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Presumably the definition of serious injuries used is ISS >15. Last time I looked, the incidence was about 1 patient per 10,000 population per year, but it may well have dropped since then (deaths from injuries certianly have). By this, London Ambulance Service (example taken as it's easy to get data) covers 7,000,000 plus population with 2,000 plus front line personnel. Works out at one case per front line personne per 3 years. Two per ambulance seems to agree with the figure of one per 18 months. The question is whether this is enough. Is there any difference in training and experience between treating a patient with ISS over 15 or treating a patient with AIS 3 tibial fracture, suspected (but later disproven) spinal injury and suspected (but disproven) chest and abdo injuries. From the ambulance crew viewpoint, probably not- the relevant assessment and treatment skills apply regardless of the final diagnosis. It's too easy to attack people for level of experience based on final diagnosis and subgroups. Why not go further- how many patients over 70 or uner 16 (or under 5) with trauma do you see? How many pregnant victims of major trauma? How many penetrating trauma? (Probably more important in initial assessment and managment than the ISS). It does raise the interesting question of how many patients with major trauma a doctor should see a year. If we achieve the BAEM staffing recommendations, there should be one case per SHO per 6 months; 8 cases per consultant per year (and dropping). Probably works out to a bit under one case per nurse per 18 months. Don't know whether we should be having some consultants dropping out of trauma call, sabbaticals to countries with more trauma (build up experience so that we get it right when we treat British patients) or reduce the number of consultants. Matt Dunn Warwick