Wash. Trauma Care Program Saving Lives


 
 

M. Alexander Otto | | Wednesday, January 2, 2008


TACOMA, Wash. -- Last Wednesday, an elderly woman was taken to Tacoma General Hospital after a fall.

Doctors didn't find any broken bones, and the woman was released from the hospital that day.

While that was certainly good news for the woman and her family, her visit had broader significance.

The woman was the 10,000th person treated by the Tacoma Trauma Center since the service started in June 2000.

Since then, a team of dedicated trauma surgeons and physician assistants, with the help of neuro and orthopaedic and other specialty surgeons, has been tending to local victims of car crashes, falls, gunshot wounds and other injuries, treating patients at Tacoma General Hospital and St. Joseph Medical Center on alternating days.

The program has saved many lives, including those who probably would have died on their way to Harborview Medical Center in Seattle, where adult trauma victims from Pierce County were treated before the local service began.

According to statistics from the National Trauma Data Bank, the service does its job well.

While about 4.4 percent of seriously injured patients die in comparable trauma services elsewhere in the country, the mortality figure for the Tacoma trauma service is 3.2 percent.

The service has been "a great success story. It provides a service to this community that's been desperately needed for years," said Dr. Mike Newcomb, senior vice-president and chief medical officer of the Franciscan Health System, which owns St. Joseph Medical Center.

CRASHES AND FALLS

The Tacoma trauma service treats about 1,500 people a year, about 10 percent of whom are victims of gunshots or stabbings.

"Most of what we do are car crashes and falls," said trauma surgeon Dr. Lori Morgan, head of the service.

"That's not gang-bangers," she said, a common misconception about who trauma teams most treat. "That's mom, dad, your neighbor, you."

Christmas, though, "is really bad for interpersonal violence and suicide attempts," Morgan said.

"The season is supposed to be filled with joy and family. When it's not," there can be problems, she said.

Morgan's team usually includes six surgeons and six physician assistants, though she's currently in the process of replacing two surgeons who left recently.

The team has an established routine for dealing with trauma cases.

The emergency room handling trauma duty that day will page Morgan's team when they learn a trauma case is coming in.

Almost always, one of her surgeons and physician assistants they live at the hospital while they are on duty are in the emergency room to meet the victim when he or she arrives. A room is always ready.

Morgan said the first goal is to quickly determine how seriously the person is hurt.

Next, they are stabilized to prevent what Morgan calls the "death triangle" a significant drop in blood pressure coupled with hypothermia and the buildup of acid in the blood, sometimes a sign that a person isn't breathing well enough or has very poor circulation.

The patient's injuries are then attended to.

The trauma team manages the patient during their hospital stay, and afterward, at a trauma clinic at St. Joseph.

With such a system in place, only about 60 Tacoma-area patients a year are sent to Harborview these days, mostly burn patients and people who need to have limbs reattached.

Overall, trauma care in Tacoma is "an essential service," Morgan said.

HOSPITALS, OTHERS, STEP UP

Tacoma couldn't always provide that vital service.

The state required that communities provide trauma care in 1990.

To meet the requirement, general surgeons at the time were called in to Tacoma General and St. Joseph Medical Center to treat trauma patients, no matter the time of day or night, or the obligations of the surgeon's daytime practice.

"There was no infrastructure to handle trauma," said Tacoma surgeon Dr. James Rifenbery. "It was a lone surgeon trying to make everything happen," including finding an available operating room, and other essentials.

"It was just a nightmare," he said, especially with the area's rampant gang violence at the time. Sometimes, shooting victims were simply dumped at the hospitals' doors.

By 1995, the local medical community had had enough. Surgeons, for one, couldn't balance their own regular practices with trauma duties, and they weren't always getting paid for their trauma services if patients didn't have insurance.

So, Pierce County trauma victims began to be airlifted to Harborview Medical Center.

Sometimes they'd die on the way. If they made it, they'd often be far away from their families.

By the late 1990s, Tacoma General and St. Joseph Medical Center administrators "recognized a huge unfilled need for a coordinated trauma program," Newcomb said.

So, Rifenbury and his physician colleagues; Tacoma General and St. Joseph Medical Center administrators; local politicians; and Madigan Army Medical Center administrators, who have their own trauma service and agreed to treat some civilian patients; all worked together to set up the Tacoma trauma system.

Morgan was hired soon after.

A COMMITMENT TO CARE

Today, the service runs on about $5 million a year.

Like trauma services elsewhere in the state, it's funded in part by surcharges on car sales and moving violations, a system set up by the state in 1997 largely to cover trauma care for uninsured or under-insured people.

There is also some federal funding through Madigan's Department of Defense budget.

But more than $2 million a year comes directly from Tacoma General Hospital and St. Joseph Medical Center.

The hospitals have also boosted support staff and outfitted special trauma rooms, among other things, to help the team.

"I think it very admirable" and unusual "that (two) hospitals are willing to maintain that level of service for the community," said Kathy Schmitt of the state Office of Emergency Medical Services and Trauma Services.

Hospital administrators have "made a commitment" to trauma service, she said.

CHART: Trauma patients

Male 69%

Female 31%

Age 0-15 1%

Age 15-54 79%

Age 55-plus 20%

Pierce County residents 85%

Injuries

Motor vehicle crashes 47%

Falls 23%

Gunshots, stabbings 10%

Assaults 8%

Car-pedestrian accidents 4%

Bicycle accidents 2%




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Related Topics: Industry News, Leadership and Professionalism, Trauma, History of EMS

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