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Deficient trauma care


An independent study of the Maryland Shock Trauma Center has raised disturbing questions about the center's quality of care. Maryland's primary emergency medical-care facility ranks near the bottom -- not the top -- of the list when its survival rates are compared to other similar centers across the country.

Some experts at the shock-trauma center say the study, which compared data from 1989 and 1990, is flawed. It did not take into account the high number of severely injured patients treated there, especially brain-injured patients. Yet even they admit that the state facility is below the national norms when it comes to successful treatment of blunt trauma and penetrating trauma wounds. That is a troubling admission.

The study, by Tri-Analytics of Bel Air, confirms much of what Dr. Kimball I. Maull has been saying about the deficiencies at the Maryland trauma center. Dr. Maull, who came to Maryland from Tennessee last spring, has been bitterly challenged by veteran trauma doctors, who resent the new director's attempts to shake things up. Three doctors have been fired and another demoted. Other changes are on the way.

Once the Maryland center was the world's pioneer in emergency medical procedures. But the center has rested on its laurels, especially since the heyday of its legendary founder, Dr. R Adams Cowley. Too many people connected with the trauma center have fought stubbornly to maintain the status quo, believing that the Maryland center was still the best of its kind. They were deceived. They should have recognized the need to keep pace with the rapid advances in medical procedures and medical technology.

One example is the recent discovery that rescue companies in many Maryland subdivisions do not use a crucial advanced lifesaving skill to deliver oxygen to patients who have stopped breathing. In fact, Baltimore City paramedics are forbidden to use this technique, plus other important lifesaving skills. It is the only large city in the country that fails to use up-to-date lifesaving methods.

That is an appalling situation. It justifies the shake-up that Dr. Maull has begun at Shock Trauma. Better, safer ways of helping patients in life-threatening situations must be adopted.

It is time to review many of the traditional treatment approaches used at the center, as well as to study how other successful trauma units in this country operate and institute innovations that will once again place the Maryland center on the cutting edge. That's how Dr. Cowley established the shock-trauma center's international reputation. It can happen again.

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