<html><div style='background-color:'><DIV class=RTE>Thanks for your responsis so far. </DIV>
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<DIV class=RTE>in reply to the ambulance triage: unfortunatly where i work the ambulance personel are still relativly untrained--not more then a first aid degree and some theoretical courses: the ambulance personal decided (rightly) not to wait for the medicalised ambulance (medic and nurse) and transport the 5 miutes to our hospital instead of the 40 minutes to the trauma cente.</DIV>
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<DIV class=RTE>continue: the pacient sudenly entered into bradycardia without pulse and reanamacion was started, the surgeon alerted the OR for an emergency toracotomia ( with some advising on my part) and advised the head of surgery (two surgeons have to be present during OR), after 5 minutes the pacient entered into sinus rithum with pulse. Instead of going to OR (the head of surgery and the anestesiologist were agaist operating here) it was again decided to transport the pacient to the trauma center, on reading the pacient for transport she entered into asistolia and died after 30 minutes of reanimacion.</DIV>
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<DIV class=RTE>Comments: a sad case of how a non prepered sistem failed a pacient. Unfortunatly where i work (spain) ATLS is still in its early days ( I was the only one in resus who has done the course) and having worked in an level 1 dutch trauma centrum know how the sistem should work. For this i want to review this casa with my fellow emergency physicians and the surgical department to improve our own respons to, thankely, rare cases in our part of the world.</DIV></div><br clear=all><hr>Hotmail en Messenger on the move <a href="http://g.msn.com/8HMAENNL/2752??PS=47575" target="_top">Click here</a> </html>