"Standards" of EMS and Trauma Center Care

[William Bromberg]

Dr Mattox, 

In that you are the master of the one word, black and white, right or
wrong answer, I am surprised to see such equivocation and temporizing. I
can only surmise  that it is in pursuit of continued international
amity.  As my opinion is meaningless on an international level, I feel
no such compunction.

The statement that we can't pass judgement on the quality of the French
EMS system (or more specifically the PHILOSOPHY behind the French EMS
system) because we can't agree on the best way to follow wrist fractures
in our own community is, to me, complete moral relativism akin to
stating that we can't feel morally superior to the Taliban for stoning
women to death because we failed to pass the ERA.  It is taking the
phrase "Why beholdest thou the mote that is in thy brother's eye, But
considerest not the beam that is in thine own eye?" and turning it
completely around, ignoring the 2X6 sticking out of their eye whilst
digging at the eyelash in our own. <way to stretch a metaphor — ed> 

If the argument is that  CPR in blunt trauma is futile than fine,
no-one should do it any longer under any circumstances. But it is
ridiculous on its face that CPR stopped outside the doors of the
hospital is useful. If CPR is useful at all it is to get the person's
brain "alive" to definitive care whether it's because they need a
cardiac cath, active rewarming from a near drowning or a cracked chest.
N'est ce pas?


Bill



>>> <KMATTOX at aol.com> 12/30/2007 9:37 PM >>>
I would agree with Dr. Ursic, that ideally, EMS, Trauma, CriticaL Care,
and  
Acute Care Surgery would be "standardized."   However, among the 
trauma 
centers in Houston (There are only two level I, and 8 Level II), there
is  not 
agreement as to even standards of care regarding fluid management, 
hypothermia, 
and continuity of care for simple hand and wrist  fractures.      
 
One major problem is that each "trauma surgeon" believes that her/his 

particular approach should be the standard for their community.   
Indeed, as our 
government and HHS is now discovering, there are often more than  one,
two, 
three, or even 10 acceptable and standard approaches to one particular 
clinical 
problem.   The differences are  judgement.      
 
We are discovering that the "BEST PRACTICES" developed by hospital  
non-physicians are often punitive and regulatory for control  purposes.
    
 
Soooooooooooooo
 
How do we reach agreement as to what would be the standard. ??
 
k



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