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Fri Aug 17 15:23:07 BST 2007

Yeah - what HE said!

>>> <KMATTOX at aol.com> 8/16/2007 10:17 PM >>>
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