I. Requesting and Reviewing the Medical Record

In any traumatic injury case, obtaining the medical records is one of the early steps in evaluating the client's claim.

Most states have a section in the Rules of Civil Procedure covering specifics of request format, time to respond and charges for medical billing. Be sure to check your state code prior to preparing a request for medical records.

Below are some tips for paralegals and attorneys who will need medical records in order to substantiate a claim and answer discovery through production of medical records.

• Interview the client to obtain as complete a medical history as possible. If they have billing records copy and retain those, as they will contain important contact information for health care providers.
• Remember billing and medical records may not be maintained at the same facility and a separate request for each is needed.
• Obtain the pharmacy billing records prior to and subsequent to the incident in question. Have the potential client bring these for the initial interview. They will contain a thumbnail sketch of the patient's medical care prior to the incident in question, identify prescribing/healthcare providers as well as document medication taken (such as pain medication) to aid in supporting damages.
• Many medical records, especially nursing documents are multiple pages with dates, signatures only on one page. It is suggested you request multiple pages be stapled in order, this is crucial for establishing dates/times and providers in a chronological order.
• Often treatment and medications records are double-sided with initials/signatures and comments on the opposite side. Be sure to request double sided copies, or if single sided copies, request they be stapled together. These records may contain crucial information in a case.
• As in any case of medical negligence or malpractice, the medical records are extremely important in proving the facts showing negligence, causation, and damages.
• Obtain ALL of the clinic, urgent care, emergency room, ambulance, visiting nurse, occupational therapy, speech therapy, physical therapy and respiratory therapy records and ALL doctor and hospital records.
• Sometimes urgent care, ambulatory care clinics, emergency rooms, ambulances, nursing and various therapy services, etc., are independent contractors. Establish with the hospital or institution what care is provided by independent contractors and where to address medical records requests to ensure you are ordering ALL of the available medical records.
• Even if all of the available medical records are not part of the alleged incident and hence are not subject to the medical review, they should still be obtained as reference material.
• The records just prior to and after an alleged incident are especially important in providing documentation as to the person's medical condition, the extent of the alleged injuries as well as an indication of any probable long-lasting complications that may now exist.
• Key Point: Information is often obtained from seemingly obscure records, hence the need for ALL of the medical records.

B. Components of the Medical Record

HOSPITAL RECORDS:

Hospital records include, but are not limited to:

• Admission Information/Summary - documents date/time of admission, admitting diagnosis. Admitting physician and other basic admission information
• Discharge Summary - documents condition at time of discharge, any post discharge instructions for lab tests, physician appointments and medications prescribed, as well as instructions for physical activity and other treatment modalities.
• Admission History and Physical - documents condition at time of admission, usually performed by admitting physician, but sometimes deferred to a medical resident or physician assistant. There may also be a separate document, "Physician's Admission History and Physical" in some health care facilities.
• Physician's Progress Notes - daily chronology of patient's progress, often gives rationale behind change in treatment or medication and documents physician visits.
• Emergency Room Records - documents condition upon arrival, chief medical complaint and may also include emergency room physician evaluation of any tests performed such as ultrasound, radiology and laboratory tests. Also recommendations for referral, admission and/or discharge are obtained here.
• Consultation Reports (Physician and other professional.) documents evaluation and recommended treatment by physicians, and other health care providers asked to consult in reference to patient care.
• Physician's Orders - documents date and time of treatments and medications ordered by treating physicians. These are to be signed by the physician ordering, even if a telephone order or phone/verbal order given to a nurse.
• Operating Room Records and Report (Physician, Nursing and Anesthesia Record) - documents procedure performed, surgeons, nurses and anesthesia personnel present during surgery. Also documents patient condition before, during and after surgery. Some hospitals document post operative care in the "PAR" (post anesthesia recovery) record.
• Laboratory Reports - documents results of tests performed in the laboratory. Includes not only blood and urine tests, but also cultures of tissue and microscopic exam of tissue.
• Graph Sheets - documents basic vital signs and other basic functions such as urinary and intestinal elimination. Some graphic sheets also document dietary and fluid intake.
• I and O record - documents fluid and solid intake and output on a daily basis. Usually tallied on a daily basis, but may be recorded with each shift (two to three times a day)
• Treatment Sheets - documents all manner of treatments such as wound care, hot and cold therapy not given in physical therapy, etc.
• Medication Sheets - documents medications given. PRN medication is given on an "as needed" basis and may be listed separately from regularly scheduled medications.
• X-ray/Radiologist Reports - documents radiologist's impression of radiology tests. Will also contain name of ordering physician.
• Physical Therapy Records - documents treatments/therapy given in the Physical therapy department as well as the patients response to therapy.
• Speech Therapy Records - documents therapy given by speech pathologist.
• Occupational Therapy Records - documents therapy given by occupational therapist. May be included as part of physical therapy records in some institutions.
• Nurse's Notes/Nursing Progress Notes - Chronological documentation of patient's condition, physician visits, change in condition and treatments given as well as patient responses. Usually written in longhand, but more and more frequently are seen as a computerized record.
• Nursing Care Plans - Each patient has a general plan of care, and the foundation is determined by the policy of the health care facility. However, generally the nursing care plan covers all treatments, medications and therapies ordered for the patient. Goals are also stated for patient care.
• Interdisciplinary/Multidisciplinary Progress Notes (Not utilized in all facilities.) - documents progress of each therapeutic department in chronological order, rather than a separate progress note maintained by each department. May include notes made by more than one department, such as speech, physical and occupational therapies.

