Surgeons who served in Vietnam say the current plan to send seriously injured soldiers from the Persian Gulf almost exclusively to military and veterans hospitals is a misguided decision that means these patients will not go to the American hospitals best equipped to care for them -- civilian trauma centers.

Since the end of the Vietnam War, staff members at most military and veterans' hospitals have treated relatively few serious injuries. Most such hospitals cannot offer the critical-care nursing,

technological know-how and 24-hour laboratory backup that are routine in the country's trauma centers, said Richard Carmona, director of trauma services at Tucson Medical Center and a Vietnam war veteran.

He urged that the plan be revised to allow the most severely wounded patients to be sent directly from the air base receiving them to the nearest civilian trauma center. Even if patients do not arrive in the United States until three to seven days after they are injured, "a lot of critically wounded patients will still need expert trauma services," he added.

The country's network of trauma centers was established because military doctors and nurses in Vietnam had developed a new team approach to taking care of serious injuries. "The paradox is, we learned this from the military 20 years ago and put it to use in civilian practice," Carmona said, "and now we're ignoring it."

"If you've got somebody who is on a ventilator, with gunshot wounds, blast injuries, brain injuries . . . send them to a trauma center," he said. "Put them in the hands of people that take care of these injuries every day."

Carmona said he made these points several weeks ago as a member of a regional advisory committee to the National Defense Medical System, a nationwide contingency plan under which military and civilian hospitals have agreed to cooperate to handle war casualties. He said all of his fellow committee members told him they agreed with him.

But he said he was informed that under the current plan most of the seriously injured patients are expected to go to local military hospitals or to hospitals administered by the Department of Veterans Affairs, not to civilian trauma centers. Civilian hospitals will be asked to accept the overflow from the military system.

Surgeons in other parts of the country said they shared Carmona's concerns. "It's a question of having the right people available," said Peter Galpin, a former Vietnam medic who is now a surgeon in a plastic surgery training program at the University of Miami. Galpin said a war injury left his legs paralyzed, and he was treated in veterans hospitals. Later, as a doctor-in-training, he worked in them.

"Quite frankly, with all due respect to the VA hospital system, they're really not capable of taking care of these kinds of injuries," he said. "Any Joe Blow drug dealer who gets shot on the street down here goes through a better trauma system than, apparently, these guys will when they come back."

Most of the doctors who have been called up from the military reserves to fill vacancies in U.S. military hospitals "are not trauma-trained," said Gary Clark, a former Vietnam medic and trauma surgeon now in charge of the surgical training program at Oakland-Kaiser General Hospital. "They're general surgeons or other surgeons who don't have trauma experience and have not been taking care of

those patients on a day-to-day basis."

Brig. Gen. Ronald R. Blanck, chief of medical corps affairs in the office of the Army Surgeon General, said that military hospitals are well equipped to care for seriously injured patients, and that he expected the military medical system to be able to handle most of the trauma cases.

James W. Holsinger, chief medical director of the Department of Veterans Affairs, said most veterans hospitals designated to receive war casualties are affiliated with nearby medical schools and will be able to draw on their trauma specialists' expertise.

"If we have an individual with major traumatic injury, we can move that individual to the medical school hospital, where they would be able to have that kind of trauma care," he said.

Blanck said wounded soldiers will go first to Germany and will not be brought back to the United States until they are medically stable enough to make the trip. Some seriously injured patients might go to trauma centers, he said, if a military or veterans hospital could not handle them, but even those patients would first have to pass through the military medical system.

If injured soldiers were sent directly to civilian trauma centers, he said, "what I'm afraid of is, the military would lose them in an accounting sense. They are not now part of the organization to which they have given a lot. Psychologically, it's very important for the patient to identify with the {military} system and for the system to provide support to the patient."

Carmona said military officials had told him they thought that the most severely injured soldiers would die before leaving the Persian Gulf region, and that those stable enough to make it back to the United States would not need the services of a specialized trauma center. But he said that studies of critically injured patients contradict this view.

Such studies show three "peak" periods after injury during which deaths occur, he said. The first peak represents injuries that are immediately fatal. The second peak, representing deaths that occur from several hours to a few days later, is caused by injuries that are not immediately recognized.

The third wave of deaths occurs between five days and two weeks afterward, and is caused by infections and medical complications such as lung, liver or kidney fail- ure.

"Those patients are the ones we have the most difficult time with," he said.