Industrial Reboot – Trauma 101

Go Lean Commentary

Define basic needs …

… no doubt this includes food, clothing and shelter. These are the age-old means of sustenance that every generation of mankind have had to contend with.

But in modern times, that list is expanded; add: energy, transportation, telecommunications and …


Can these be considered luxuries as opposed to basic needs?

An argument can be made of this point; many times even medical necessities are de-prioritized – think immunizations – until absolute emergencies. This latter scenario – medical emergencies – is the subject of Trauma medicine, an absolute necessity, vital service, and essential offering. Trauma becomes a basic need and not an optional luxury. So there will always be a demand for Trauma medicine; how will it be supplied?

This commentary – from the movement behind the book Go Lean … Caribbean (available to download for free) – continues the discussion on the economic principles of supply and demand; it focuses on fostering Industrial Reboots for the Caribbean homeland since the region is in dire straits economically. This Industrial Reboot is badly needed as our current economic landscape – based on Tourism – is in shambles! Our Supply-Demand dynamics are not optimized.

The Go Lean book serves as a roadmap for the introduction and implementation of the technocratic Caribbean Union Trade Federation (CU). It explains that Tourism is a service product that depends heavily on Supply-Demand dynamics. In Economics, higher demand and consistent supply results in higher prices; so in a normalized scenario, revenues should grow and grow. The Caribbean tourism is under assault in every member-state due to the fact that many visitors to the region have shifted from stay-overs to cruise arrivals. The Caribbean demand continues, but the supply is different. Cruises mean less economic impact to the local markets than stay-overs. So as a region, we must reboot our industrial landscape so as to create more jobs … from alternate sources. What options do we have?

The Go Lean book urges the region to reform and transform the economic engines around the delivery of basic needs, so we need to better prepare for medical-trauma emergencies. (There is the industrial sub-group of medical tourism). Medical-trauma needs are currently being supplied by other service providers … in foreign destinations. See the news article here portraying how the Joe DiMaggio Children Hospital in Ft. Lauderdale promotes its Neo-Natal and Pediatric treatments:

Title: World renowned Doctors convene in Saint Lucia
Press Release:–  Dr. Kak-Chen Chan, Pediatric Cardiologist and specialist in Adult Congenital Heart Disease and Dr. Steven Bibevski, Cardiothoracic surgeon who specializes in Pediatric and Congenital Heart Surgery, as well as heart transplantation and artificial heart support, will participate as speakers at the 33th Caribbean Cardiac Society in St. Lucia, from July 18th to July 21st, that will take place in the Royalton- Saint Lucia Resort and Spa.

The doctors will share with their colleagues the knowledge, cutting edge procedures, and experiences performed at Joe DiMaggio Children’s Hospital, part of Memorial Healthcare System.

Since 1988, the Caribbean Cardiac Society has been a non-profit organization proud to be one of the most important gatherings of cardiac specialists from around the world, who are committed to providing services to cardiac patients in the Caribbean region, by sharing their experiences and exchange knowledge. This year’s theme is “Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean.”

One of the most common Congenital Heart Defects is Patent Ductus Arteriosus (PDA) defined when the two major blood vessels leading from the heart remain open after birth. PDA accounts for 5%-10% of all Congenital Heart Defects. To share more insight Dr. Kak-Chen Chan will present his lecture on Extreme Prematurity, chronic lung disease, persistent ductus arteriosus and pulmonary hypertension: The potentially deadly Quartet tamed.

Extreme premature infants are often affected by chronic lung disease, patent ductus arteriosus and pulmonary hypertension.  As medical science improves, more of these babies are surviving past their early infancy.  However, these disease process continues to be important causes of morbidity and mortality.

Dr. Steven Bibevski will be presenting a talk, showing data of survival rate on 10 years of surgical experience with patients from the Caribbean at Joe DiMaggio Children’s Hospital.

“I am very excited and honored to speak at this year’s CCS meeting. As physicians, our focus is on the health, well-being, and healing in of all patients. We are very fortunate to have an experienced team of doctors who work together to provide innovative treatments while delivering compassionate care to our patients,” stated Dr. Bibevski.
Source: St. Lucia News Daily Newspaper; posted & retrieved July 17, 2017 from:

There is the opportunity for a business model in the field of medical Trauma. Others are making money, why not Caribbean stakeholders. (Still, our motive must not just be profit, it must be the Greater Good). This is how and where jobs are to be forged for a new Caribbean economy.