Other records found but not consistently maintained by all facilities may include:

Records/Treatment Logs

• Treatment Records, Nursing Treatment Records (Sometimes in with the medication records; sometimes listed separately.)
• Physical Therapy
• Speech Therapy
• Occupational Therapy
• Rehabilitation Therapy, Restorative Services
• Recreational Therapy, Activity Therapy or Service
• Any other form of therapy records
• Visiting Nursing or Home Care Nursing Records
• Records from Independent Medical Laboratories
• Records from Independent Radiology and Nuclear Medicine Services

EMERGENCY SERVICE RECORDS:

• Ambulance Records (EMS --- Emergency Medical Service) - these records may be maintained by either an independent EMS service or a municipal fire department, or hospital EMS service.
• Emergency Room Records (These are often not part of the hospital records, where the emergency room is operated by an independent contractor.)

In some situations, the records of emergency response personnel such as the local police and rescue portions of the fire department will also apply and will be separate from other EMS records, and a separate request for each entity will be required in order to obtain all records.

C. Building Your Medical Library

At times the terms used in the medical records can be confusing and the rationale for diagnosis and treatment is not clear. In other instances you wish to review a standard of care as it relates to your client's diagnosis and treatment.

Below is a general listing of resources, both in text print as well as online which might be of benefit to your office.

We are all sensitive to the issue of overhead for the law office. Therefore, you may want to consider obtaining some of these books as library materials for a shared legal medical library established through your local bar association or in co-operation with other law firms in your immediate area.

Medical Abbreviations: 24,000 Conveniences at the Expense of Communications and Safety, by Neil M. Davis

Temple Univ., Philadelphia, PA.

Annual pocket quick-reference guide to 24,000 meanings of medical abbreviations and 3,400 cross-referenced generic and brand drug names. Thumb-tabbed pages. Includes single-user access code to the Internet version of the book which is updated with 80-120 new entries per month. Softcover.

Paperback: 430 pages

Publisher: Neil M. Davis Assoc; ; 11th edition (December 2002)

ISBN: 0931431115

Laboratory and Diagnostic Tests with Nursing Implications (6th Edition) by Joyce Lefever Kee, RN, MSN,

Each test is discussed in seven subsections in the following sequence: (1) reference values/normal findings, (2) description, (3) purpose, (4) clinical problems, (5) procedure, (6) factors affecting laboratory or diagnostic results, and (7) nursing implications with rationale. Following the name and initials for each test, there may be names of other closely associated tests. Reference values/normal findings are given for children and adults, including the elderly. The description focuses on background data and pertinent information related to the test. The general purpose for each test is listed. Clinical problems include disease entities, drugs, and foods that cause or are associated with abnormal test results. The procedure is explained with a rationale for the test and with appropriate steps that the nurse and other health professionals can follow. Factors affecting laboratory or diagnostic results alert the nurse to factors that could cause an abnormal test result. The last subsection and most valuable information for each test concerns the nursing implications with rationale. For most diagnostic tests, nursing implications are given as "pretest" and "posttest."

