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Wed Jun 13 23:01:49 BST 2007

Rob,
Thanks for looking at the papers. Quick search and no analysis on my part. For sure, this one patient 
didn't won't damage the system. No analysis will and an checked trend will. Outcomes? On of these 
days Iowa will have its systems evaluation running well and hopefully the data will provide directions for 
the future of the system. Right now, I suppose it's more eminence than evidence. Outcomes are 
improved by high volumes, such as hearts, and pancreas, but that doesn't extend to everything. 
Outcomes are improved in trauma by systems and preparation. I enjoy your passion about "the 
hollering " theory, but I won't embrace it exclusively as the way. At least in Iowa, it needs to be an 
inclusive system, with all parts playing a role. BTW, as much as the Utah sentence appears very self 
serving, there may be some truth to it. 
--
Kind regards,
Phil
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com

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