J Natl Med Assoc
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This article discusses the uninsured population and the phenomenon known as "patient dumping"--the transfer of a patient from one hospital (typically a private hospital) to a public hospital because of the patient's lack of insurance or inability to pay. The uninsured are the most vulnerable to patient dumping. The growth of patient dumping, a profile of the uninsured who are most likely to be a minority, and an analysis of federal and state policy responses to patient dumping are all discussed. The need for reform of the American health care system is highlighted and the Canadian health system is suggested as an alternative model.
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This article retrospectively reviews 258 consecutive abdominal trauma admissions who required laparotomy from July 1985 to June 1989 at a level one urban trauma center to define the population at risk, the patterns of injury, and the resulting morbidity and mortality. The findings were compared with a series of 252 abdominal trauma patients reported in 1974 by one of the authors. The majority of injuries in this series were gunshot wounds (GSWs) (47%), followed by stab wounds (SWs) (43%) and blunt abdominal trauma (10%). ⋯ Major vascular system injury was the primary cause of death. Prompt evaluation, resuscitation, and operative intervention are mandatory in all abdominal GSW patients. More than half of those patients with major vascular system injury did not present in shock but had a high associated mortality.