Reception of severely injured patients at hospital: organizational requirements.

All trauma admissions to the Royal Victoria Hospital, Belfast, in 1987 were entered in a computerized trauma register. Analysis of these patients by severity showed that only 3.8 per cent had ISS scores of 16 and over. Of these, 42 per cent arrived at hospital between midnight and 0900. Only 24 per cent arrived in normal office hours. The specialties involved in the treatment of these patients are analysed. It is argued that we cannot instantly leap from the present arrangements to fully developed trauma centres. The most efficient and cost-effective way of initiating better systems would be to appoint sufficient accident and emergency consultants to a number of pilot scheme hospitals so that there would always be a senior doctor present, day or night, in the accident and emergency department to carry out the initial resuscitation and to mobilize the correct trauma team for the severely injured patients.