For All Our Sakes, It's Time for a State Trauma System


 
 

John Rogers | | Tuesday, January 13, 2009


ATLANTA -- I was a surgeon in Macon for several years before dedicating myself to emergency medicine. It was my privilege to have been one of the original members of the trauma service when the Medical Center of Central Georgia first established it in the early 1990s. Over the years I saw and cared for many injured people from babies to grandparents. There are some of these trauma victim's stories that I will never forget and will share with you. Then I shall ask you to urge the Legislature to create a statewide trauma network in Georgia.

I remember three small boys whose throats were slashed by their father because he was mad at their mother, and the young woman who had been beaten with a crow bar and then run over by her jealous boyfriend. She broke both arms, both thighs and her pelvis.

There was the 16-year-old girl who was in a bad car wreck and came in on two ambulances --- she was in one and her leg from the mid-thigh down was in the other, and the young mother who was shot nine times by her husband in front of their small children.

I remember a man who tried to cut his own head off with a chain saw and a 7-year-old girl who was shot while trick-or-treating and blew apart the blood vessels leading to her liver.

And I remember all of the heartbreaking talks with families, which became too common and increasingly difficult for me to do. What I learned from all of this was that life can end or change dramatically in a matter of minutes and we should not take anything for granted. Sometimes we forget how lucky we are.

I also learned that good trauma care was the only chance most of these people had to survive or to limit the disabilities they will suffer. Part of the success is getting those badly injured to an appropriate facility as soon as possible.

Sometimes it is not possible or safe to transport them directly to a trauma center as they are too badly injured and need to be stabilized first at the nearest hospital. Thus, small hospitals are an important part of the system, as are the large trauma centers. Also not every trauma patient needs to go to the trauma center. To do so would overwhelm the trauma center with patients who very well could have been taken care of elsewhere.

What you may not realize is that Georgia has no organized trauma system. People are transported haphazardly without much rhyme or reason. There is no system, there is no organization and some people are taken to inappropriate places and others are brought to the trauma center when it was not necessary.

The Institute of Medicine has recommended the establishment of coordinated regionalized emergency system. When hospitals and EMS services fully integrate their communications and activities, patient services can be delivered seamlessly. It can reduce the time from injury to arrival at the most appropriate center. Regionalization allows early responders to identify the provider best suited to meet the needs of a particular patient and direct them to that care.

The move to establish a statewide trauma system in Georgia began 30 years ago. In 2006, the Legislature began a study of the infrastructure and funding needed. The keys are establishing an integrated trauma infrastructure throughout the state and easing the financial burden on the hospitals, physicians and EMS providers who deliver an estimated $250 million of trauma care a year but are not paid for their services. Those losses discourage hospitals from adding trauma centers and pressure participating hospitals to close their trauma centers.

It's about time that Georgia had a statewide trauma system. It's about time for action that will ensure that trauma care will be available for our families, our neighbors, and us. We simply can't afford not to.

By the way, all of the patients I mentioned earlier survived but one --- the 7-year-old trick-or-treater. She died on the operating table, still with part of her costume on and despite the efforts of everyone in the operating room that night. I will not forget the weeping from the nurses. Nor will I forget the absolute look of devastation on her mother's face when I had the task of telling her that her little girl had died. It is the duty of the most senior surgeon to have these conversations and it is a duty I do not miss.

Dr. John Rogers is emergency medical director at Monroe County Hospital in Forsyth.


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Related Topics: Operations and Protcols, Trauma

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