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As a result, many patients who do not have life- or limb- threatening injuries and who could have been treated at Presbyterian end up at the HUP trauma center. Such patients needlessly take up the center's time and resources, center director William Schwab said last week. A year ago, when Presbyterian faced staffing problems in its emergency room, Presbyterian Emergency Room Director Lawerence Gavin asked the police and fire departments to send all patients who met city criteria for transportation to a trauma center to HUP. Presbyterian does not run its own trauma center. "All we did was ask the city to comply with their truama protocols, which say that if people have certian types of injuries, they're supposed to be taken to a trauma center and not to a non-trauma center," Gavin said. "It has exacerbated [HUP's] volume because we did take care of a fair number of trauma patients," Gavin added. "We were probably getting three or four serious trauma patients a week, as well as a fair number of patients who may have met the city's criteria for trauma patients, but who didn't need to go to the operating room right away." Sixty times from January to September, the HUP truama center was put on "divert" status, meaning that it was unable to accept additional patients because the two emergency room trauma beds were full or because all intensive care unit beds in the hospitial were full. On those occasions, trauma patients had to be diverted to one of the city's six other trauma centers. Gavin said that the city's critieria for who should be transported to a trauma center are fairly inclusive of injuries that can be severe, but are not always life-threatening. As a result of his request, HUP may now get some patients who meet the city's standards, but could be treated at a standard emergency room, Gavin added. "I think [HUP's] problem isn't with us, but is with the city's criteria," Gavin said. "[HUP has] become overwhelmed and would like us to take some of the burden off of them, which we would be happy to do as long as we didn't get anyone who was seriously injured and needed the services of a trauma center. How that gets sorted out is the challenge right now." HUP Trauma Center Director Schwab said that city police and fire rescue often do a poor job of triage -- deciding what patients should go where -- but added that when faced with disasters, such as the recent Market-Frankford subway derailment, the city's response has been "beautiful." Gavin added that Presbyterian still receives one or two trauma patients in need of immediate surgery every week. All of them are transported by police.

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