Rowley has hit the nail on the head once again.
Our experience in Scotland is that the presence of an A&E consultant during
the initial management of a major trauma case has a number of direct and
indirect benefits. The importance of having someone with a combination of
airway and surgical skills but who also has a general overview of the
patients needs cannot be overemphasised. Otherwise you get abdominal
injuries missed in unconscious patients with severe injury mechanisms
because "the abdomen is soft and the blood pressures normal" or patients
getting litre after litre of fluid when what they really need is an
operation etc. In addition to this avoidance of "tunnel vision" by each
specialty, our main role is to make sure the senior people in the other
specialties attend when they would make a diffirence. It is not uncommon
that when no A&E consultant is involved the patient will not be seen by ANY
consultant when they are admitted (with the exception of intensive care if
they go there).
This has been backed up now by 2 studies (from the Scottish Trauma Audit
Group and now UK-TARN)
Sorry for the grumpiness, doing escharotomies at 4am today as none of the
available surgeons had ever done one.
Phil Munro
Glasgow
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