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Trauma Surge Baffles Fresno Hospital

JEMS.com Editor s note: Read up on trauma issues and care with Trauma Talk, a montly column written by Will Chapleau, EMT-P, RN, TNS.

FRESNO, Calif. -- Patients are pouring into Community Regional Medical Center s trauma center, where officials expect to see cases jump by one-third this year.

The number of trauma victims -- patients with life-threatening injuries caused by shootings, freeway pileups and other serious accidents -- is expected to exceed 2,800 in 2007, up from 2,109 in 2006, say officials at the Fresno hospital.

The sudden jump, which follows years of little or no growth, surprises local health and public-safety officials because it exceeds the rate of population growth in the region and is far higher than increases seen in other big California hospitals.

I am kind of in shock over this, said Community Regional trauma director Lynn Bennink. I think the word is probably baffled.

While no one can offer a definitive reason for the increase, health and hospital officials suggest that more patients are coming from the regions surrounding Fresno County. Most are patients who cannot get specialty treatment at smaller hospitals.

But not everyone is satisfied with these explanations and say the increase warrants further investigation.

Community s trauma center is one of seven Level 1 centers in the state and the only one between Los Angeles and Sacramento. It serves a nine-county area from Mariposa to Kern. Under the Level 1 designation, the hospital is required to have trauma surgeons on site 24 hours a day and other specialists available to treat critically injured patients.

Last year, the trauma center -- which moved downtown from University Medical Center in April -- averaged about six patients a day.

This year, the average is nearly eight patients a day.

On a recent Tuesday, a man was brought in after being rammed by a bull, a woman came in after her car was hit by a train and a man with multiple gunshot wounds was transferred from a hospital in Tulare County -- all within a few hours.

Hospital officials said doctors have been able to keep up with the increase in cases -- so far.

The hospital s new Table Mountain Rancheria Trauma Center, built with a $10 million donation from the Table Mountain tribe, has larger operating rooms and a 68-bed emergency department -- up from 22 beds at UMC.

The hospital also has added doctors in recent months, including emergency room physicians, a neurosurgeon, an orthopedic surgeon and two general trauma surgeons. Ancillary staff, such as physician assistants, also has grown.

Explanation elusive

Jeff Cardinale, spokesman for the Fresno Police Department, said he doesn t know why the trauma center is so busy this year.

Apart from a slight increase in shootings, All of our violent crimes and collisions across the board are down in the city, he said.

Trauma patients usually are airlifted or brought in by ambulance. Community is getting more and more of those patients from outside the Fresno County area -- not just Tulare, Kings and Kern counties, but San Luis Obispo and other counties as well, said Daniel Lynch, director of emergency medical services for Fresno County.

Smaller hospitals in these areas are struggling to hire and keep medical specialists, Lynch said.

Rick Elkins, spokesman for Tulare District Hospital 45 miles south of Fresno, said more trauma patients in his area are being taken directly to Community, bypassing smaller hospitals emergency rooms. He said emergency medical officials are sending them directly to a trauma center to get serious cases treated more quickly.

The use of helicopters at the scene is up, he said. It s the best thing for the patient.

None of this fully explains the dramatic increases in trauma patients at Community, however, Lynch said, who would like Community officials to further investigate.

Population increase cited

Population growth is likely one factor, he said. But it cannot explain all of the increase. Fresno County grew 2% last year. Nearby counties had similar rates: Kern County grew 2.8% last year and Tulare County 2.1%. Statewide population growth has hovered around 1.3% the past few years, according to population estimates by the state Department of Finance.

Other trauma centers in the state are not seeing the same dramatic surge in cases reported in Fresno. The four trauma centers in Los Angeles County have seen only moderate increases in business since 2005, said Thuy Banh, spokeswoman for Los Angeles County Emergency Medical Services.

At UCLA Medical Center, the number of trauma patients grew from 997 in 2005 to 1,117 to 2006 -- about a 12% increase, for example. Two other trauma centers in the county saw similar increases, but Cedars-Sinai Medical Center saw its trauma numbers drop by 1% in the same period.

Trauma caseloads at San Francisco General Hospital rose 1% in 2005 and 9% in 2006, said Patricia O Connor, trauma program manager.

The reporter can be reached at tcorrea@fresnobee.com or (559) 441-6378.

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