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The center was closed all day on Friday and Saturday and again all day yesterday. Trauma Center Director William Schwab said violent crime in Philadelphia increased dramatically over the summer and fall, stretching the five senior HUP trauma surgeons to their breaking points. "To be a trauma center you have to dedicate the surgeons -- they can't do anything else but stand by and be ready for trauma patients," Schwab explained. "On these particular days there just weren't enough trauma surgeons to guarantee that we could have one there all the time." This is first time the trauma center has ever been closed because of staffing problems, Schwab said. He said it is "one of the most demoralizing things that can happen at a trauma center." "At times we have gotten absolutely overwhelmed with urban violence," Schwab said. "When you work surgical teams continuously you have to give them a break. The hospital is helping us put some things into place that will hopefully keep this from ever happening again." Schwab said that in the short-term the hospital will change staffing routines to give the surgeons more rest. In the long-term the hospital will hire more trauma surgeons if necessary. The homicide rate in Philadelphia for the first half of 1990 was up 20 percent over the rate for the first six months of 1989, according to FBI statistics released this week. Robbery was up 35 percent and aggravated assualt was up 19 percent in the city over the same period. Almost 50 percent more patients came into the trauma center by ground transportation in academic-year 1990 than in the previous academic year, and 230 percent more patients came into the center on the PennSTAR helicopter, Schwab said. "It's been an extremely violent summer and fall," Schwab added. "Our admissions have gone up an additional 30 percent since June." "We took care of 247 handgun injuries last year," Schwab said. "That is much higher than we ever saw before, and the vast majority of those people had no way to pay for it." "Urban violence is absolutely stretching the resources of this hospital, as well as those of many others, to the point where we have to be safe in what we can offer," Schwab added, saying that if the center remained open during the three days it was closed, patients' welfare may have been in jeopardy. The center was closed Friday night when a University student was seriously injured in a robbery attempt near campus. Paramedics had to transport the student to the Thomas Jefferson University Hospital Trauma Center in Center City. She was listed in fair condition at Thomas Jefferson yesterday. About a week before the closures of the HUP Trauma Center, Schwab notified city Emergency Medical Services Director John Lewis and the trauma centers at Thomas Jefferson and Hahnemann University Hospital so that patients would not be taken to HUP. "For three years, all the level-one trauma centers have worked out a cooperative bypass system for anytime we get overwhelmed," Schwab added. "It's not unusual for us to receive four trauma patients at once, and we'll tell EMS to bypass us. There are times when we each, individually, get overwhelmed. The key is not the time between injury and arrival at a hospital, but rather the time between injury and surgery."

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