Thursday, March 25, 2004
VIVA LAS VEGAS......
Needless to say I fattened the bottom line at many of Las Vegas' finest (and not so fine) casinos while finding time to make the meeting. It was fun and educational. We learned of trauma applications for such hemostatic agents as QuickClot, Chitosan, and the bane of hospital and pharmacy administrators, recombinant factor VIIa. We learned that if you have 24/7 operating room capability with immediate access and in-house surgeons, you can manage abdominal gunshot wounds non-operatively. Of course not everyone works under those circumstances, and those rules don't apply to the intoxicated, head-injured, or those requiring general anesthesia for other purposes. As this limits the eligible patient population, your results may vary. It was nice to hear how the "big dogs" of academic trauma handle things during the case discussions. Discussions of EMTALA were lively with the opinion of the speaker echoing my thoughts (posted here) about how smaller hospitals won't be required to provide specialty (read neurosurgery and orthopedics) coverage. This will place additional burdens on the larger trauma centers.
Plenty of discussion was about the lack of interest in trauma as a career among current surgical residents. The reasons, as discussed before, include lousy hours, poor reimbursement, largely inappreciative patients, high litigation risk, and the increasing move of trauma surgery from an operative practice to a resuscitative one. Many academic trauma surgeons are also taking over the "emergency surgery" (after-hours appendectomies) duties in addition to trauma surgery. In fact it seemed that many of the speakers would go to great extremes to avoid operating on trauma patients. The impression I received was the growing desire of the "trauma establishment" to bring in the community trauma surgeon, a move long overdue in my opinion.
On the last day, half of the morning was spent on discussions of "ethical issues" the most interesting one was related to the presence of family members in the trauma bay during resuscitation. Objections included the lack of space in the ED, having family members "fall out" during a resuscitation, family member interference and criticism (that's not how Dr. Carter did it on ER last night!) and of course, fear of litigation if things don't go well. Those that support the presence of family members during resuscitation cite reports (mainly related to ICU codes) that state the emotional benefits and "closure" that having family members present provides. The speaker polled the audience asking who would want their family member to see them with all of the accessories that go along with a complicated trauma resuscitation, very few said yes. I think that the presence of families in the trauma bay can only be a hindrance.
Anyway, it's good to be back home. |
Needless to say I fattened the bottom line at many of Las Vegas' finest (and not so fine) casinos while finding time to make the meeting. It was fun and educational. We learned of trauma applications for such hemostatic agents as QuickClot, Chitosan, and the bane of hospital and pharmacy administrators, recombinant factor VIIa. We learned that if you have 24/7 operating room capability with immediate access and in-house surgeons, you can manage abdominal gunshot wounds non-operatively. Of course not everyone works under those circumstances, and those rules don't apply to the intoxicated, head-injured, or those requiring general anesthesia for other purposes. As this limits the eligible patient population, your results may vary. It was nice to hear how the "big dogs" of academic trauma handle things during the case discussions. Discussions of EMTALA were lively with the opinion of the speaker echoing my thoughts (posted here) about how smaller hospitals won't be required to provide specialty (read neurosurgery and orthopedics) coverage. This will place additional burdens on the larger trauma centers.
Plenty of discussion was about the lack of interest in trauma as a career among current surgical residents. The reasons, as discussed before, include lousy hours, poor reimbursement, largely inappreciative patients, high litigation risk, and the increasing move of trauma surgery from an operative practice to a resuscitative one. Many academic trauma surgeons are also taking over the "emergency surgery" (after-hours appendectomies) duties in addition to trauma surgery. In fact it seemed that many of the speakers would go to great extremes to avoid operating on trauma patients. The impression I received was the growing desire of the "trauma establishment" to bring in the community trauma surgeon, a move long overdue in my opinion.
On the last day, half of the morning was spent on discussions of "ethical issues" the most interesting one was related to the presence of family members in the trauma bay during resuscitation. Objections included the lack of space in the ED, having family members "fall out" during a resuscitation, family member interference and criticism (that's not how Dr. Carter did it on ER last night!) and of course, fear of litigation if things don't go well. Those that support the presence of family members during resuscitation cite reports (mainly related to ICU codes) that state the emotional benefits and "closure" that having family members present provides. The speaker polled the audience asking who would want their family member to see them with all of the accessories that go along with a complicated trauma resuscitation, very few said yes. I think that the presence of families in the trauma bay can only be a hindrance.
Anyway, it's good to be back home. |
