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Mon Nov 19 21:18:17 GMT 2007

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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