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Mon Nov 19 22:39:00 GMT 2007

Hi Allen,

Since we have been "plagued" in the last 13 years with "mini" surges of
multiple casualty incidents (MCIs), I can tell you that when planning a
TRAUMA SYSTEM the goal is to provide best possible care for the daily
"normal" situation.  If you have a good system to provide excellent care in
"regular times" you will probably mange to cope with Multiple casualty
incidents and even Mass casualty incidents (MCIs) reasonably well if you
plan (and exercise properly).  One should not build a system primarily to
cope with the rare MCIs by compromising quality for the daily "regular"
trauma casualty (by sending "everyday" trauma victims to ALL hospitals in
the system).  This will end up with the provision of reduced quality care
due to the "Diluted" experience between all players (hospitals) in the
system of trauma care.

During the worst year (2002) with multiple MCIs, The portion of MCI victims
out of all trauma victims was only 4%!!! Why compromise the quality of care
for the vast majority of "everyday" trauma victims? Just To increase
(hopefully) the quality of care for the relatively rare MCIs?

In Israel: for ~7 Million pop:
	6 Hospitals - Level I centers (because we have 6 Neurosurg. Dpts in
the 	country (Medical political issues)
	1 Hospital - Level I-II (has only Neurosurg. Unit, but otherwise is
the same as 	the other Level Is.

	3 Hospitals - Level II's with official Trauma Services
	5 Hospitals - Level II's without official Trauma Services
	2-3 Hospitals - Level III's (Less than the ACS required
capabilities)

Trauma Pt volume:

	Level I  = 2200-4000 Trauma admissions per year - 11-16% ISS >/= 16
	Level II = 1500-2400 Trauma admissions per year - 6-10%  ISS >/= 16
	Level III= 500-1000 Trauma admissions per year  No data on severity
because they have no registries

In everyday life situation the EMS will transfer 80% of all trauma and 90%
of all major trauma to the 6 Level Is and 4 Level IIs in our system.

Although the Trauma System has been developing for the last 15 years (or
more) it is still being modified and has not reached the final format (to my
opinion).

Hope this helps.

Mickey Stein

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of gsuywy at pacific.net.sg
Sent: Monday, November 19, 2007 10:17 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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