----- Original Message -----
From: S A Hughes
> Better training and consultant expansion are the answers here and NOT
> merely concentrating the experience to a few centres.
>
> What happens if the roads are blocked?- The patient either has a delayed
> journey to the centre or goes to an A/E department that has been de-
> skilled.
>
> The proposals make sense only if there is no desire for dissemination of
> trauma skills.
>
> I doubt that I am (for once!) alone with my views
> --
> Steve Hughes SpR Harlow.
On the contrary, I'm sure I'm not alone in suggesting your views are rather
simplistic. Expertise in managing trauma in the A&E department is but a
small part of an effective trauma system. Severely injured patients require
the expertise of specialist surgeons, sophisticated imaging and
intensivists. This debate is not about A&E folk having "experience", it's
about developing effective systems of care. Your argument about road blocks
is pure sophistry, and could be extrapolated to justify re-opening the
cottage hospitals! Sure, a lot of trauma can be managed in current DGHs, but
over 50% of severe injury is neurotrauma, and much of the rest requires
chest, vascular or plastic surgery etc, and such surgeons are already
centralised or they are becoming more centralised for other reasons. The
idea of having 40 to 50 trauma units in a city like London is ludicrous. And
don't worry, having 5 trauma centres in London will still require
considerable consultant expansion etc.
Adrian Fogarty
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