Paperback: 805 pages ; Dimensions (in inches): 1.25 x 9.50 x 7.25

Publisher: Prentice Hall; ; 6th edition (September 12, 2001)

ISBN: 0130305197

Alexander's Care of the Patient in Surgery by Jane C. Rothrock, RN, DNSC, DN0R, FAAN (Editor), Dale A. Smith, RN, CNOR, RNFA (Editor), Donna R. McEwen, RN, BSN, CNOR, CRST (Editor)

ALEXANDER'S CARE OF THE PATIENT IN SURGERY, considered the standard in perioperative care for over 50 years, is a comprehensive reference for students and practitioners alike. Unit I covers basic principles and patient care requisites. Unit II details step-by-step procedures for over 400 general and specialty surgical interventions. The unique needs of ambulatory, pediatric, geriatric, and trauma surgery patients are discussed in Unit III. New features include highlighted patient education and discharge planning, sample critical pathways, expanded coverage of endoscopic/minimally invasive procedures, and internet resources. A new chapter, Surgical Modalities, addresses today's technologically advanced perioperative environment.

Hardcover: 1409 pages

Publisher: Mosby-Year Book; ; 12th edition (January 15, 2003)

ISBN: 0323016227

Merck Manual Diagnosis & Therapy (Includes Facsimile of 1st ed. of the Merck Manual) by Mark H. Beers (Editor), Robert Berkow (Editor), Mark Burs (Editor)

The most widely used medical text in the world and the hypochondriac's bible, the Merck has the lowdown on the vast expanse of human diseases, disorders and injuries, as well as their symptoms and recommended therapy. It's intended for physicians and medical students, but though the type is tiny and the language technical, the Merck's a valuable volume for anyone with more than a passing interest in bodily ills.

Leather Bound: 2833 pages

Publisher: Merck & Co; 17th edition (March 5, 1999)

ISBN: 0911910107

Rosen's Emergency Medicine: Concepts and Clinical Practice (3-Volume Set) by John, Md. Marx, Robert, Md. Hockberger (Editor), Ron, Md. Walls (Editor), Robert S. Hockberger

ROSEN'S EMERGENCY MEDICINE continues to be the premier source that defines the field of emergency medicine. It describes the science of emergency medicine and its application, focusing on the diagnosis and management of problems encountered in the emergency department. This stellar new team of editors has introduced many new features including a "Cardinal Presentations" section, chapter consistency, and more diagnostic imaging throughout. All existing chapters have been extensively revised, and reference lists have been edited to include more significant, up-to-date references.

Hardcover: 2766 pages

Publisher: Mosby-Year Book; 5th edition (January 15, 2002)

ISBN: 0323011853

Joint Commission on Accreditation of Healthcare Organizations. (CAMH) Comprehensive Accreditation Manual for Hospitals: The Official Handbook: Accreditation Policies, Standards, Scoring, Aggregations Rules, Decision Rules.

Oakbrook Terrace, IL, Joint Commission on Accreditation of Healthcare Organizations, 2001. CAMH, $350.00; CAMH and 1-year update, $565.00; CAMH annual subscription update, $245.00.

Cecil Textbook of Medicine (Single Volume) by Russell L. Cecil (Editor), J. Claude Bennett (Editor), Lee Goldman (Editor)

Cecil Textbook of Medicine, 21 Edition CD-ROM provides rapid-access to the complete text, illustrations, tables and references. Review questions with answers are linked to the relevent sections of the textbook and complete drug monographs from Mosby's GenRx are included. Plus, this CD-ROM gives you FREE access to Cecil Online! --This text refers to the CD-ROM edition.