There are other business models too, that the new Caribbean economy can deploy to grow the regional economy; we can, and must, reboot our industrial landscape. This commentary has previously identified a number of different industries that can be rebooted under this Go Lean roadmap. See this list of previous submissions under the title Industrial Reboots:

  1. Industrial RebootsFerries 101 – Published June 27, 2017
  2. Industrial RebootsPrisons 101 – Published October 4, 2017
  3. Industrial RebootsPipeline 101 – Published October 6, 2017
  4. Industrial RebootsFrozen Foods 101 – Published October 6, 2017
  5. Industrial RebootsCall Centers 101 – Published July 2, 2018
  6. Industrial RebootsPrefab Housing 101 – Published July 14, 2018
  7. Industrial Reboots – Trauma 101 – Published Today – July 18, 2018

The Go Lean book stresses that reforming and transforming the Caribbean economic engines and medical deliveries must be a regional pursuit. This was an early motivation for the roadmap, as pronounced in the opening Declaration of Interdependence (Pages 11 – 13):

ix. Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, mental health, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.

xxiv.  Whereas a free market economy can be induced and spurred for continuous progress, the Federation must install the controls to better manage aspects of the economy: jobs, inflation, savings rate, investments and other economic principles. Thereby attracting direct foreign investment because of the stability and vibrancy of our economy.

xxvi.  Whereas the Caribbean region must have new jobs to empower the engines of the economy and create the income sources for prosperity, and encourage the next generation to forge their dreams right at home, the Federation must therefore foster the development of new industries, like that of ship-building, automobile manufacturing, prefabricated housing, frozen foods, pipelines, call centers … – impacting the region with more jobs.

Accordingly, a regional medical trauma eco-system can help to make the Caribbean a better place to live, work, heal and play. Many jobs could derive from these medical deliveries.

In addition, the CU will facilitate the eco-system for Self-Governing Entities (SGE), an ideal concept for Trauma Centers with its exclusive federal regulation/promotion activities. Imagine bordered campuses – with backup power generations, autonomy for professional standards, and autonomous air/sea transportation modes. The Go Lean movement (book and blogs) details the principles of SGE’s and job multipliers, how certain industries are better than others for generating multiple indirect jobs down the line (or off-campus) for each direct job on the SGE’s payroll.

According to the Go Lean book (Page 257) , there could be many jobs in the related fields of Trauma & Emergency Management – separate and apart from general health-care deliveries. The book quotes these figures:

Jobs from Trauma Centers, Emergency Managers, Volunteer Fire/Rescue: 4,000

The Go Lean book prepares the business model of Trauma Centers for consumption among Caribbean people. The book describes a scheme with 6 different Level I Trauma Centers – see Appendix below – throughout the region. This scheme will save lives, and also launch the new business model. Yes, business model refers to jobs, entrepreneurial opportunities, trade transactions, etc. In addition to these industry jobs; there is also the reality of indirect jobs – unrelated service and attendant functions – at a 3.75 multiplier rate would add another 15000 jobs.

This truly constitutes an Industrial Reboot. The Go Lean book details this business model, as such – see this quotation here from Page 196:

The Bottom Line on Trauma Medicine
A trauma center is a hospital facility equipped to provide comprehensive emergency medicine to victims suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced multidisciplinary treatment and specialized resources. According to the US Center for Disease Control (CDC), injuries are the leading cause of death for children and adults ages 1–44. The leading causes of trauma are motor vehicle accidents, falls, and assaults.

Trauma centers vary in their specific capabilities and are identified by “Level” designation: Level-1 being the highest, to Level-3 being the lowest (though some states have five designated levels, in which case Level-5 is the lowest). Higher levels of trauma centers will have trauma surgeons available; those trained in such specialties as Neurosurgery and Orthopedic surgery as well as highly sophisticated medical diagnostic equipment. Lower levels of trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for transfer of the victim to a higher level center.

The operation of a trauma center is extremely expensive. Some areas – especially rural regions – are under-served by trauma centers because of this expense. A variety of different methods have been developed for dealing with this. For example, many trauma centers have helipads for receiving patients that have been airlifted. The trauma level certification can directly affect the patient’s outcome and determine if the patient needs to be sent to a higher level center.

The strong point from this quotation is that “the operation of a trauma center is extremely expensive“; this allows for jobs.

According to the Go Lean book, societal engines refer to economics, security and governance. The industrial strategy of Trauma Centers relate to economics and security provisions. This CU/Go Lean roadmap has these 3 prime directives:

  • Optimization of the economic engines in order to grow the regional economy to $800 Billion & create 2.2 million new jobs.
  • Establishment of a security apparatus to ensure public safety and protect the homeland; and the economic engines.
  • Improve Caribbean governance to support these engines, including a separation-of-powers between the member-states and CU federal agencies.

