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<P>in general the system in our area does work and this case is an excepcion, during the day time we do have helicopter coverage unfortunatly this case was at night, unfortunatly the cost of night time coverage is two high, the french do have night time coverage and in rare case we can call them being only 20 km from the border (unfortunatly only if the pacient is of french nationality, to transport to the nearest french trauma center--about the same distance as the nearest spanish center). I myself was on the rapid respons team that night but was out dealing with a 50 year old with an acute MI living the region uncovered and the nearst rapid respons 40 minutes away, a second team would be preferable but of course cost and politics is the main setback. Coming from a very trauma orientated netherlands I do see that were i work now in spain the trauma system is still underdeveloped-
most people our still nor intrested in the medical emergencies. Spain still has one of the highest road death rates of europe but luckely fire arm and stabbings our still relativly rare with only 1-2 cases per year in our area.</P>
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<P>regards richard.<BR><BR></P></DIV>
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<DIV></DIV>From: <I>"Simon Scothern" <Simon.Scothern@lakesdhb.govt.nz></I><BR>Reply-To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>Subject: <I>RE: penetrating posterior torax injury continued</I><BR>Date: <I>Thu, 2 Nov 2006 09:38:09 +1300</I><BR>>Once again some very poignant points in this thread. It's a "heart-sink"<BR>>story and not atypical of some rural areas in various counties.<BR>><BR>>Yes you need a robust system of fast delivery of patients to a place<BR>>capable of doing the job. The system also relies on a small number of<BR>>professionals at the workface. The workforce demographics can change so<BR>>frequently in rural areas, hence system creation has to allow
for that<BR>>(easily said from my desk eh?).<BR>><BR>>It would seem that you need a "scoop and run" system to your nearest<BR>>trauma centre. Hesitation at the front door often doesn't help the<BR>>patient. Having said that, I'm not sure it would have helped this one.<BR>><BR>>Dare I say, given your description of your local geography, that you<BR>>need a helicopter and a good rapid response team.<BR>><BR>>Kia Ora<BR>><BR>>Simon Scothern<BR>>FRCA, MRCP<BR>>ICU Clinical Director/Consultant Anaesthetist<BR>>Rotorua Hospital<BR>>Pukeroa Hill<BR>>Private Bag 3203<BR>><BR>><BR>>-----Original Message-----<BR>>From: trauma-list-bounces@trauma.org<BR>>[mailto:trauma-list-bounces@trauma.org] On Behalf Of Robert Smith<BR>>Sent: Thursday, 2 November 2006 6:21 a.m.<BR>>To: 'Trauma &amp; Critical Care mailing
list'<BR>>Subject: RE: penetrating posterior torax injury continued<BR>><BR>>Never the less, going straight to the trauma center was the patient's<BR>>only<BR>>and best chance at survival. This is one of the most difficult things to<BR>>convince people of when implementing a trauma system. The shortest route<BR>>to<BR>>definitive acute care is best. There is no point in driving the patient<BR>>someplace where the injury cannot be meaningfully addressed. There is<BR>>also<BR>>no point in trying to provide any "treatment" to seriously injured<BR>>patients<BR>>in the pre-hospital setting.<BR>><BR>>Rob<BR>><BR>> _____<BR>><BR>>From: trauma-list-bounces@trauma.org<BR>>[mailto:trauma-list-bounces@trauma.org]<BR>>On Behalf Of Richard van der Kleyn<BR>>Sent: Wednesday, November 01, 2006 12:11 PM<BR>>To:
trauma-list@trauma.org<BR>>Subject: RE: penetrating posterior torax injury continued<BR>><BR>><BR>><BR>><BR>>prehospital protocols are in place, unfortunatly just for the<BR>>medicalised<BR>>ambulance (of which we hace one covering a poulacion of about 100,000<BR>>(in<BR>>the summer anywhere up to 400,000) and an area including mountains. In<BR>>this<BR>>casa this ambulance was occupied and the medical ambulance was sent out<BR>>from<BR>>the trauma center (35-40 minutes), the normal paramedics arn't used to<BR>>taking theses decisions and the only treatment the can give is O2. If<BR>>they<BR>>had gone straight to the trauma center in this casa the pacient would<BR>>have<BR>>arested in the ambulance in the time to get to the trauma center.<BR>><BR>><BR>><BR>>i agree that a lot of work has to be done (and money) in the
prehospital<BR>>setting to reach the standards of most european countries<BR>><BR>><BR>> _____<BR>><BR>>Live Search, for accurate results! Click here<BR>><http://g.msn.com/8HMAENNL/2734??PS=47575><BR>>--<BR>>trauma-list : TRAUMA.ORG<BR>>To change your settings or unsubscribe visit:<BR>>http://www.trauma.org/traumalist.html<BR>>Attention:<BR>>The information contained in this message and or attachments is intended only for the<BR>>person or entity to which it is addressed and may contain confidential and/or privileged<BR>>material. Any review, retransmission, dissemination or other user of this information, or<BR>>taking of any action in reliance upon this information by persons or entities other than the<BR>>intended recipient is prohibited. If you received this in error, please contact the sender<BR>>and delete the
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