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Thu Jun 11 16:42:23 BST 2009

Dr. Mattox,
I believe you meant to say Prince George's County Hospital.

My question is there really an increase in immediate survival benefit for
Level I versus Level II trauma centers?  I recall this was debated on the
list some time back but don't recall the precise outcome of the argument.
>From what I vaguely recall the differences seemed to be largely in terms of
research/education and the availability of rehabilitation and reconstructive
specialties on an on-call vs in house basis (hospital accreditation is
obviously not one of my primary areas of interest so I do not pay much
attention to the specific requirements), rather than the availability of
surgical and critical care teams that would seem to be what would play the
greatest role in impacting survival from trauma as trauma centers are
intended to do.

Also, in that part of the US (although more pronounced in Baltimore) there
seems to be a major thumbing of one's nose at outside review and critique of
trauma services (both prehospital and in-hospital)  so you wind up with
several trauma capable hospitals that have not achieved the formal "trauma
center" designation as it is commonly defined.  In fact, I have repeatedly
heard that Shock Trauma outright refuses to participate in the standard
accreditation process since they "created the trauma center concept".
Whether this is correct or not, it still stands to reason that several of
the hospitals in the DC area may not be "trauma centers" on paper but have
the resources on hand (or did the last time I checked) to more than
adequately handle pretty much anything that rolls through their doors.  PG
County is one example, Inova Fairfax is another, Bethesda is a third and you
have National Children's as a more than capable pediatric receiving
facility.  The situation is very similar here in Indianapolis:  Wishard is
the trauma center, but I trust the physicians (especially the neurosurgeons
and CT guys) and even more so the nursing, RT and support staff at the St.
Vincent's far more and would protest being taken to the trauma center simply
because it is the "trauma center".  If brought in unconscious or incoherent,
as soon as I was able, I would begin demanding to be transferred out to a
better facility.

As for the military medical side of things, as someone else pointed out,
there is a "joint" program at Washington Hospital Center (?) that involves
the military in providing care to the trauma victims for that side of town.
>From a budget standpoint, I question the need for a separate military trauma
center in the National Capitol Region (NCR) simply because of cost and the
dilutional effect of adding another trauma facility to the mix especially
when it would simply be more cost effective and logistically feasible to add
the military personnel to the teams of the local facilities already in place
especially given the current deployment schedules.  During my tenure in the
NCR as a military medical provider the hospital I worked at was hard pressed
to have the staffing to tend to even a small group of critical patients.

Given the difficulties inherent in recruiting, training and retaining
critical care and trauma professionals in this day and age, it would be very
difficult if not patently impossible to adequately staff a military trauma
center and still be able to rotate the staff out to hotspots around the
world.   The duplication of effort is in part why Walter Reed and Malcolm
Grow Medical Center (the hospital at Andrews AFB) are facing severe cutbacks
at the demands of BRAC and care is increasingly being consolidated at
Bethesda which has been the far better equipped and better staffed of any of
the military facilities in that area since at least 2001 when I arrived in
the DC area.  If memory serves me correctly, even Wilford Hall down in San
Antonio was downgraded from formal trauma center status a while back because
of similar issues and the presence of the Univ. of Texas-San Antonio's
trauma center.

On Thu, Jun 11, 2009 at 11:10 AM, <KMATTOX at aol.com> wrote:

> From what I have learned from those that have posted here the hospitals
> that some persons believe are "Trauma Centers" in the Washington DC  area:
>
> DC General Hospital - Closed for 5 years or more
> Washington Hospital Center
> George Washington Hospital
> Howard University School of Medicine Medical Center
> Fairfax Hospital
> Maryland Institute for Emergency Medical Services System
> St George County Hospital
>
> I learned that other hospitals that some believe to have a trauma
> capability are NOT trauma centers.
> Note that the agencies that are currently the most involved in trauma care,
>  THE US MILITARY MEDICAL ESTABLISHMENT, do not have a trauma center,
> although  they do spend lots and lots of money sending their doctors,
> nurses,
> medics, etc.  to civilian trauma centers for training, all over the United
> States.    Missing from the above list are Bethesda National Naval Health
> Center,
> Walter  Reed Army Hospital, USUHS, and others.
>
> k
>
>
>
>
>
> In a message dated 6/10/2009 11:35:10 P.M. Central Standard Time,
> nappio at aol.com writes:
>
> walter  reed is not a level one center..  MEDSTAR at Washington hospital
> center  probably has the most advanced trauma center and experience.  I am
> not
>  sure if GW is a level one or not.  I am surprised that they did not take
> them to Medstar as it is a straight shot down north capital street to get
> there.dn.
>
>
>
>
>
>
>
> -----Original Message-----
> From:  KMATTOX at aol.com
> To: trauma-list at trauma.org
> Sent: Wed, 10 Jun 2009 11:43  pm
> Subject: Shooting in Washington DC
>
>
>
> Nightline stated that  the TWO shooting victims at the museum were taken to
>
> he "NEAREST"  hospital, George Washington.    This museum is very  close to
>
> any important buildings including the White  House.   I have several
> uestions?
>
> do not understand,  the  DC EMS takes patients to "the closest  hospital"
> nd not a trauma  center??
>
> hat level I trauma centers are in this area of Washington  DC?
>
> s not Walter Reed Army Hospital a Level I Trauma Center?
>
> n  Houston, these patients would have been transported across town,
> ypassing many non-trauma center hospitals to get to a Level I trauma
> center.
>
> omething seems to be wrong with this picture of EMS and trauma  systems in
> ur nations capital.
>
>
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-- 
Stephen Richey, CRT

"It is not unreasonable that we grapple with problems....Our responsibility
is to do what we can, learn what we can, improve the solutions, and pass
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