> What needs to be demonstrated is better outcome by direct transfer to
> 'Teaching Hospital'.
Being a "Teaching Hospital" does not automatically mean better care (as we
all know) but it may often mean more rapid access to neurosurgery and
cardiothoracic for that small group that require early definitive surgery
from them!
> I believe this would be v complex, with lots of variables - are you able to
> demonstrate that 'direct transfer' by land or air is of benefit, for (say)
> ISS >16.
Certainly not in Leeds at the moment, and, to my knowledge, not beyond
question anywhere in the UK! Best management for trauma is rather like best
management for cancer ... it depends on the specifics.
Taking isolated neurosurgical trauma, I believe that the neurosurgeons aim
for evacuation of a significant haematoma in less than three hours (at the
very least as quickly as possible) to give the best possibility of favourable
outcome. HEMS-London has demonstrated that its triage process can reduce time
from injury to treatment from a mean of over 6 hours to one of just less than
3.
Taking the trauma population as a whole, we will be unlikely to show
significant benefit. Slowly, and by injury group, the evidence will become
more clear. We each have our own intuitive position but isn't that Class V
evidence?
Best wishes
Darren
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