Trauma Care Hours Away in Parts of Ky.


 
 

Karla Ward | | Monday, January 21, 2008


LEXINGTON, Ky. -- The fall happened as Linda Gayheart headed down the steps from the upstairs office in her Hindman home with a cup of coffee in one hand and a stack of papers in the other.

Near the bottom of the stairs, she managed to grab the banister, but she swung around and hit her back against its decorative knob.

"It was one of those freak things that could happen to anybody," she said. But the damage was anything but average. Gayheart's liver was severed.

When the internal bleeding was discovered and she was airlifted to the University of Kentucky's Chandler Hospital, she said her local doctor gave a poor prognosis.

"He said I probably had two or three hours to live," Gayheart said.

She spent 17 days on life support. Her recovery took 21/2 months.

Now, two years after she fell, Gayheart said she's doing most of her work downstairs -- and much of that work has a new purpose. She's become one of Kentucky's staunchest advocates for a statewide trauma system.

"You just think that every emergency room is a trauma center," Gayheart said. "That's just not true."

Kentucky has only three verified trauma centers. The University of Kentucky and the University of Louisville's hospitals are Level I centers; Taylor Regional Hospital in Campbellsville is a Level III center.

Depending on where in the state a person is severely injured, "in many instances you are hours away from getting to us," said Dr. Jeffrey Coughenour, a trauma surgeon at the University of Kentucky. "The potential is that you're going to die before you ever get to us."

Hundreds of injuries

Nationwide, trauma -- from car crashes, gunshot wounds, farming accidents and other causes -- is the leading killer for people ages 1 to 45.

Last year, 857 Kentuckians died in traffic crashes, according to the Kentucky State Police.

A disproportionate number of those deaths occur in rural areas, far from a hospital equipped to deal with such serious injuries, said Julia Costich, director of the Kentucky Injury Prevention and Research Center.

"There really are parts of the state where you're four times as likely to not survive a traffic crash," she said. "People in rural parts of the state do not have equal access to potentially life-saving (care)."

The American Trauma Society says 28 percent of the state's population lives more than an hour's drive or flight from a Level I or II trauma center.

Creating a new system

State Rep. Bob DeWeese (R-Louisville), a surgeon, said he expects to file legislation early this week that would create a statewide trauma system.

The system would provide more education for doctors, nurses and paramedics to care for and assess severely injured patients, so that they are taken to the most appropriate facility as quickly as possible.

Coughenour said valuable time is lost when trauma patients are kept at their local hospitals for hours while X-rays and other tests are done.

"Every few days we see somebody where we throw our hands up and say, 'you know, we can do better,'" he said.

The legislation would also encourage more community hospitals to seek designation as trauma centers, and would enable statewide guidelines and protocols on where patients should be taken for triage.

"There's no standardization right now," Coughenour said. "That's one of the problems."

A data registry would track the handling of severe trauma cases, and the entire system would be overseen by a coordinator at the state Department for Public Health.

Kentucky is one of only a handful of states that do not have such a system.

States with mature systems have seen a 15 percent to 20 percent reduction in the death rate from traumatic injuries, according to Coughenour.

In Kentucky, the most severely injured patients who are not near UK or U of L are often taken to Cincinnati, Nashville, Knoxville, Huntington, W.Va. or Evansville, Ind.

Even so, there are still parts of the state where getting to those trauma centers would take hours, Coughenour said.

Upgrading care

Several Kentucky hospitals, including Ephraim McDowell Regional Medical Center in Danville, have expressed interest in becoming verified trauma centers through the grading system set up by the American College of Surgeons.

Level I centers, such as those at UK and U of L, are usually university teaching hospitals. They must have a full staff of specialists to provide trauma care and must take the lead in providing trauma education, research and prevention.

Level II centers are also expected to provide complete trauma care, but they are often not located at academic institutions and might not be able to provide the full range of sub-specialists that a Level I center would.

The state has no Level II centers, but probably does not have a great need for them, or for more Level I centers, Coughenour said. Instead, he and others say the state needs more hospitals to become Level III and IV centers.

Level III centers can quickly assess, resuscitate and stabilize trauma patients and must have a general surgeon to perform emergency operations.

Level IV centers can provide advanced life support before patients are transferred to a higher-level hospital, but are not required to have a surgeon.

Marcum & Wallace Memorial Hospital in Irvine expects to become the state's first Level IV trauma center by the end of this year.

The hospital has spent about a year educating staff and area paramedics about trauma care, and it is now writing policies and procedures for dealing with trauma patients, said John Isfort, vice president of network development and physician services.

"You have a system approach to that so that you're not out in the field deciding which hospital to go to," said Isfort, a former flight paramedic for UK.

Resources needed

Becoming a verified center requires an investment of staff, time and money, but Isfort thinks more hospitals will do it if legislation will support them.

Minnesota lawmakers passed trauma system legislation in 2005, after 20 years of advocacy. Before that, the state had three Level I trauma centers and three Level II centers. Today, Minnesota has four Level I, three Level II, four Level III and 16 Level IV centers.

Ultimately, the state wants nearly all its hospitals to become at least Level IV centers, said Tim Held, coordinator of the Minnesota Statewide Trauma System.

Held's $352,000 yearly budget is provided by a fee hospitals pay per licensed bed. He said the fee isn't popular, but it has helped improve the level of trauma care.

In Kentucky, advocates of a trauma system have been trying for years to get legislation passed.

Last year, the bill passed the House 96-0, but it stalled in the Senate.

Parochial opposition

Sometimes, smaller hospitals have balked at the idea because of competition -- they fear that the hospital in the next county will look better if it becomes a trauma center and they don't, Coughenour said.

There's also the concern that a trauma system will cause small community hospitals to lose patients to the larger trauma centers.

That was also a concern among Minnesota hospitals before the legislation was enacted, Held said.

But, he said, the levels used to designate centers are not a statement of quality, but rather the resources a hospital has available.

Coughenour said UK is not interested in taking patients away from community hospitals.

"There's a lot of people that come here that didn't need to," he said. "We don't want everybody. We're too busy here as it is."

DeWeese said his bill has the support of the Kentucky Hospital Association, Kentucky Medical Association and other groups.

Cost might be a key barrier, though.

DeWeese said he'll ask for about $2.8 million over a two-year period. He's hoping some of that could come from homeland security budgets.

But if the money isn't available, he'd still like to see the bill passed.

Aside from saving lives, Coughenour said, the system would save money over time. By getting people to the most appropriate care quickly, they would have shorter hospital stays and less duplication of services.

"They'll be back at home in their community, actually being productive," he said.

Reach Karla Ward at (859) 231-3314 or 1-800-950-6397, Ext. 3314.

To see more of the Lexington Herald-Leader, or to subscribe to the newspaper, go to http://www.kentucky.com. Copyright (c) 2008, The Lexington Herald-Leader, Ky. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.




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Related Topics: Communications and Dispatch, Head and Spinal Injuries, Operations and Protcols, Medical Emergencies

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