Hardcover: 2308 pages

Publisher: W B Saunders; (January 15, 2000)

ISBN: 072167996X

Current Pediatric Diagnosis & Treatment by William W. Hay, Jr, MD (Editor), Anthony R. Hayward, MD (Editor), Myron J. Levin, MD (Editor), Judith M. Sondheimer, MD (Editor)

Provides clinical information on ambulatory and inpatient medical care of children from birth through adolescence, focusing on clinical aspects of pediatric care and their underlying principles. Emphasis is on ambulatory care, acute critical care, and a practical approach to pediatric disorders. This edition contains new chapters on developmental disorders and behavioral problems, substance abuse, allergic disorders, and fluid, electrolyte, and acid-base disorders and therapy, plus expanded illustrations.

Paperback: 1320 pages

Publisher: Appleton & Lange; 16th edition (October 25, 2002)

ISBN: 0071383840

Clinical Nursing Skills & Techniques by Anne Griffin Perry, Patricia Ann Potter, Anne G. Perry, Patricia A. Potter

The 5th edition of Clinical Nursing Skills and Techniques offers new up-to-date content and improved features, in addition to complete coverage of more than 200 nursing skills, a nursing process framework for a logical and consistent presentation, and a convenient 2-column format with rationales for each skill step.

Paperback: 1320 pages

Publisher: Mosby, Inc.; 5th edition (June 15, 2001)

ISBN: 0323014062

ACEP - Critical Decisions

Critical Decisions in Emergency Medicine, reliable, relevant clinical updates/risk management. two lessons each month. Subscription for non member $244 a year.

Index of past issues found at: http://www.acep.org/1,5012,0.html

Order by calling ACEP or going to www.acep.org and order online

ACEP - Foresight CEU Risk Management

Example: http://www.acep.org/library/pdf/Foresight-56.pdf

Print monthly from online resource.

AMA - Medicolegal Forms with Analysis - Documenting Issues in the Patient-Physician Relationship.

Covers issues such as consent, informed refusal, ama, and others. Contains current forms and references to legal citations related to each issue discussed.

Binding: Hardcover

Publisher: American Medical Association

Published Date: 06/01/1990

List: USD $32.00

ISBN: 0899704026

D. Other suggested Book Lists/Links

Brandon/Hill selected list of print books and journals for the small medical library - http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=11337945

"Selected List of Books and Journals for the Small Medical Library" was published almost forty years ago, this series of selection guides has been heavily used and highly valued by librarians, nurses, health care practitioners and publishers. The Small Medical Library list was followed in 1979 by the "Selected List of Nursing Books and Journals" and by the "Selected List of Books and Journals in Allied Health Sciences" in 1984. In 2001, the publications were made available on the internet, promoting unrestricted access.

It was always the instruction of Alfred Brandon and Dorothy Hill, the original authors, that the selected lists would not be published under their names without their direct involvement which is why they retained copyright of the lists. With the recent retirement of Dorothy Hill, this longstanding project has drawn to a close.

Brandon Hill Journal Links - http://nnlm.gov/libinfo/ejournals/branhill.html

This list of Journals available in full text online was updated on a regular basis by the National Library of Medicine through May 12, 2003, This page is valuable in terms of information to online resources, but this page, "MLA Brandon/Hill Journal Links", is no longer updated.

General Reference Internet Links

Medscape - http://www.medscape.com/

Medscape is a multi-specialty Web service for clinician and consumers that combines information from journals, medical news providers, medical education programs, and materials created for Medscape. Here you will find a combination of peer-reviewed publications, a free version of drug information via the "First Data Bank File" and free Medline.

MD Consult - http://www.mdconsult.com/

Founded by leading medical publishers that include Mosby and W.B. Saunders, MD Consult integrates peer-reviewed resources from over 50 publishers, medical societies, and government agencies. From this site you can obtain full text from respected medical reference books from a variety of specialties, medical journals, and MEDLINE. In addition you can obtain comprehensive USP drug information (beyond the scope of a PDR), as well as more than 600 clinical practice guidelines. This is not a free service, but for a small fee you can have access by the day, month or year. Also there is a free seven day trial membership.

