committee
> >> > about whether trauma related consultants (neurosurg, ortho, ent,
> >> > etc)
> >>
> >> > should be required to have taken ATLS to care for a trauma pt. The
> >> > question is whether this should be part of the requirements for
> >> trauma
> >> > center designation. No question that members of the trauma service
> >> and
> >> > the ED should but what about the subspecialists? Sure its a good
> >> concept
> >> > but actually getting them to take it is another thing. What is the
> >> > practice of other trauma systems?
> >> > Thanks
> >> > Ron Simon, MD
> >> > Jacobi Medical Center
> >> > Bronx, NY
> >> >
> >> > --
> >> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > settings or unsubscribe visit:
> >> > http://www.trauma.org/traumalist.html=20
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html=20
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Bjorn, Pret" <pbjorn at emh.org><~!B*+R^&>> To: <
> >trauma-list at trauma.org>
> >> Date: Fri, 6 Oct 2006 12:18:52 -0400
> >> Subject: NoM Spleen Returns
> >> Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as
> >> Grade I in spite of contrast blush (not intended as the thrust of =
this
> >
> >> thread).
> >>
> >> The patient was admitted for two nights, stable throughout, and
> >> discharged with her cooperation and enthusiasm.  She was prescribed
> >> house arrest for a week, drastically limited activity, and an office
> >> visit to follow.
> >>
> >> As fate would have it, on post-injury day 6 she suffered a sudden
> >> sharp LUQ pain with what sounds like a brief vagal response.  She
> >> reported immediately to her local ED, where another CT shows both a
> >> persistent blush plus intraperitoneal hemorrhage (second image).
> >>
> >> At the local hospital, vitals were stable (she was in fact
> >> hypertensive consistent with her medical history) and her labs were
> >> unremarkable (H&H
> >> 12 and 35, roughly identical to previous discharge numbers).  She was
> >> admitted to the local hospital for observation, but her counts =
slipped
> >
> >> overnight (10 & 27), and so she was transferred back to us.  She
> >> arrives stable and without any major complaints.  Even a little
> >hungry.
> >>
> >> Interested in what others would plan for her.  Observe?  Coil?  Both?
> >> Other?
> >>
> >> Pret Bjorn, RN
> >>
> >>
> >> <<FirstImage.jpg>>
> ><<SecondImage.jpg>><~!B*+R^&>><~!B*+R^&>><~!B*+R^&>> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html=20
> >>
> >>
> >>
> >--
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