Issue in Depth: Statewide Trauma Care - @ JEMS.com


Issue in Depth: Statewide Trauma Care

It s time to take action, save lives


 
 

Ken Foskett for the editorial board | | Monday, February 9, 2009


ATLANTA -- Georgians have been discussing the problem for nearly 30 years, and for nearly 30 years we haven't done much to address the need for a statewide network to provide emergency care for wreck and accident victims.

Lawrence Manker Jr., 20, was a lucky one. He lived to tell his story to state legislators last month.

Burned over 85 percent of his body, Manker survived the horrific sugar refinery explosion in Port Wentworth last year thanks to the lifesaving work of doctors and nurses from Memorial University Medical Center in Savannah and the Doctors Hospital in Augusta. The deadly inferno, which killed 14 and injured dozens, occurred two months before Georgia legislators closed the 2008 General Assembly without adopting a long-term funding plan to help Georgia's 15 trauma hospitals. A proposal to dedicate about $90 million in state-collected property taxes to trauma care ended up in the trash on the session's last night.

Amid the finger-pointing between House Speaker Glenn Richardson and Lt. Gov. Casey Cagle, you'd have thought the two sides were bargaining over cattle, not human lives.

This year, political ambition and weak-kneed leadership again threaten to scuttle permanent funding for trauma care, despite bipartisan consensus that action is years overdue. Gov. Sonny Perdue is at least trying, proposing a mix of fees on HMOs, hospitals and speeders to provide an estimated $60 million in trauma care funding.

It was Perdue's one-time infusion of $58.5 million last year that prevented Georgia's trauma system from slipping deeper into crisis. Without the funds, two or three hospitals might have been forced by finances to drop out of trauma care, denying emergency care to hundreds of patients.

State Rep. Fran Millar (R-Dunwoody) wants to resurrect the plan to redirect state-collected property taxes to trauma care, but such a step would force legislators to cut other programs already facing significant cutbacks. State Rep. Austin Scott (R-Tifton) has proposed a $10 tag fee that could raise about $80 million.

In the Senate, Cagle refuses to support new taxes or fees, sticking to a no-tax pledge that he believes will help get him elected governor in 2010. Cagle has also criticized how the Georgia Trauma Care Network Commission spent last year's money, moaning that state financing brought no new hospitals into the trauma network. That's hardly a surprise, given that Cagle and the Legislature had made it clear that they couldn't guarantee funding for more than a year.

Millar's proposal to redirect property tax revenue to trauma care offers Cagle a way to address the problem without a tax increase, but the lieutenant governor must lead the way in finding credible budget cuts to offset the revenue shift.

Traumacare funding also offers Cagle a way to win the votes of rural Georgians in his campaign for governor in 2010.

The hard truth is that accident victims have a greater chance of dying from serious injury in rural Georgia, where trauma care is often unavailable, than in metro Atlanta.

More than 1 million Georgians, primarily from rural north and south Georgia, live more than 50 miles from a trauma center. That puts them beyond the "golden hour" when emergency caregivers have the greatest chance to save someone's life.

That number doesn't include the millions of motorists who drive Georgia's interstate highways, often traveling through counties that are 75 miles or more from a trauma center. In fact, south of Macon, legislators ought to erect signs along I-75 that read "Warning! Entering the dead zone. Next emergency room 100 miles."

In metro Atlanta, a traffic fatality happens about once every 339 accidents. In rural Georgia, a fatality occurs once every 74 accidents. The higher death rate is no accident; injured motorists simply can't get to a trauma hospital quickly.

Experts estimate a stronger trauma care network in Georgia could save 700 lives a year.

Those lives could easily be someone you know --- a son driving home from Georgia Southern, neighbors heading to the mountains, or parents driving from Ohio to Florida for the winter.

"It happens without warning," says Dr. Arthur Kellermann, Emory's ER authority. "You're in your car thinking about a business deal and the next minute you're unconscious fighting for your life. This is the great equalizer for all Georgians."

Unfortunately, trauma care is much more expensive than a trip to the doctor's office. Trauma hospitals require specialized staffing 24 hours a day. They must attract and keep trained surgeons. And they need help covering the cost of uninsured patients who end up in the operating room or in costly rehabilitation.

Dedicated trauma funding will help hospitals defray these costs, plus help Georgia EMTs develop a more efficient system for routing patients to hospitals that can treat them.

Under Millar's proposal, legislators would have to approve a constitutional amendment reserving the state property tax for trauma care funding, and state voters would then have to approve that measure on the November 2010 ballot.

It would be far more direct and simpler for legislators to solve the problem the old-fashioned way, by setting priorities and finding the revenue to pay for them.

More specifically, legislators should adopt both Perdue's proposal for $200 fines on so-called super-speeders (over 85 mph on four-lane roads and over 75 mph on two-lane roads) and Scott's proposed $10 car-tag fee.

That $10 fee works out to less than 3 cents a day. Who wouldn't buy life insurance for that?




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Related Topics: Leadership and Professionalism, Operations and Protcols, Trauma

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