Guidelines Clearing House - http://www.guidelines.gov/

This site is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) in partnership with the American Medical Association and the American Association of Health Plans. A medical term search will retrieve objective, detailed information on clinical practice guidelines. Results in a search will obtain: structured abstracts (summaries) about the guideline and its development, a utility for comparing attributes of two or more guidelines in a side-by-side comparison, syntheses of guidelines covering similar topics, highlighting areas of similarity and difference, links to full-text guidelines, where available, and/or ordering information for print copies and, annotated bibliographies on guideline development methodology, implementation, and use.

CPT Codes - http://www.ama-assn.org/ama/pub/category/3113.html

This website gives users of CPT the opportunity to perform CPT code searches and obtain information about Medicare's relative value payment amount associated with the codes. Searches can be performed using 5 digit CPT code numbers or key word(s) in the code description. Also you can order the CPT coding handbooks in paperback format. The codes are updated annually.

Additional Internet Resources

Anatomy

http://www.innerbody.com/htm/body.html

Anesthesiology

http://www.abanes.org

http://www.asahq.org

Cardiology

http://www.acc.org

http://www.augusta.net/atlantic/ascp.ascpscm.html

http://www.asecho.org

http://www.americanheart.org

Chiropractic

http://www.amerchiro.org

http://www.accoweb.com

http://www.chiromed.org

http://www.nysca.com

Emergency Services

http://www.aaem.org

http://www.abem.org

http://www.acep.org

Endocrinology

http://www.aace.com

http://www.women-in-endo.org

http://www.diabetes.org

Gastroenterolgy/Liver

http://www.acg.gi.org

http://www.gastro.org

http://www.asge.org

http://www.sgna.org

http://www.liverfoundation.org

General Medicine

http://www.aafp.org

http://www.abms.org

http://www.ama-assn.org

http://www.aamc.org

http://www.msweb.net/aaps/

Hematology

http://www.hematology.org

Iatrogenic Injuries

http://www.iatrogenic.org

Immunology

http://www.ashi-hla.org/

http://www.aaaai.org

Infectious Disease

http://www.idac.org/idlinks.html

http://pages.prodigy.net/pdeziel/

http://www.cdc.gov/ncidod/id_links.htm

http://www.amm.co.uk/

Internal Medicine

http://www.acponline.org

http://www.aibm.org

http://www.sgim.org

Obstetrics/Gynecology

http://www.acog.org

http://www.abog.org

http://www.accesspub.com/tempobg/soc/socm.htm

Midwifery

http://www.acnm.org

Neurology

http://www.stroke.org/

http://www.aan.com/

http://www.neuroguide.com/

Oncology

http://www.asco.org

http://www.cancernet.nci.nih.gov

http://www.oncolink.upenn.edu

http://www.cancer.org

Opthamology

http://www.eyenet.org

http://www.ascrs.org

http://www.asoprs.org

http://www.glaucoma-foundation.org/info/

Optometry

http://www.aaopt.org

http://www.aoanet.org

Orthopedics

http://www.aaos.org

http://www.sportsmed.org

Pediatrics

http://www.aap.org

Pharmacy

http://www.aphanet.org

Physical Therapy

http://www.aaptnet.org

http://www.apta.org

http://www.nationalrehab.org

Physiology

http://www.faseb.org/aps/

Plastic Surgery

http://www.facial-plastic-surgery.org

http://www.plasticsurgery.org

Podiatry

http://www.apma.org

http://www.footandankle.com/podmed/

Preventative Medicine

http://www.acpm.org

Psychiatry

http://www.abpn.com

http://www.psych.org

Pulmonology

http://www.lungusa.org

http://www.aarc.org/

http://www.chestnet.org/

http://www.thoracic.org/

Radiology

http://www.asrt.org

http://www.rsna.org

http://www.acr.org

Rheumatology

http://www.rheumatology.org

http://www.arthritis.org

Surgery

http://www.facs.org

http://www.acfas.org (foot and ankle)

