I fear you're correct, Danny although, as I work in a place with no Obs Ward
and Neurosurgery, it's not too bad for us at the minute.  However, our
general surgeons have already said they don't want to have head injuries
(and the drunks who usually come with them) in their beds and I suspect
we'll end up looking after everyone who doesn't need a neurosurgeon.
Naturally, they will be the ones who make the decision as to who needs them.
There have been some papers recently about guidelines for CT, etc and there
is going to be a new big NEXUS study in the states to try to work out who
should be scanned so the jury's obviously still out.  I agree that the SIGN
guidelines are probably as good as there are out there at the moment.
Rocky
----- Original Message -----
From: "Danny McGeehan" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, December 20, 2002 5:48 PM
Subject: Re: Head injury guidelines


> I beleive the Faculty signed up the speciality to manage head injuries.
If my memory serves me correct there were a few lead professors.  One from
our speciality and one from Orthopaedics, they practised not a million miles
away from where Corrie is filmed.  Rocky will know who they were.
>
> One of the Professors again if my memory serves me correct was
follicularly challenged.  I can remember him standing up every year and
giving the esteemed lecture to the faculty on MTOS and laterally TARN.  I
cannot recollect the slides ever having changed significantly once in 5
years, if my memory serves me right.
>
> Like most things they have reached the age of retirement and moved on to
pastures new leaving a legacy and no doubt a lot of work that has to be
implemented.  I understand that they are quite active in medico-legal work
now.
>
> Every year or two I get a circular asking me if we have implemented the
guidelines of the RCS Viz a ziz head injury management.  My answer is no.
>
> Another esteemed colleague of mine who held a chair in disaster medicine
was instrumental in suggesting to the powers that be the advantages of trick
and treat.  If I can remember he was not follicularly challenged but was the
opposite and was quite hirsuite in the peribuccal region.
>
> Nevertheless as sure as eggs are eggs we will be faced with a fait
accompli and have to manage head injuries.  The general Surgeons are washing
their hands and what happens when no one wants the patients they send them
to A & E.  The idealists on the list will rub their hands in glee and
pontificate about the wonderful chance for the speciality.  However like the
Modernisation and Collaberative Study there will be no and I repeat no extra
resources.  A & E Departments will be expected to cope.  Any extra funding
will be for data collection and project managers.
>
> This will be another task along with:
> 20 min door to needle times
> 4 Hour turn around times
> Trick and treat that will have to be implemented at all costs.
>
> What are the experiences of the list as regards head injury management?
As the list can deduce I have a deep and lasting suspicion of quasi
acaedemics.  They stand up at International Meetings and pontificate and yet
expect other people to do the work.
>
> PS Happy Xmas and a Prosperous New Year to all the Hard Workers on the
list, even in this season of good will on earth, I extend it to Govt. Health
Advisors.
>
> Danny McGeehan
>