The Go Lean book provides 370-pages of turn-by-turn instructions on “how” to adopt new community ethos, plus the strategies, tactics, implementations and advocacies to execute so as to reboot, reform and transform the societal engines of Caribbean society. One advocacy in rebooting the industrial landscape is to foster better Emergency Management, of which Trauma Centers are a subset. Consider the specific plans, excerpts and headlines from the book on Page 196 entitled:

10 Ways to Improve Emergency Management

1 Lean-in for the Caribbean Single Market
This treaty allows for the unification of the region into one market, thereby expanding to an economy of 30 countries, 42 million people and a GDP of over $800 Billion (according to 2010 metrics). This treaty calls for a collective security agreement for the Caribbean member-states so as to prepare-respond to natural disasters, emergency incidents and assuage against systemic threats against the homeland. The CU employs the professional arts and sciences of Emergency Management to spread the costs, risks and premium base across the entire region and refers to more  than  just medical scenarios, but rather any field of discipline that can impact the continuity of a community or an individual. The CU also has the direct responsibility for emergencies in the Exclusive Economic Zone and Self Governing Entities.
2 Trauma Centers

The CU envisions 6 strategically placed Level-1 trauma centers, and a series or lower level centers, placed throughout the region to service the entire population. The goal will be to ensure that every citizen is within a 1 hour transport from the closest trauma center. The trauma center may be physically located within a hospital campus, or stand-alone, but will be governed (and funded) by the CU and not the member-state’s public health system. (See Appendix ZM on Page 336).

3 Airlift / Sealift – Getting there by Helicopters, Airplanes and Boats

In addition to Air Ambulances (helicopters & airplanes), the CU will deploy Water Ambulances to quickly convey the injured to trauma centers among the islands. The vessels will all be equipped with certified and trauma-trained EMTs.

4 Mobile Surgical Centers and Tele-Medicine
5 Epidemiology – Viral & Bacterial Rapid Response
6 Mobile Command Centers
7 Intelligence Gathering & Analysis
8 Casualty Insurance Plans – Reinsurance “Sidecars”
9 Volunteer Fire – Rescue Brigades
10 ITIL – Information Technology Infrastructure Library

This formal discipline of ITIL is the art and science that describes processes, procedures, tasks and checklists used by organizations for managing risks associated with information technology deployments. This includes “focus areas” for Change Control, … Disaster Recovery, Problem and Access Management. (See Appendix ZN on Page 338).

This Go Lean book projects the roll-out of the 6 Trauma Centers as Day One / Step One of the Go Lean/CU roadmap. Over the 5-year implementation more and more of the features of the roadmap will be deployed and their effect on the region will be magnified and undeniable – think R&D. These will help to make the Caribbean a better place to live, work, heal and play.

This Go Lean roadmap seeks to foster best-practices in the administration of a Trauma Centers and Emergency Management. There is a lot of coordinate; there have been many issues detailed in previous Go Lean commentaries; see a sample here: Puerto Rico’s Trauma-Emergency Failings – A Lesson Learned Lessons from China – Managing Trauma & Organs Transplantation ‘Crap Happens’ – So What Now? Sum of All Fears – ‘On Guard’ Against Deadly Threats Managing a ‘Clear and Present Danger’ 911 – Emergency Response: Systems in Crisis

According to the foregoing news article, the Caribbean Cardiac Society (CCS) is meeting today through Saturday (July 18 – 21). They do meet annually. This year’s conference or congress – 33rd annual – is meeting in St. Lucia; last year (2017) was Trinidad, 2016 was Barbados, 2015 was Jamaica, 2014 was in the Bahamas and the 2013 conference was held in Curacao. So this organization already has a footprint in all the key destinations of the Caribbean. The CU formally launching 6 Trauma Centers can easily utilize the CCS’s infrastructure.

The subject of Trauma Centers is not a luxury; assuaging trauma is a basic need for the region. We are spending the money now – many times raising money through Bake Sales, Car Washes and Raffles – and enriching foreign entities. Making provisions to provide our own basic needs is just … mature. This is to be expected of emerging societies. This is the type of development that sends the message to Caribbean citizens, at home and in the Diaspora, that “one” can now prosper where planted in the Caribbean.

This plan – the roadmap to deploy a regional network of Trauma Centers – is conceivable, believable and achievable. We can deploy our own brand of Pediatric Hospitals in the Caribbean, much like the Joe DiMaggio one in the VIDEO here:

VIDEO – A Look At What We Like About Joe DiMaggio Children’s Hospital

Joe DiMaggio Children’s Hospital
Published on Jul 14, 2015
Joe DiMaggio Children’s Hospital is one of the region’s leading pediatric hospitals, offering a comprehensive scope of healthcare services and programs in a child-friendly atmosphere. A full-service hospital, we treat minor illnesses, trauma-related accidents and some of the most complex medical conditions.

Established in 1992, Joe DiMaggio Children’s Hospital combines advanced technology and the expertise of the largest, most diverse group of board-certified pediatric specialists in the region. With its summer 2011 expansion, Joe DiMaggio Children’s Hospital now has 204 beds and is South Florida’s newest freestanding children’s hospital.