http://www.fascrs.org (colon and rectal surgeons)

http://www.womensurgeons.org

Urology

http://www.auanet.org

http://www.kidney.org

Vascular Medicine

http://www.svmb.org

Veterinary Medicine

http://www.abvp.com

http://www.avma.org

Medical Terminology

http://mywebmd.com/encyclopedia

http://www.nlm.nih.gov/medlineplus/mplusdictionary.html

http://medmatrix.org

http://www.edae.gr/dictionaries.html

http://www.medicinenet.com (then click on dictionary)

http://www.4woman.org/nwhic/references/dictionary.htm (on line med dictionaries and journals)

Large Listing of Medical-Related Sites

http://www.sciencekomm.at/links/medicine.html

I. Requesting and Reviewing the Medical Record

As a medical-legal consultant and Internet researcher I am asked every day to find authoritative medical literature references for a broad spectrum of topics. The information I am looking for may be used to support a claim, to debunk an expert theory, or to educate the attorney during the course of a case evaluation.

Changes in the way medical information is stored, accessed, and retrieved have created a wealth of health care information. The Internet provides free access to a great deal of the medical literature, either in full text or citation/abstract format. Because anyone with access to the Web can establish a web page, many medical sites contain little useful information, even though they may be visually appealing. For this reason, the quality of information available varies from very good to poor, and some sites even intend to mislead. It is important to search for peer reviewed information, from an authoritative source.

Define The Search

Before you start your search, be clear as to the specific type of information you are seeking. It may be a standard of care for a particular procedure, it may be the rate of occurrence for complications related to a specialized treatment, or it may be basic information defining a disease or particular injury. You must identify the main concepts in your topic and determine any synonyms, alternate spellings, or variant word forms for the concepts.

In order to define your search, you will need a grasp of basic medical terminology. The medical terms used in your search usually come from records showing a diagnosis or particular treatment. The terms may include the name of a medication or specialized medical equipment. It is a good idea to keep a medical dictionary and drug guidebook close at hand as references, because spelling of medical terms must be accurate in order to get relevant search results.

Because the Web is not indexed in any standard manner, finding information can seem difficult. Search engines are popular tools for locating web pages, but they often return thousands of results. Search engines crawl the Web and log the words from the web pages they find in their databases. Without a clear search strategy, using a search engine is like wandering aimlessly in the stacks of a library trying to find a particular book.

Performing the Search

Most of the major medical literature search sites have tutorials or help functions to assist you in customizing your search. It may take some time to learn how to master the specific commands and options offered by the various search engines, but it pays off by helping you avoid hundreds of hours fruitlessly searching.

Do not let the similarity between the appearance and function of medical search sites fool you into thinking they are all alike. They are not. They use different rules and procedures to analyze your queries and decide what results are seen.

If you have tried a query a few times and are not getting the results you are looking for, switch to another search engine. It is natural after searching for awhile to have "favorite" search sites. In one way this is good, the more you use a particular site the more likely you are to master a particular tool. But, instead of relying on one search site for all your needs, try using several different sites on a regular basis. This way you will get a feel for which ones work best for specific types of searches.

Over time, it will become automatic for you to select the "best" search site for each query from among the several that you know well.

Boolean operators (and, or, not) allow you to construct very precise queries that theoretically should give you very precise results. But this is not necessarily the case for two reasons. First search sites implement Boolean operators in slightly different ways. If you are going to use Boolean operators, be sure you understand exactly how each site implements them. Secondly, despite the apparent simplicity, Boolean logic is anything but simple. A misused "not" or a poorly "nested" phrase can lead to wildly inappropriate results. For a good Boolean primer, with helpful illustrations and examples is Boolean Searching on the Internet, from the New York University.
http://library.nyu.edu:8000/research/tutorials/boolean/boolean.html

Some search engines ignore certain words. They are never used to find a matching document, despite what amounts to a direct command when you type them into a search form. These are called "stop words" because the search engine does not "search" when they are found in its index. This is because the stop words are either too common to generate meaningful results, or are parts of speech like adverbs, conjunctions, prepositions, or forms of "be" that mean nothing unless they are part of a phrase with more "important" nouns and verbs. If you use a stop word in a query you may get wildly irrelevant results. Some search engines will tell you when they are ignoring a stop word at the very top of a results page. How can you identify stop words? They are listed at Most of the 300 Most Common Words in English found at the URL: http://www.myenglishlessons.net/most_common.htm.

