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Yes -
we had the exact smae experience. Here is the deal...as explained to me by our
designator / reviewers. Any ED across the country has ED MD's who see patients
and then "decide" to call in surgery, internal medicine, respiratory, radiology
etc... that is what they do for every patient. WHEREAS, a trauma center
has those resources available and waiting for the patient for those meeting
criteria. Our reviewer recommended 5 criteria in which the surgeon and OR crew
get activated ahead of time: BP < 80 adults, loss of peripheral pulses in
children; GSW between neck and groin; GCS < 8 and trauma transfer patietns
receiving blood to maintain vitals.
You
will get nailed during review if the ED MD's are deciding. Plus we had a "let's
wait and see" on a 90 year old involved in a head-on 55 mph crash." I got damn
mad at trauma committee and put my fist on the table and said in my biggest
baddest voice...WHEN I GET TO BE 90 AND I GET IN A CRASH I HAD BETTER BE A
TRAUMA-STAT or I will come back and haunt the person who made that decision. My
typical ED MD advisary smiled and then laughed and PROMISED me that I get to
be a Trauma-STAT when I am in a MVC and I am 90. There has been no
arguement since then.
Lisa
McLaughlin
Santa
Fe, NM
We
have recently opened a can of worms here and I am wondering how other
institutions across the country activate the trauma team. Our current system is the triage nurse
informs the ED physician of an incoming patient, then he decides according to
our criteria if a trauma should be activated. In some circumstances, the physicians
have taken a "wait and see approach" to activation, wanting to see the patient
themselves and not rely on EMS triage decisions. I am thinking that this could crucify
us during a verification visit.
The ED physicians do not want to give this up. Any
thoughts?
Brian J. Green
Trauma Program
Manager
St. John Hospital and Medical
Center
313 343 7309
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