Use of Trauma Center Hospitals

From the standpoint of a surgical resident at County/USC Hospital, being the primary physician for, and operating on large numbers of trauma patients, several points should be made regarding the trauma center system.

First, the idea that trauma centers need to be 20 minutes or less from the scene of injury is misdirected. About six years ago, with the trauma center system in planning, the Fire Department was concerned that if paramedics had to transfer a patient for more than 20 minutes, it would take ambulances out of the response network for too long a period and make it difficult to respond to 911 calls promptly. The concern was not that a greater than 20-minute transport time might be detrimental to the survival of trauma patients.

In fact, there is no evidence that 10 or 20 or 30 minutes should be the maximum transport time. Among patients meeting trauma center criteria, only a very small fraction need lifesaving therapy 30 minutes or less after arrival at a hospital. These are victims with heart wounds or massive ongoing blood loss and need immediate surgery. They would definitely benefit from a short transport time. These few patients are easily identified at the scene by the presence of shock.

Second, the reason the busiest private hospitals have dropped out is simply that they were overwhelmed by the numbers of shooting and stabbing victims, the vast majority of whom did not have shock. Many of these patients were transferred to county hospitals after hours, days or weeks of treatment in various stages of stability and frequently with incomplete information conveyed to the accepting doctors. It is thus impossible for “post-op transfer” patients to receive optimal care.

Because I have seen numerous people saved by immediate (within 15 minutes after arrival) surgery who otherwise would have died, keeping all necessary surgical personnel “in-house” (including anesthesiologist) 24 hours a day should be a non-negotiable item in any revamping of the trauma system.

I conclude by proposing that all shooting and stabbing victims not in shock (and therefore able to tolerate a longer transport) be brought directly to the nearest county hospital, and those in shock, where minutes truly county, be brought to the nearest trauma center. This will improve continuity of care, decrease the financial burden on private hospitals and yet enable them to remain open for those patients who really need immediate surgery.

FRANK KENNEDY, M.D.

Pasadena