Another problem for the net-searcher is whether to use capital letters in a query. Some engines are case sensitive, while others are not. As a rule of thumb, it is best to always use lower case letters when you search This will typically return results that contain both upper and lower case letters.

It is a good idea to bookmark or print out the information you find. It is easy to believe once you have found a page or site using a search engine that you will find it again. It does not work that way. You may not get the same search results using the same terms if you repeat a search within an hour, let alone days or weeks later. The Web is in constant flux. Thousand of new pages are published to the Web every day, and thousands more moved to new "addresses", or are removed entirely. This means a particular "relevance" of a particular document for a specific search query also changes constantly, as it is compared to other documents added to or removed from the search engine index.

If you get stuck, and can not find what you are looking for on the Internet, do not stop looking. Sometimes your best bet for finding information is to log off and take a trip to your local medical library. Libraries have many resources that are not available on the Internet. And, the librarians are trained experts who are usually more than willing to help you find what you are looking for. Effective searching requires a blend of learned skills, common sense, and a bit of clever intuition. If you are reviewing cases involving a medical issue and/or medical records, below is a list intended as a starting point for your office reference library. Each case will call for different resources related to the medical specialty involved, the training and licensure of the parties, and the standards current for the year in which the incident made the basis of the lawsuit occurred.

A. Specific Research Links Related to Traumatic Injuries

(US) National Institutes of Neurological Disorders and Stroke

http://www.ninds.nih.gov/index.htm

National Spinal Cord Injury Association

http://www.spinalcord.org/

American College of Surgeons - Trauma Data Bank

http://www.facs.org/dept/trauma/ntdb.html

American Association for the Surgery of Trauma

http://www.aast.org/

American Trauma Society

http://www.amtrauma.org/

National Safety Council

http://www.nsc.org/

Orthopedic Trauma Association

http://www.ota.org/

American Trauma Society (for Survivors of Trauma and their Families)

http://www.amtrauma.org/survivor/survivor.html

The National Institute on Disability and Rehabilitation Research (NIDRR)

http://www.ed.gov/about/offices/list/osers/nidrr/index.html

Alabama Head Injury

http://www.ahif.org/

American Academy of Neurology

http://www.aan.com/

Brain Injury Association

http://www.biausa.org/

Brain Injury Association of Queensland

http://www.biaq.com.au/

Brain Injury Ring - Homepages of brain injury survivors, care givers, friends, family and BI resources.

http://f.webring.com/hub?ring=bir

CDC Resource Page - Traumatic Head Injury

http://www.cdc.gov/node.do/id/0900f3ec8000dbdc

CDC Heads Up - Head Injury Resource packet for physicians

http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/toolkit.htm

Coma Recovery Association

http://comarecovery.org

Head Injury Outline

http://www.headinjury.com

Life With TBI

http://www.tbilife.com

National Resource Center for TBI

http://www.neuro.pmr.vcu.edu

Neurological Surgeons Association

http://www.neurosurgery.org/aans

Neuroscience Center

http://www.neuroscience.cnter.com

Neurotrauma-Law Nexus

http://www.neurolaw.com

Office of Special Education and Rehabilitative Services

http://www.ed.gov/about/offices/list/osers/index.html?src=mr

TBIHelp.com

http://www.tbihelp.org

Traumatic Brain Injury Resource Guide

http://www.neuroskills.com

TBI Resource Online

http://comarecovery.org

There are many resources available to assist the attorney in telling the client's story of traumatic injury. This is not intended to be an exhaustive listing. Performing repeated searches often brings the researcher to new resources.