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

Tony Joseph tjoseph at ihug.com.au
Sun Apr 23 08:35:58 BST 2006

Dear Caesar
The availability of attending Surgeons is a little dependent on who is on
I don't think that any of the surgeons you have mentioned provide a 24/7
coverage so that while the system may work when they are on call and
in-house, I don;t think it is universal in Sydney or in the rest of
Australia for that matter. The Alfred in Melbourne ( the busiest Trauma
Hospital in Australia) doesn;t have trauma surgeons in house 24/7 last time
I checked,
If a hospital can provide an attending trauma surgeon within 15 mins they
are doing pretty well down here. With the Trauma laparotomy rate at about 5%
for all major trauma cases ( and much less for a thoracotomy) it is
difficult to argue for an in-house Attending trauma surgeon. Perhaps if we
ever managed to consolidate the Trauma services in Sydney to 1 or 2 centres
providing acute Trauma and Surgical care, we may have a chance?
Hope you are well
Tony Joseph

On 23/4/06 8:28 AM, "Caesar Ursic" <cursic at gmail.com> wrote:

> 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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