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<P>Mark,</P>
<P>This is part of the problem, the fact that a lot of A&Es do it badly (partly because they have no interest in trauma etc.) The same is true for all specialities (including surgery, anaesthetics/ITU etc. and that there are always bad eggs in every basket.)</P>
<P>My belief stands firm that the A&E department does NOT have any role in trauma. This is NOT that A&E staff don't have a role or aren't any good at it - in fact quite the contrary in some places. For those A&E doctors who have an interest in trauma your role should NOT be as an A&E department receiving trauma and holding onto the patients - but instead your role is best maintained as part of the pre-hospital care team (e.g. HEMS etc.) This is in fact what many of the A&E Consultants & Registrars [Attendings and Residents equivalents] who are excellent in managing trauma patients and also have a keen interest in it ACTUALLY DO and is now becoming more common place (especially in the U.K.). You then have a vital role in ensuring that patient can then be "scooped and run", ensure adequate haemorrhage control (patient's OWN blood is the best fluid for them), obtain IV access (and administer analgesia), ensure that NO fluid is given by paramedics/EMTs (unless the patient has a SPECIFIC indication for fluid), perform RSI etc. etc. The key is to ensure that things are kept to the Diamond 5, Platinum 10 & Golden Hour etc. There is cleary a vital role for ANY such clinician (including A&E/ED staff) it is just that it is NOT in the A&E department itself.</P>
<P>Hope this clarifies it for you.</P>
<P>Matthew</P>
<P>_____________________________________________________________________________________________________________________________Mark Harvey <A title="Operating Room Resuscitations" href="mailto:trauma-list%40trauma.org?Subject=Operating%20Room%20Resuscitations&In-Reply-To=20080131120549.EB23F2AD21%40sitemail.securepod.com">cometomark at hotmail.com </A><BR>
<I>Thu Jan 31 15:37:57 GMT 2008</I>First posting on this list so go easy on me been sitting back and reading for a long time, apologies if I'm missing the point here. Taking patients straight to the ICU/HDU for Resus is a grand idea, however in the 5 minute pre alert you get from the Ambulance for the patient to be expected in the hospital it would take nothing but a miracle to magic the ICU/HDU bed from thin air. A&E resus rooms are designed to take the patients in stabilise and ship out, whilst the faffing is going on the bed is made ready and ICU can calmly take the patient in with open arms. Slightly annoyed with the notion that an A&E department has no part to play in the Emergency care of patients.<BR>
Mark_____________________________________________________________________________________________________________<BR>
From: <A href="http://list.mistral.net/mailman/listinfo/trauma-list">mgreeds at reeds.uk.comTo</A>: <A href="http://list.mistral.net/mailman/listinfo/trauma-list">trauma-list at trauma.orgDate</A>: Thu, 31 Jan 2008 12:05:49 +0000Subject: Operating Room Resuscitations<BR>
I agree Errington. I would in fact go further by saying that the ICU/HDU is THE ONLY place for patients who need resuscitation but DON'T needthe operating room (unless they are going to interventional radiology for embolisation etc.) <BR>
Further to Ken's comment on the role of the A&E/ED department "waving to the patient", this I fully agree with and wholeheartedly support. However I would say that the A&E does actually have ONE useful purpose - for the receptionist to book the patient into the hospital. They can also ensure that the order for massive transfusion packs is made IMMEDIATELY for them to be sent STRAIGHT to theatre/OR for the patient (for those hospitals that implement the 1:1 transfusion protocol.) I'll happily conceed that this is in fact two purposes.<BR>
Matthew<BR>
____________________________________________________________KMATTOX at aol.com KMATTOX at aol.com Thu Jan 31 03:26:29 GMT <BR>
BINGO. Great point. For any trauma patient that is not going to be able to be dismissed from the ER following minor treatment for a minor injury, there is NO REASON TO KEEP THAT PATIENT IN THE ER ANY LONGER THAN IT TAKES TO COMPLETE THE LOGISTICS OR PAPERWORK TO GET THEM TO THE OR, ICU, FLOOR, IR, OR OTHER LOCATION. Kenneth L. Mattox, MDHoustonIn a message dated 1/30/2008 9:23:48 P.M. Central Standard Time, errington at erringtonthompson.com writes:The ICU is a great place for patients who need resuscitation but DON'T needthe operating room. E<BR>
____________________________________________________________In a message dated 1/30/2008 9:23:48 P.M. Central Standard Time, errington at erringtonthompson.com writes:<BR>
I would add that those patient that don't need to go to the OR but stillneed significant resuscitation maybe better in the ICU than the ER oranywhere else. For the most part trauma surgeons run their own ICU's.These are the nurses that have heard your lectures. They come to yourconferences. They know what you want. The ICU is a great place for patients who need resuscitation but DON'T needthe operating room. EErrington C. Thompson, MD, FACS, FCCMTrauma/Surgical Critical CareAuthor - Letter to AmericaAsheville, NC-----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald GrossSent: Wednesday, January 30, 2008 6:52 AMTo: trauma-list at trauma.orgSubject: Re: Operating Room ResuscitationsYeah - what HE said! ;-)Matt, you and I are on the same page here - but you said it far better thanI did - Thanks!Take care,Ron>>> Matthew Reeds <mgreeds at reeds.uk.com> 1/30/2008 5:27 AM >>>Mike & Ron,When pontificating over the treatment that I give to any patient, I alwaystry to ask what I would want for myself and apply this to give the besttreatment to each patient. I would NOT want to be in an A&E/ED resuscitationroom but would "rather" be in either theatre/OR, ITU/HDU, the ward orradiology (depending upon my injury) having the proper treatment that Ineed. This is what I would strive for with any of my patients.Therefore I see NO reason for the patient to remain in A&E/ED forresuscitation. As Ron says, if the patient needs surgery, then off totheatre/OR they go. If they need non-operative resuscitation, then off toITU or HDU they go for the care required. [This frees up theatre/ORresources and time as Mike says if surgery is not required for betterutilisation.] Radiology resuscitation is ONLY required for THERAPEUTICintervention such as angio for pelvic haemorrhage and stabilisation (if theextra-peritoneal pelvic packing approach is NOT used etc.)>From my experience, there is NO need/role for A&E/ED resuscitation - if thepatient is that sick, then they need to be elsewhere (e.g. theatre/OR,ITU/HDU etc.)Even for major haemorrhage that requires surgery, these UNSTABLE patientsSHOULD be rapidly transported to theatre/OR for surgery for emergencytreatment. I would NOT NORMALLY advocate A&E/ED operating UNLESS absolutelynecessary which has happened to me on a couple of occasions [such as cardiacarrest secondary to IVC transection at the bifurcation from multiple stabwounds from a bayonet in a 19 year old male.] He had been "down" for 3 minswhen he arrived in A&E by paramedics/EMT and there was no way we couldtransfer him to theatre/OR on the top floor (11th floor) and at the otherend of the hospital to save him - a fault of the hospital design. Thereforewe performed a laparotomy in the A&E/ED resus room and got him back withRAPID abdominal packing and then transferred to theatre just as rapidly.However, this should be a RARE occasion and ONLY be absolutely necessary toimminently save life rather than be the norm. In essence this comes down toclinical acumen, experience and ability of the clinician to use soundjudgment and I agree with Mike, that if the patient doesn't need surgery,then theatre/OR is not the best place to resuscitate the patient - theyshould be in the ITU/HDU instead.MatthewSurgery U.K.<BR>
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