Replies to post #565 on Medical World News

[tsurge]

PL1,

Thank you for putting this on your site....
As you know, most of Civilian Trauma care improvement has risen out of almost all Military conflicts throughout history....(in fact, being on call last night, dealing with several Gun shot wounds, Knife wounds, and blunt force motor vehicle crashes---there is no such thing as an accident...any one can see there are many similarities and the critical care management of these patients has allowed the murder rate and motor vehicle deaths to be lower than ever before in most cities!)...

Many of the authors of the NEJM article are counterparts of mine and a few(Trunkey, Moore, etc.) are the Godfathers of Trauma care and the instigators of Surgical Critical Care.....they helped develop the programs for the care of the injured patient...

The current military conflict, regardless of a person's political perspective, shows how military trauma care and civilian trauma care are indelibly linked and have "learned from each other." This is even more evident with the medical treatment for severe coagulopathy (bleeding) from the "triad of death": acidosis-hypothermia-and coagulopathy....Factor VII...

we use factor VII frequently, even though it is not yet approved for use by the FDA for trauma care and it is very expensive (i.e. a hospital will usually not get remimbursed for the treatment, since it is not yet FDA approved)...we use it because it works and I personally know it has saved several of my patients by "shutting down" the coagulopathy that develops even after all surgical bleeding has been stopped....

the use of protocols and process improvement initiatives shows how an organized trauma system can impact care by constantly evaluating outcomes and making changes in the process of care...this is what the American College of Surgeons Committee on Trauma (ACS-COT) Verification process oversees to allow a city's trauma center to be Nationally verified as a Level 1 trauma center (although most states have their own verification process, they are not as stringent as the American College of Surgeons Verification Process)....as an example, in NC there are 5 state level-1 trauma centers, but until recently we were the only national ACS-COT Verified Level-1 trauma center....which is evaluated every three years by the ACS-COT....

Sorry to be long winded....just got going after reading the NEJM article....Thanks again, PL1

Everyone have a safe and happy New Year...