Trauma Care at County-USC Medical Center
The article (Nov. 19) regarding trauma care at Los Angeles County-USC Medical Center seriously misrepresents the situation at this facility. It is quite apparent that The Times took the American College of Surgeons’ (ACS) survey report as fact and has simply provided a forum for its dissemination to a readership that cannot possibly be expected to evaluate the legitimacy of that report.
The selection of two surgeons from the ACS as the only surveyors to visit County-USC was inappropriate from the outset.
The contention that emergency physicians are not qualified to evaluate and initially manage trauma patients is simply a biased point of view. At County-USC our system has evolved because of the volume of trauma patients and other factors unique to this institution. What can be shown is that patients do very well in our center in terms of outcome. What has not been shown is that patients do better in the centers with systems of trauma care espoused by the ACS. If there are preventable deaths (few would deny that they occur inadvertently), it is because our people (emergency physicians, surgeons and nurses) are human, and life being a fragile entity, cannot be pushed beyond certain limits. To purport that any of these people would ever put a “turf” issue before the welfare of the patient is blatantly irresponsible.
Trauma centers throughout Los Angeles County and across the country are closing, and one of the major reasons is that the ACS’s requirement for a surgeon to meet every trauma patient has been found to be unnecessary and prohibitively costly. There must logically be a screen of patients by someone qualified to make such a screen as well as to begin lifesaving resuscitation when indicated. The emergency physician is uniquely qualified to do this and that is exactly how the County-USC system operates. Instead of attacking it because it does not fit ACS dogma, perhaps it should be considered as the prototype of a workable national concept in trauma care.
GAIL V. ANDERSON, MD
Professor and Chairman
GERALD P. WHELAN, MD
Department of Emergency Medicine
County-USC Medical Center