RE: Pt. Scenario

["Eric Niegelberg [Emergency Medicine]" <eniegelb@epo.hsc.sunysb.edu>]

Is it possible that the Level 1 center may make an error, sure it 
is.  It is possible that the community hospital has resources equal 
to the Level 1 center, sure it is.

The difference is that the Level 1 center guarantees that they have 
certain capabilities available around the clock.  These of course 
include surgeons, OR teams, Cat Scan,  etc.  When you take a patient 
who meets trauma center criteria to a non trauma center it is a "crap 
shoot".  Could the patient have minor injuries, sure he could.  Could 
the patient languish in the community hospital for hours before he is 
transferred, sure he could.

There are reasonable national recommendations (and many states also 
have them) that identify patients who are candidates for a trauma 
center.  Most of these recommendations include anatomic, 
physiologic, and mechanism criteria.  Most also include a caveat 
that patients with an unmanageable airway or in arrest should be 
transported to the closest hospital.  Many also include a caveat 
that if transport time to a trauma center is beyond "x" (commonly 1 
hour from injury) that the patient should be transported to the 
local hospital.

If your system has reasonable protocols in place as well as a 
geographic wide CQI review process your trauma system and the patient 
can only benefit.



> From:          "Thomas M. Hansen" 
<thomasmhansen@hotmail.com>
> To:            flightmed@flightweb.com
> Subject:       RE: Pt. Scenario
> Date:          Thu, 03 Jan 2002 08:11:17 -0800
> Reply-to:      flightmed@flightweb.com

> Do you really think that Level 1 centers don't make mistakes interpreting CT 
> or MR or plain x-rays?  Do you think that the only institutions with trauma 
> surgeons are Level 1 centers?  Do you think that it's the board certified 
> attending physician holding the knife over your patient's belly-or could it 
> be the third year resident with the chief resident assisting.  Maybe it's 
> the 2nd year er resident that's receiving your patient.
> 
> Many Level 1 centers are associated with training programs.  That is how 
> they are able to receive the financial support to provide the services, and 
> it's the residents, not the board certified physicians, that are there 24/7. 
>   The chief resident that the year before was still in training and was 
> receiving your patient graduated from the program and is now in 
> practice--maybe in practice in a community hospital.
> 
> I simply don't understand how one can make a blanket statement that it's 
> better to go to the Level 1 center when one doesn't know the capabilities of 
> the local hospital.  Drawing from the previous paragraph, maybe the local 
> hospital's trauma surgeon was the chief resident at the Level 1 center last 
> year.  (And the radiologist is board certified and not a resident.)
> 
> Hey, we're having fun now!
> 
> tom
> 
> 
> 
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******************************************************
Eric Niegelberg                     Tel: 631-444-2496
EMS Director                        Fax: 631-689-7376
Emergency Department Administrator
Stony Brook University Hospital

******************************************************

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