Pre-Hospital implications of the British Orthopaedic Association and the
Royal College of Surgeons of England trauma reports 1997: an alternative view
McGeehan DF Pre-Hospital Immediate Care 1999;3:109-12
Danny
Congratulations on a well-reasoned response to this paper.
Although I understand what Keith Porter and his colleagues are trying to
achieve, I think that you have highlighted how much of the argument is based
on extrapolation of data from other systems, which come from a different
paradigm (your comment on penetrating trauma in the UK is well-made).
In the more remote parts of England and Wales, and certainly in the Highlands
of Scotland and Ireland, Hospitals serve much smaller populations, and are
much more sparsely located. In Lincolnshire, we have 3 DGHs, covering the
third-largest county in England, and the county with the highest road
fatality rate per capita.
Using the transfer and bypass approach would mean our casualties taking
something like 2 hours to get to the Trauma Centre (or 30-60 minutes by air).
Our Air Ambulance Service (which, incidentally, often carries a Doctor, one
of the few outside London so to do) operates under CAA guidelines, by day,
and weather restrictions, such as lightning risk, often mean that the
aircraft is unavailable. Even if it were, the flight time from its base in
Lincoln, out to the Lincolnshire coast, is about 15 min. Add to that any
on-scene time, and the return flight to a regional centre, adds up to
something like 60-90 minutes from call to resuscitation.
If we are to expedite the transfer of critically-ill patients to regional
centres, where their injuries can best be treated (if, indeed that has ever
been incontrovertibly established?), we must deploy the skills of BASICS
Doctors, Paramedics, A&E Doctors/Nurses, and Intensivists together, rather
than shouting at one another and protecting our own domains. If rural
medicine teaches us nothing else, it is the value of teamwork.
I know that few of my Paramedic friends will relish the responsibility of
escorting unstable patients past the door of one A&E Dept, to drive 40 miles
to another, for the sake of a 3.5% reduction in mortality.
Regards,
Andrew J Mowat
BASICS Doctor
Lincolnshire
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