In its first year of operation, Joe DiMaggio Children’s Hospital’s medical staff included 90 physicians and patient admissions numbered 2,000. Through the years, the hospital has enhanced and expanded its services and programs to help meet the growing and diverse needs of the community.

The hospital is staffed 24 hours a day by world-class pediatricians, pediatric specialists, specialty-trained nurses and ancillary support staff. Today, more than 650 physicians are on the medical staff, and during the 2014 fiscal year our team recorded:

  • 8,707 admissions and observations
  • 6,039 pediatric surgeries
  • 53,450 outpatient visits
  • 110,322 visits at three Joe DiMaggio Children’s Hospital Emergency Department locations

Uniquely inspired by and designed for kids and families, the freestanding building offers many amenities. The vibrant colors, whimsical décor and larger-than-life murals welcome children to an upbeat environment where the “Power of Play” is a healing force. Each floor reflects an individual theme of sports, arts, games or dreams. All patient rooms are private and are wired for movies, video games, the Internet and educational programs, and room-service meals are available any time of the day.

This four-story, 180,000-square-foot, environmentally friendly facility features six pediatric operating rooms, dedicated medical/surgical units, family resource centers, ambulatory services, imaging services that feature a CT scanner disguised as a pirate ship, and an entire floor dedicated to inpatient and outpatient pediatric oncology treatment.

A glass pedestrian skywalk connects to the Wasie Neonatal Intensive Care Unit, Pediatric Intensive/Cardiac Care Unit, and Level 1 Trauma Center and Children’s Emergency Department.

Conveniently located on the campus, Conine Clubhouse provides a special home away from home for families of hospitalized children. Accommodations are based on availability.

The team at Joe DiMaggio Children’s Hospital embraces a patient- and family-centered approach to care, working with families in the effort to best meet the needs of the child.

We should not just be “running to Florida” for any/every medical emergency; how long should the expectation be for our young nations to grow-up. The Go Lean roadmap declares that it is high time and past time for the region, to stand-up and step-up to satisfy the needs of our people. While this delivery may be too big for any one Caribbean member-state alone, surely together-united-integrated we can leverage the kinetics of a 42 million Single Market economy.

We urge all Caribbean stakeholders to lean-in to this roadmap for economic empowerment and medical delivery. We can make the Caribbean homeland better places to live, work, heal and play. 🙂

Download the free e-Book of Go Lean … Caribbean – now!

Sign the petition to lean-in for this roadmap for the Caribbean Union Trade Federation.


Appendix ZM – Trauma Center Definitions

A trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons (ACS) [a]. The details of these trauma levels are as follows:

Level I

A Level I Trauma Center provides the highest level of surgical care to trauma patients. Being treated at a Level I Trauma Center increases a seriously injured patient’s chances of survival by an estimated 20 to 25 percent. This has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. A Level I trauma center is required to have a certain number of surgeons, emergency physicians and anesthesiologists on duty 24 hours a day at the hospital, an education program, and preventive and outreach programs. Key elements include 24-hour in-house coverage by general surgeons and prompt availability of care in varying specialties—such as orthopedic surgery, neurosurgery, plastic surgery (plastic surgeons often take calls for hand injuries),anesthesiology, emergency medicine, radiology, internal medicine, oral and maxillofacial surgery (trained to treat injuries of the facial skin, muscles, bones), and critical care—which are needed to adequately respond and care for various forms of trauma that a patient may suffer. Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention, and is a referral resource for communities in nearby regions.

Level II

A Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a Level I institution. It provides 24-hour availability of all essential specialties, personnel, and equipment. Minimum volume requirements may depend on local conditions. These institutions are not required to have an ongoing program of research or a surgical residency program.

Level III

A Level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries, Example: Rural or Community hospitals.

Level IV

A Level IV trauma center exists in some states where the resources do not exist for a Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may also provide surgery and critical-care services, as defined in the scope of services for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient’s arrival to the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.

Level V

A Level V trauma center provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. This type of center may provide surgical and critical-care services, as defined in the service’s scope of trauma-care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department. If not open 24 hours daily, the facility must have an after-hours trauma response protocol.

Pediatric Trauma Centers

A facility can be designated an adult Trauma Center, a pediatric Trauma Center, or an adult & pediatric Trauma Center. If a hospital provides trauma care to both adult and pediatric patients, the Level designation may not be the same for each group. For example, a Level 1 adult Trauma Center may also be a Level 2 pediatric Trauma Center. This is because pediatric trauma surgery is a specialty unto itself. Adult trauma surgeons are not generally specialized in providing surgical trauma care to children, and vice versa, and the difference in practice is significant.

Cited Reference:

a. American College of Surgeons. “ACS Verification Site Visit Outcomes”. Retrieved April 2013 from:


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