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Thursday, June 3, 1999 Published at 01:45 GMT 02:45 UK


Centralised care 'dangerous'

There is a move to centralise care for the severely injured

A drive to centralise care for the severely injured is misguided and may even be dangerous, a casualty expert has warned.

The Royal College of Surgeons and the British Orthopaedic Association have proposed that services be centralised so that expertise can be concentrated and standards of care improved.

The proposals advocate concentrating care of the severely injured into 30 trauma centres, each backed up by a network of specialist units and district general hospitals and serving 2-3 million people.

But accident and emergency consultant Dr Daniel McGeehan, from Staffordshire General Hospital, warns in the journal Pre-Hospital Immediate Care that the policy could backfire snd could place lives at risk.

The proposals are based on current practice in the US.

But Dr McGeehan says that the type of severely injured patients that the US units deal with is very different from those in the UK.

For instance, gunshot injury is the the second most common cause of death in the US, but very rare in the UK.

He says that results from pilot studies show no benefit in terms of either money or lives saved.

Paramedics do not currently have the required skills to treat severely injured patients when they arrive at the scene of an accident, Dr McGeehan says, and the extra delay that transferring a patient to a trauma centre could entail might be critical.

Air ambulances needed

[ image: Air ambulances are hugely expensive]
Air ambulances are hugely expensive
Dr McGeehan argues that if services were centralised, more air ambulances would be needed to ferry patients to trauma units.

However, the cost would be enormous. The London air ambulance service costs more than £1.5m a year - sufficient money to upgrade more than eight A&E departments.

"The centralisation of services would be prohibitively expensive," he concludes.

"There is no reliable evidence that it would be of any benefit."

Dr McGeehan argues that the best solution would be upgrade certain existing A&E departments to trauma centres and support these with a network of land based medical "flying squads" working out of A&E departments.

But he is worried that A&E departments have already closed as momentum gathers behind the drive for centralisation.

"All the major outrages of recent times such as Omagh and Warrington occured close to a district general hospital. If those units had been closed down more lives would certainly have been lost," he said.

Dr Peter Holden, spokesman for the British Association for Immediate Care (Basics), the organisation which represents doctors who provide care at the scene of accidents, said centralisation was inevitable for non-clinical reasons such as cost and lack of available manpower.

He said: "What is important is that in any location there is an integrated system to get a patient to the right hospital in the right time by the right mode of transport."

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