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Thu Dec 6 23:10:56 GMT 2007

Julie, I'm reading this late and am very impressed by your numbers! The
busiest NSW centre (John Hunter in Newcastle) sees about 400 ISS > 15,
the other designated major traum centres 250 - 300. My hospital is a
designated regional trauma centre (meaning we can handle most things but
not necessarily everything) with 180 - 200 ISS > 15 per year.

The politics are spectacular, between one team pushing for more of a
Victorian model of only a few busy trauma centres [but which ones?!!]
and others arguing firstly that transport times are too great in a very
spread out city (over an hour by ambulance from one side to the other,
then take in to account the surrounding semirural areas where a lot of
the trauma happens) and secondly that if specific hospitals lose 'major'
trauma they will also lose a lot of the other services that go with it
and will be unable to manage less major trauma. In any case, as
ambulance officers can't assess ISS, there will be a huge overtriage of
'potential majors'.

Certainly the (non trauma) surgical fraternity at the current major
trauma centres seeing 300 major/yr don't any increase on that, as they
perceive the places will be taken over by trauma and they will find it
very hard to get any of their non trauma work done.

Finally, and in defence of the status quo, there is no evidence that
outcomes in a diffuse (but still well organised) trauma system are any
different to outcomes in a very centralised system, and all the figures
I've seen show that NSW outcomes are no better and no worse than
Victoria's. As a benchmarking exercise I recently compared 6 month
neurotrauma outcomes in my own ICU [approx 50 severe head injuries/yr],
with national data from the ATBIS dataset, and some data from the Alfred
(more like 250 severe head injuries per year). Recognising all the
methodological difficulties in this sort of benchmarking exercise, our 6
month outcomes were identical to both the ATBIS data set and to the
Alfred (p=0.9).

There is some huge politics in all of this!!!!!

Best wishes, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

>>> jamiller444 at yahoo.com 20/11/2007 8:18am >>>
Allen,
In my state of Victoria (Australia) we have two adult and one pediatric
trauma centre for a population of 6.2 million. Australia is sparsely
populated compared to the US. In Victoria, most of the population (65%)
is concentrated in Melbourne, with the remainder spread out around the
rest of the state. We have a well-developed pre-hospital service that
flies patients in from rural areas by both fixed-wing and helicopter
transport. At the Royal Melbourne Hospital, we see about 700 majors (ISS
> 15 or intubated) and ~2200 minor traumas per year. The other centre
(The Alfred Hospital) sees about 900 or 1000 majors per year. Most
players feel this setup is entirely adequate.

New South Wales, on the other hand, has more trauma centres that see
fewer patients each per year. From a distance, it seems to be a
satisfactory arrangment as well, but I would be interested if any of our
NSW colleagues will comment on how it is working for them.

Kind regards,

Julie Miller
Endocrine and General Surgeon
Trauma Surgeon
Royal Melbourne Hospital

----- Original Message ----
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, November 20, 2007 2:11:21 AM
Subject: RE: Trauma Systems & Centres

Allen,

There has been much written about and speculated about the need for
trauma centers. One of the recurrent quotes seems to be one 750 bed
sized level I trauma center per 1 million population in the United
States. In San Diego we have 6 trauma centers, 5 adult and 1
pediatric.
Seems like a lot of centers. However, when you factor in the reality
that we are a community of medium sized hospitals - none with a census
over 300 - and that the population is approximately 3 million in the
area we serve - San Diego County - it equates to the above mentioned
average. Our 5 adult center see between 1,600 and 2,500 trauma
activations and consults each year - a range of reasonable numbers -
which seems to be the appropriate number for the capacity (facility
and
staff) of each center. We've been at it over 23 years and it seems to
work. Other tertiary centers in the area have not suffered and remain
excellent in their core missions. They cooperate with the trauma
centers
to get the right patient to the right center at the right time.

The most important principle in deciding the number of trauma centers
would seem to be what works in the local culture of health care that
allows those trauma centers to provide sustainable excellence in the
care of the injured. There is not one answer to the appropriate number
of centers. Every community has its unique formula. However, there is
a
clear set of standards that must be met - the American College of
Surgeons Committee on Trauma Verification Process is the goal all
centers must achieve. A tried, tested, and true measure of excellence,
the ACS standard is the "gold standard". 

Disaster planning is a very different process than the every day
provision of trauma care. Our 6 trauma center physicians and nurses
just
completed the ACS Disaster Mangement Course led by Drs. Jeff Hammond
and
Rick Frykberg. This one day course is outstanding and a geat asset
taught by physicians for physicians. Hopefully it will be coming to
your
area soon. The role of trauma centers and other tertiary hospitals in
a
disaster is addressed and an important part of the course.

Mike Sise

-----Original Message-----
From: gsuywy at pacific.net.sg [mailto:gsuywy at pacific.net.sg] 
Sent: Monday, November 19, 2007 12:17 AM
To: trauma-list at trauma.org 
Subject: Trauma Systems & Centres

I would appreciate the list's opinion on the recommended number of
trauma centres needed in a trauma system - is it based on population,
volume of major trauma per institution or per surgeon. Is there such a
thing as 'deskilling' the other bypassed tertiary hospitals that will
impact their ability to handle the surge in trauma patients during
disasters.

Thanks

Allen Yeo
Perth, WA

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