L~sing hospi tal based emergency medical technic ians (~Ts) to t ake v i ta l s igns can allow the phys ic ian and ~ursi~g personnel more t ime for the cognit ive processes 0f triage. Use of an electronic t h e r m o m e t e r g rea t ly re- duces the t ime requ i red to obta in v i ta l signs. The child ¢ith high fever (thus prone to seizures), the hyper tens ive patient, the dizzy pa t i en t wi th an a r r h y t h m i a , and the -^ung girl wi th a pu lmonary embolus and unexpla ined Y~ ~.,,ardia, are a few examples of pa t i en t s who m a y look essential!y well , b u t do fal l in the c a t e g o r y of '~true

emergencms- proper t r i age by pa ramedica l and nur s ing personnel

~ill allow the emergency phys ic ian to meet the demands placed on the emergency depar tment .

Jerry Goddard, MD Emergency Physician's Group, PC

Tacoma, Washington

Author's Reply I appreciate Dr. Goddard 's comments r ega rd ing our ar-

ticle. Basically, I agree tha t i t would be op t imal to ob ta in vital signs on every person coming to the emergency de- partment, and as I pointed out in the paper , th is would, in fact, modera te ly increase the precis ion of nurse t r iage . It was my opinion, however, t h a t the increase in t ime necessary to ob ta in complete v i ta l s igns was not cost ef- fective for the nurse t r iage process.

John Mills, MD Chief, Division of Infectious Diseases

University of California, San Francisco

Schizophrenia Defined To the Editor:

Michael E l i a s t am, MD, wrote you ( Janua ry 1977) con- coming his desire to " improve the qua l i ty of scientif ic evaluation . . . "

I would beg of him, and of you, please allow those of us in psychia t ry the same privi lege.

Schizophrenia is admi t t ed ly a vague ly def ined diag- nosis but i t is not a synonym for "confusing," " improper ," or "unscientific," a l l of which could have been used in Dr. Eliastam's l e t t e r to more por t ray his feelings.

J. F. Hooper, MD Department of Psychiatry

University of Kentucky

Author's Reply Dr. Hooper ' s comments a re obvious ly app rop r i a t e . I

have a l r e a d y been v e r b a l l y a s s a u l t e d by m y wife, a psychiatry res ident , who pointed out t~a t I was us ing an entirely incorrect cl inical defini t ion.

In a t t emp t ing to hold an emba t t l ed posit ion, I would like to point out t ha t I used the word schizophrenic to SUggest t h a t the author ' s comments on the va lue of the

esophagea l ob tu ra to r a i rway ref lected a form of dissocia- t ion or "spl i t t ing." The d i s s o c i a t i o n r e l a t e d to the absence of good cl in ical s tudies to suppor t the c la ims about the "proven" appl icab i l i ty of t r achea l in tuba t ion in the pre- hospi ta l care set t ing.

Michael Eliastam, MD Director of Emergency Services

Stanford University Medical Center

Complications of G-Suit To the Editor:

"Clinical Use of the G-Suit ," by Soler, et al (August 1976) does much to exp la in some of the theore t ica l as- pects of the G-sui t and is ce r t a in ly t imely. There are two areas, however, I m u s t d isagree with.

"A drop of 40-60 m m Hg or more in blood pressure can be expected on deflat ion." This is t rue if the t rousers are rap id ly deflated. However , they should never be r ap id ly deflated. The a u tho r s s ta te t h a t in r a r e cases of pro- longed use wi thout surgery , def la t ion should proceed step by step. I bel ieve s tep by step def la t ion should t a k e place in al l cases. Step by step def la t ion and moni to r ing the blood pressure as the var ious compar tmen t s (beginning wi th the abdominal ) are def la ted, wil l give adequa te re- t u rn of blood pressure before anes thes ia is induced. This can f requent ly be accomplished over a period of 20 to 40 minutes , while a pa t i e n t is be ing prepared for surgery . If complete def la t ion cannot be accomplished pr ior to ini t ia- t ion of anes thes ia , the abdomina l segment at l eas t usu- al ly can be def la ted and g r a d u a l def la t ion of the leg seg- m e n t s accompl i shed i n t r a o p e r a t i v e l y . No hypo tens ion should occur.

"Sudden increase in i n t r a - a b d o m i n a l pressure can pro- duce dyspnea, f r ank r e sp i r a to ry embar r a s smen t , emesis , defecation and/or u r ina t ion ." Al though these complica- t ions are ment ioned i n the l i t e r a tu r e 1 and in the man- ufac turer ' s in format ion (David Clark) , in our recent ex- perience of 50 cases repor ted in September to the Amer i - can Associa t ion for the Surgery of Trauma, 2 we had none of these complicat ions. In only th ree cases was there a drop in blood pressure in the r ange of 30-60 m m Hg. This was due to someone i n e x p e r i e n c e d in the use of the t rouse r s not p rope r ly r e p l a c i n g f luids and m o n i t o r i n g blood pressure dur ing the i r deflat ion.

I would l ike to compl imen t the authors on the i r work but do not feel t h a t compl ica t ions are of the f requency commonly bel ieved bu t do feel t hey are theoret ical . I em- phasize t h a t they do not need to produce severe hypoten- sive problems.

Norman E. McSwain, Jr, MD, FACS Department of Surgery

Kansas University Medical Center

REFERENCES 1. Kaplan BC, _Civetta TM, Nagel EL, et al: The military anti- shock trouser in civilian pre-hospital emergency care. J Trauma 13:843-848, 1973.

2. McSwain NE: Report of 50 cases of G-suit use. J Trauma (to be published).

~ ] ~ ) 6:5 (May) 1977 225/71