The Team Approach to Trauma Care

To the Editor." I would l ike to commend the College, and in part icular

the planners of the 1986 Winter Symposium, for their in- depth exploration of t rauma care [Annals, December 1986]. I wholehear tedly agree wi th Dr Whelan, the proceedings ed- itor, in highlighting the importance of t rauma management as part of the spectrum of care rendered by emergency phy- sicians3 However, I s t rongly disagree wi th Dr Whelan 's analysis of our present and future relationship wi th t rauma surgeons. Being a firm believer in the team approach for the optimal management of trauma, I find the "us versus them" philosophy encouraged by Dr Whelan discouraging and un- productive.

The advent of t rauma centers has improved the quali ty of t rauma care, and, yes, that does mean that surgeons will be at the t rauma patient 's bedside earlier in his course. I view this as a positive development. Why shouldn ' t the person responsible for definitive management be involved as early as possible? This part icipat ion does not preclude the emer- gency physician from playing an active, vital role in t rauma resuscitation. To the contrary, as part of the t rauma team, the emergency physician can actively part icipate in hands- on care and in management decisions.

The key to a successful interact ion is demonstrated com- petency in t rauma care on our part and a wil l ingness to work wi th our surgical colleagues. The phi losophy of sta- bilize first and then call the surgeon will never be accept- able to our consultants, and serves only to further polarize

the two specialties. Certainly not all surgeons support our par t ic ipa t ion in trauma, but that resistance is waning. I agree that education and research are the means by which we mainta in or improve our posit ion in t rauma care. Our goal in these endeavors, however, should not be to outshine our surgical counterparts, but rather to stand side by side wi th them in stabilizing t rauma patients and in expediting their definitive care.

A sound working relationship can be achieved between surgeons and emergency physicians. I have personally expe- rienced such a relationship in three Level I t rauma centers in two geographical areas of the United States. Be assured that this type of team effort does not result in a token role in t rauma care. Instead, it permits a vital part icipation and engenders mu tua l respect between the two disciplines. I suggest that all of us involved in t rauma practice artful di- p l o m a c y p u n c t u a t e d by so l id c l i n i c a l p e r f o r m a n c e in achieving opt imal t rauma care and professional satisfaction.

Robert C Jorden, MD Division of Emergency Medi'cine University of Mississippi

Medical Center Jackson, Mississippi

1. W h e l a n G: Editoriah Trauma management and emergency medicine. Ann Emery Med 1986;15:1382.

To Sponge Or Not To Sponge

To the Editor: A febrile seizure is not an earthshaking event in the eyes

of most pediatricians and emergency physicians. To the par- ent of the child, however, the incident is terrifying and is, indeed, an earthshaking event.

For decades the t rea tment of febrile seizures has involved the judicious use of antipyretics and some method to at- tempt to lower the body temperature. These have run the gamut from cold bath immers ion to alcohol sponge baths to tepid water sponge baths. Recent literature1, z has con- demned the use of tepid sponge baths. This leaves the emer- gency physician wi th an a rmamenta r ium consisting s imply of administer ing antipyretics and pat ient observation unt i l the temperature begins to return to normal. Certainly, such a protocol is usual ly successful and there is no argument wi th the fact that it is medical ly sound.

I suggest that we should, perhaps, take another look at the subject. It is m y content ion that a tepid sponge bath will do the child l i t t le harm. Although lacking statistical, prospective study proof of this contention, it is possible that it migh t even help. It is a more impor tant content ion that involvement of the family in the t rea tment of a child is good medic ine and is good psychotherapy for the parents. It takes approximately five minutes to fill a basin wi th tepid water and to show a parent how to give a sponge bath. True,

16:5 May 1987

the child hates it, the mother soon tires of it, and the water drenches the mother and the floor. Nevertheless, the par- ents are involved. They are playing a part in "curing" their child. There are fewer visits to the examining room door. There is less frustration from being ignored. In general, the parents u l t imate ly leave the emergency depar tment wi th a better memory of the incident.

With all due respect to m y learned colleagues in pedi- atrics, I suggest that, in the ED setting, t rea tment should include the frightened, worried parents of the febrile child. In this light, a tepid sponge bath adminis tered by the par- ents is a beneficial part of the therapy, for both the parent and child,

Bert A Glass, MD Department of Surgery Division of Emergency Medicine Texas Tech University School

of Medicine E1 Paso, Texas

I. Newman J: Evaluation of sponging to reduce body temperature in febrile children. Can Med Assoc ] 1985;132:641-642. 2. Goldbloom RB: Sponging for fever - A second look. Pediatric Notes 1985;9:(19)1.

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