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Fri Aug 17 17:02:37 BST 2007

... but there's no mistaking that the lion's share of fingers pointing
at the level III hospital and its personnel are wearing gloves from
level I operating rooms.

The smaller hospital in this scenario has been systematically
desaturated of trauma, owing to its participation in an ostensibly
mature and organized system (how many immature or disorganized trauma
systems bother to verify their level III's?).  It can be assumed that
nobody in that shop has seen trauma of this magnitude in months.

A level III is not required to have an OR available, nor even a team in
house.  A dedicated general surgeon and published back up are merely
"desirable."  And while I'm not on the VRC (for an endless variety of
good reasons), I suspect that their relationship with the level I down
the road probably helped them achieve their existing verification, even
in the absence of services you suggest should be taken for granted.

If they were not up to caring for this patient, such was (in every
conceivable likelihood) a consequence of system engineering.  Give these
guys a freaking break -- at least until you know more about them.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Friday, August 17, 2007 11:40 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Transfer - NO

C'mon Pret,

Just how "flabby" can an OR and a surgeon get (I mean a "real" surgeon)
when it comes to opening a room for a STAT case, making an incision,
putting a spleen in a bucket, and stuffing the abdomen full of lap pads?

I would hesitate in pointing a finger at the hospital AND the system
here, even not knowing either.

Ron

>>> "Bjorn, Pret" <pbjorn at emh.org> 8/17/2007 11:11 AM >>>
"I'm not sure why any trauma center no matter what level would consider
transferring this patient.  Fix the abdominal problem then worry about
transfer.  If the aorta is the problem then the patient's survival
depends
on the skill of the trauma surgeon."

Dr. Thompson,

Lest I have been unclear: we should expect that a level III trauma
center in proximity to a level I might predictably become a bit flabby
in the damage control department.  Such would not (to my understanding)
represent a criteria deficiency for level III -- especially with an
ivory tower fifteen minutes away sucking in all the good cases.

Like you, I know next to nothing of the case or the system in question;
but if only for that reason, I'm less eager to blame the hospital as I
am the local trauma system.

Pret 

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Transfer - NO