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Thu Jun 11 17:08:24 BST 2009

But is the "transfer location" mindset not very similar to the "echelons of
care" concept the military utilizes in dealing with seriously injured
soldiers, Marines, sailors and airmen which is so successful in reducing
morbidity and mortality while most effectively utilizing admittedly limited
resources?  The mindset in and of itself is not a hazardous one.

On Thu, Jun 11, 2009 at 12:00 PM, <KMATTOX at aol.com> wrote:

> Stephen Richey:
>
> You have made some very germane and interesting points which must be part
> of the conversation.   There is NOT a quality difference in expected
> outcomes among a Level I, II, or III ACS Verified Trauma Center.  NONE
> whatsoever, except for neurosurgery.       It just  so happens that
> hospitals that are
> not Level I tend to think that they are often  just transfer locations.
>
> k
>
>
> In a message dated 6/11/2009 10:42:49 A.M. Central Standard Time,
> stephen.richey at gmail.com writes:
>
> 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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> >  -
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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
> them on."- Richard  Feynman
> --
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>
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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
them on."- Richard Feynman

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