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Tripler to Bolster Hawaii's Trauma Network

HONOLULU, Hawaii -- Tripler Army Medical Center has agreed to become a trauma center for the treatment of nonmilitary residents on Oahu, providing relief to the Queen's Medical Center, which is the only civilian trauma center on Hawaii's most populated island.

Tripler plans to become a participant in the state's trauma system in six months to a year, and will care for "low-level" trauma patients, a move that will allow Queen's to focus on seriously injured individuals.

Civilian patients from the west side of Oahu, including Aiea, Ewa Beach, Kapolei, Kunia, Pearl City, Wahiawa, Mililani, Waianae and Waipahu, would be candidates for care at Tripler, officials said.

State officials say the expansion of trauma care around the state, an effort started in 2006 with the creation of a special fund, is positive news -- in contrast to the closure of Hawaii Medical Center's two hospitals on Oahu.

A hospital's ability to care for trauma in Hawaii is based on a four-level system, with "I" being the highest level of care and "IV" being the lowest. Tripler said it will enter the state's trauma system at Level III, while Queen's already is a Level II facility.

"I think it's a great thing for the state," said Dr. Linda Rosen, chief of the state Health Department's emergency medical services and injury prevention system branch. "We're actually developing a system with our neighbor island hospitals and now we're adding a Level III (trauma center at Tripler) on Oahu."

Rosen said Oahu has no other trauma centers.

Trauma care differs from emergency room treatment, which may cover an illness such as the flu, a heart attack or minor cuts and bruises, while trauma care could involve more serious injuries from a car crash, Tripler officials said.

Dr. Josh Green, an emergency room physician on Hawaii island and a state senator, offered the example of someone badly hurt in a car accident. An ER doctor won't open the patient's chest to stop bleeding, he said, and even a Level III trauma center might not be able do that.

"A Level II center, which is what Queen's is, can do everything," Green said. "A Level III will have surgical capability, meaning they will be able to stabilize and provide a heck of a lot more care."

Rosen said having only one trauma center leaves Oahu vulnerable. "On a day-to-day basis we don't usually run into too many problems, she said. "Queen's can handle the load." But in a "mass-casualty situation," that might not be the case.

Tripler said it treated more than 11,000 injury cases in fiscal 2011, 297 of which were severe enough to be classified as trauma cases.

By treating non-Defense Department civilians, the Army hospital projects that it will more than double its trauma treatment per year to 682 cases.

Lt. Col. Kurt Edwards, chief of trauma and surgical critical care at Tripler, said the hospital has the expertise.

A large percentage of Tripler's health care providers and assistants have been deployed to war zones and developed, in austere environments, the ability to resuscitate, manage, operate on and care for victims of injuries that could be horrific, he said.

Edwards said Tripler was approached by the state for trauma care assistance, and recognized the importance of participating.

Tripler plans to obtain state of Hawaii and other certifications before it starts accepting civilian trauma patients, a process expected to take six months to a year, Rosen said.

"Tripler's got great services, so we don't expect them to have a problem actually meeting the standards, but they have to build sort of a paperwork trail, if you will," she said.

Tripler said it has provided care in the past to non-Defense Department individuals on a case-by-case basis. Ambulances have been diverted to the hospital during life-threatening emergencies, for example. It also has provided medical care to civilians living on remote Pacific islands.

A number of Army medical centers already offer nonmilitary trauma treatment, including Brooke Army Medical Center in Texas and Madigan Army Medical Center in Washington state, Tripler officials said.

Under Tripler's trauma treatment plan, civilians with injuries classified as "low level" would be transported by ambulance to Tripler and receive trauma care, and then either be admitted, transferred to Queen's or discharged.

Tripler would bill civilian patients' insurance carriers in the same way that other hospitals do.

The state Legislature recognized the need for greater trauma care in 2006, saying in a bill creating a trauma system special fund that the high-level care in Hawaii was "in a state of crisis."

Hawaii's isolation rendered Hawaii "uniquely vulnerable to natural disasters." The legislation said a "functional trauma system with the capacity to handle a surge in demand is a fundamental necessity."

Money from a cigarette tax goes into the fund. Rosen, the state EMS chief, said about $6.8 million is spent annually to improve the trauma system, most of it going to hospitals.

Hilo Medical Center and Kona Community Hospital, along with Wilcox Memorial on Kauai, were designated Level III trauma centers within the past six months. Maui Memorial will be similarily designated in 2012, officials said.

"This has been a very large success," Green said of the push for greater trauma care in the state.

Tripler said it will receive a state grant given to each hospital that becomes part of the integrated trauma system, and also will receive limited state reimbursement for care rendered to civilian patients with limited ability to pay.

Green said he's relied on Tripler's expertise in the past. Following an earthquake in 2007, he said, Tripler helped him when a man on Hawaii island fell and cut off his thumb with a machete. "I was able to get through to a surgical specialist at Tripler when the phone lines were down, the Internet was down, a lot of power was down, and they walked me through a partial reattachment of this guy's thumb in order to keep it intact long enough to get him, many hours later, flown across to Oahu to get it fully repaired," Green said.


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