Developing a Trauma System Anywhere in the world

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In San Diego we are about to pass our 25th anniversary with a trauma system. The twittering about the recent high profile death in Canada is an exact replica of stories from San Diego 30 years ago with the names and a few particulars changed. We can predict what prehospital, local hospital, and tertiary centers will say about this unfortunate event. We suffered through all the same recriminations before we started our system. 
 
Here's what we learned - we agreed to identify injured patients at the scene who needed trauma evaluation and care and rapidly transport them past local hospitals to one of six hospitals with a general surgeon in-house with all of the surgical subspecialists on 30 minute back up. The six hospitals were relatively small to medium sized (225 - 325 beds)  compared to the traditional notion of a trauma center (500-750 beds). They met the commitment of having a surgeon present with access to the OR, ICU, CT scan, etc. 
 
The preventable death rate from trauma in San Diego County in 1982 was 20%. In 1984-1985, it dropped to 3%.
 
We offer our best support and hopes that injured people everywhere around the world can be taken rapidly to a surgeon who has the resources to save them from their injuries if at all possible.
 
Mike Sise
San Diego

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