The Baltimore Sun

Trauma system puts needs of patients first

It is not an exaggeration to say that Maryland has the finest pre-hospital trauma system in the nation and perhaps the world.

Is the system perfect? No. Can the system be improved? Yes.

Are all of us who work in trauma care committed to making it even better? Absolutely.

But in the wake of the recent helicopter tragedy, I fear that we will forget that the genius of Maryland's system is its singular focus on doing what is best for the patient, not what is best for an individual trauma center, medical school or the medevac fleet.

As much as all of us would like certainty in every decision we make in life, the simple truth is that triage at a crash site cannot be perfect.

The goal must be to send the right patient to the right place within the right amount of time.

Quick decisions must be made in the field, often under difficult conditions and without the added benefit of sophisticated diagnostic technology.

But I ask you: If it were your child, your loved one, which risk would you rather we take: Send too many injured patients to the trauma center within the recommended time limit or send too few?

Send too many, and we risk being accused of wasteful spending. Send too few, and we risk patients dying who would otherwise be saved.

Critics say that nearly half of the patients sent to Maryland trauma centers by helicopter are discharged within 24 hours. That makes a great sound bite, but like many sound bites, it masks the truth.

Trauma centers are designed to quickly and accurately determine which patients have sustained serious injury, and then utilize the needed resources to save lives.

But in making triage decisions, we must err on the side of patient safety.

Trauma professionals around the state are determined that this recent tragedy will have some positive outcome.

We will embrace whatever lessons we can learn.

We welcome an objective review of how our system in Maryland applies national standards of field triage and medevac utilization.

We have a responsibility to assure the public that the medevac fleet is equipped with the finest technology available and that our protocols are grounded in good science.

Above all, we absolutely reject the notion that it is acceptable to let people die to save money.

The public needs to know that the system is working, that it is safe and that it remains the best in the nation and the world.

Dr. Thomas M. Scalea, Baltimore

The writer is the physician-in-chief at the R Adams Cowley Shock Trauma Center.

Nader's candidacy deserves attention

Despite both his national stature and the fact that he has secured access to the ballot in 45 states, Ralph Nader's independent candidacy for president has been consistently ignored by nearly all major news outlets.

In marginalizing Mr. Nader's campaign and excluding his positions from public examination and debate, the media do a disservice not only to the candidate himself but to the free flow of ideas that is necessary for a vibrant democracy.

This is especially ironic in the midst of our current financial crisis and its genesis in reckless corporate greed, since most of Mr. Nader's life work has been devoted to ensuring corporate responsibility and consumer protection.

Mr. Nader has been a stalwart advocate for tougher oversight of the banking, insurance and energy industries along with strict regulation of environmental, commercial and workplace issues.

Mr. Nader's proposed policies offer meaningful alternatives to those of the major parties but remain virtually unknown to the public because of the lack of media coverage of his campaign.

For example: He is the only candidate to support a single-payer Medicare-for-all health care system and a progressive tax structure that shifts the tax burden from working- and middle-class families to those who are genuinely able to bear the costs.

His foreign policies would emphasize diplomatic and cooperative efforts to address world conflicts rather than an excessive reliance on military intervention.

To this end, Mr. Nader has called for an immediate corporate and military withdrawal from Iraq.

Ralph Nader's campaign is a serious effort to creatively address the realities and concerns of Americans with meaningful solutions.

It deserves serious attention.

Irwin Fried, Baltimore

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