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In a patient with polytrauma who has suffered significant injuries, which is the best way to organise definitive care? (see scenario in 'Should doctors...' under the EMS thread)...

Many studies suggest that multiple transfers are not entirely productive and that they would actually have adverse effects on the eventual outcome of the patient. Also the idea that longer distances/times of travel have adverse effects is a no brainer!!!

How do we balance these arguments? What is an ideal solution? The simplest answer would be to set-up several 'regional polytrauma centres' spread evenly through the country rather than have them concentrated in the major metros... this may not make business sense... but the government has to step-in to support public interest.

If a patient has a vascular problem and neuro-surgical problem, and both these specialties are not available in one centre, then the poor patient is at best doomed!!!

The other question is what transport platform would you choose in which situation? What would guide you in making this very crucial decision?