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article in the may issue of "Annals of Emergency Medicine"

Caesar Ursic cursic at gmail.com
Sat Apr 22 23:28:57 BST 2006

Dr Paul M Middleton wrote:

"just try for a moment to think outside the box you are in and imagine
living in a
country (and I am talking about first-world places like the UK, Australia,
New Zealand and many others) where THE ONLY CHOICE is a hospital with this
arrangement. When you say they shouldn't be seeing trauma patients, then
where should they go? I'll just have a chat to ambulance control here in
Sydney shall I, and ask them to divert to Houston, New York, Boston.?"

Paul, wait a sec.  Don't paint it with such broad brush strokes.  What
you call 'the only choice' ...isn't.  The situation in Sydney is not
quite as you describe it.  At Westmead Hospital and at Liverpool
Hospital, and until recently at St George Hospital, an attending or
fellow-level surgeon would be in the ER promptly for all major trauma
activations.  Michael Sugrue and Scott D'Amours can attest to that at
Liverpool (they sleep there when on call), and Valerie Malka at
Westmead; and I instituted a 'fifteen minute' rule at St George during
my two year tenure there, with specific attending call-in criteria
(and this was part of our quality assurance process).  And I'm willing
to bet that a similar policy exists at Auckland Hospital, although I
cannot be 100% sure (Ian, are you lurking?)

CM Ursic, MD
Santa Fe, New Mexico

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