The definition of serious injury has recently been revised, according to my man who collates the statistics, and is now pitched at an ISS
of 10. This allows one 4 injury to be classified as serious, or 2 threes, so this does drag the numbers up a bit (some purpose there? Surely
not!) but 200 is not that far above the numbers some other much smaller units are seeing, with smaller numbers of staff. To an extent we
need to look at two issues; unit exposure and personal exposure. An 8 Consultant A&E is inevitably going to dilute individual
experience quite considerably, while a small unit with active Consultant staff who attend trauma calls in person is likely to have a much
greater individual experience and at the end of the day, it matters a lot to the patient how experienced the doctor caring for their serious
injuries is. The point about major trauma (particularly blunt trauma) is that it is some of our most difficult work. It is the equivalent of the
Whipple's operation, or the paediatric switch. Unfortunately, unlike every other Consultant, we are not in a position to plan and
determine our work. It decides when it is going to come in, not us. Which could bring us neatly back to intensity payments but I won't
go there!
Best wishes,
Rowley Cottingham
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