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On Fri, 27 Feb 1998, Bartucci, Richard wrote:
>      And, if you want to take it one step further, the pediatric EM guys at
> children's hospitals can handle adult trauma in their sleep.  Adults don't
> have as much "snap-back" as the little ones do, but they've surely got a
> helluva lot more "stretch."
        While I agree that a neonate resulting from a perimortem C-section
will do better at a place with neonatology at hand I think the above is a
bit too casual of a remark, suggesting that a peds hospital can handle
adult trauma in a wink.  I'd be interested in hearing from others but I
think this is a quite a bit overstated.  I work in a Level 1 general
trauma center and can't handle adult trauma "in my sleep" so I don't think
my peds-EM colleagues could either.  Additionally, the staff at Peds
centers may have little to no experience with adult cases.  If the staff
completed an EM residency followed by peds-EM fellowship then I would
expect capacity for both peds and adult trauma.  However, my understanding
is that this is fairly uncommon.  This is further complicated by the issue
of familiarity thru regularity, to be a Level 1 general center in PA you
need around 750-800 major trauma cases per year as a minimum, most peds
centers have nowhere near that volume of severe trauma, peds or otherwise.
        How many torn aortas, intoxicated, violent head injuries,
penetrating truncal wounds,  grandmoms who wandered into the street or
down the basement steps, etc, etc does any peds EM person have under their
belt?  Not many unless you cross cover at a general center.  For the
index case of trauma in pregnancy I think your overall outcome for
pregnant trauma victims can also depend on the presence of Ob a service
not available at most peds centers further complicating the issue.  I
would surmise that in most cases pregnant trauma patients are better off
at a general center than a peds center.  The "adults"
drive, drink, do drugs and other dumb things a whole lot more and despite
this huge volume of carnage, "adult"  trauma still requires a high degree
of vigilance, just sit in on a Trauma M&M some time.
        Bob
********************************************************************************
Robert McNamara,MD,FAAEM
Program Director, Emergency Medicine
Medical College of Pennsylvania and Hahnemann University
3300 Henry Ave  Phila,PA 19129
Phone 215-842-6548
Fax   215-843-5121
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