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Fri Aug 17 13:32:10 BST 2007

Last I checked, prompt OR availability was only a "desirable" feature of
a level III hospital.  And with a level I center less than 15 minutes
away, you can bet the on-duty OR teams (much less requisite ancillary
services)  don't get a lot of exposure to damage control candidates.

The inexperience and inefficiency inherent in this arrangement compels
the prehospital system to prefer the level I center.  One could
forcefully argue that precious time would be saved transferring this
patient as soon as his surgical instability was evident.  If it takes
the level III center more than 15 minutes to absorb this fellow into its
OR after confirmation of his condition, then put him in a truck, aim for
the level I, and be proud of your humility.  

The fact that he died in CT reflects harshly not just on the level III
center, but on the system writ large.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Thursday, August 16, 2007 10:17 PM
To: trauma-list at trauma.org
Subject: Transfer - NO

As presented a number of comments can be made:  

1.    It is contra indicated and probably unethical to  transfer this
person 
from one trauma center (level 3) to another trauma center  (level 1)
2.    There is no quality difference nor should there  be any outcome 
difference between a Verified or Certified Level 3 trauma Center  and a
Level I 
Trauma Center,   NON whatsoever., except for  neurosurgery and
cardiopulmonary 
bypass (and then even MAYBE)
3.  A level 3 trauma surgery should be able with personnel,  equipment.,
and 
protocols to take care of anything in the abdomen, any vascular  trauma
not 
requiring CPB,  ALL orthopedic injuries, ALL neck injuries and  most
thoracic 
injuries with the same outcome as a Level I trauma  center.    
4.    A patient with a suspected thoracic aortic injury  is NOT unstable
from 
the aortic injury, unless there is total disruption of the  aorta and
total 
instability manifest as death.   
5.    As described, this patient should have the LOCAL  surgeons at the
Level 
3 trauma center do an open laparotomy NOW, and take care  of whatever is

required to control the bleeding or sepsis.   
6.    To transfer this patient as described will  DECREASE his chances
of 
survival and increase the  complications.      

Kenneth L. Mattox, MD
Houston

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Transfer - NO