From the December 2008 Issue | Monday, December 15, 2008

Central Command I was a co-author on "West Nickel Mines School Shooting" (May 2008 JEMS ). The article suggests medical command should be spread out; this is incorrect in our experience. Having only one or two doctors and one facility coordinating care are paramount to a successful MCI. Consolidated medical command during the West Nickel Mines event contributed greatly to the expeditious treatment of multiple critically injured children, and this model would be of great benefit in other mass casualty situations. Within the trauma center there can be multiple physicians available for medical command, and the practice of dividing calls is common in emergency departments. Institutions that divide medical command calls may want to modify that practice in the event of an MCI, allowing for unified, consistent medical direction; centralized medical command responsibility; a knowledge base in which one call augments the information from other calls, allowing a clearer perspective of the actual situation without the need for redundant information; and the ability for prehospital providers to speak to the same command physician for updates or changes. The practice of calling multiple institutions or physicians for medical command may complicate an already confusing situation and compromise patient care during a mass casualty event. Mike Reihart, DO, FACEP Lancaster, Pennsylvania JEMS.com Cybermail No More Guessing I read Bryan Bledsoe’s JEMS.com piece, "Houston, We Have a Problem," with great interest. Some policymakers are already on the evidence-based-medicine bandwagon. The Ohio State Board of EMS Trauma Committee performed a study on data from the Ohio Trauma Registry to determine if there was anything that could be done to improve care of elderly trauma victims. The resulting recommendations for geriatric-specific trauma triage rules are being implemented now. Two separate peer-reviewed articles have been submitted for publication, one detailing how we came to determine that "old" starts at 72 for purposes of trauma, and one detailing how we developed the triage criteria. The EMS Board has also formed a committee to monitor current medical research and perform original research on the data. The committee is still new, but the fact it was created at all is indicative of the board’s desire to create rules and policies at the state level based on something besides wild guesses. Thanks for a great article, and keep stirring the pot! Timothy A. Erskine, EMT-P Columbus, Ohio