Indiana is working to join 41 other states that have a statewide trauma system, but it will take time and effort. State health officials recently set out on a statewide Trauma Listening Tour to build on existing knowledge of trauma care in Indiana and to strengthen relationships that could serve to further improve it.
From June through September, State Health Commissioner Gregory Larkin, M.D., and members of the Trauma and Injury Prevention Division at the Indiana State Department of Health invited medical professionals, emergency responders, members of the public and other stakeholders to participate in informal discussions about trauma care in each of the state's 10 public health preparedness districts. The tour was a way to get people talking about trauma care in Indiana and what is needed for a trauma system. Since the tour focused on conversations, as well as collecting stories from individuals who have been affected by trauma, it was considered a "listening" tour.
Traumatic injuries are the No. 1 killer of Hoosiers under age 45 with more than 32,000 Hoosiers hospitalized each year due to injuries. In 2009, the most recent year for which data are available, 3,700 of those injuries resulted in death. The burden of trauma is particularly felt in rural areas of the state where lifesaving trauma care may not be available.
"In Indiana, we have the unique challenge of having the highest number of interstate highway miles per land area," said Dr. Larkin. "This often translates into fatal motor vehicle collisions in rural areas where a trauma care center may not be nearby. Our goal is to increase the number of trauma centers in the state and ultimately create a statewide trauma system which will better protect Hoosiers and reduce preventable deaths."
Indiana currently has eight Trauma Care Centers verified by the American College of Surgeons. They are in Indianapolis (3), Fort Wayne (2), South Bend (1) and Evansville (2).
"Where trauma systems are in place, they are shown to save lives," said Dr. Larkin. "Traumatic injuries such as punctures, burns and blunt force injuries require highly specialized medical professionals and equipment to treat patients within the 'golden hour' of care. When we succeed in creating a statewide trauma system in Indiana, many more Hoosiers will have access to these resources, should they need them."
Through the Trauma Tour, the State Health Department was able to get a clearer picture of the challenges and opportunities associated with achieving a statewide trauma system. Some lessons learned during the tour include:
dz? Although Indiana has many elements of a trauma system, such as injury prevention experts, professional EMS providers, trauma centers, hospital emergency departments, and rehabilitation providers, creating a statewide trauma system will take some time.
dz? Indiana needs more trauma centers. Only 58 percent of the population lives within 45 minutes of one of Indiana's eight trauma centers.
dz? Best practices suggest combining the EMS program, currently at the Indiana Department of Homeland Security, with the trauma program at the State Health Department, as 41 other states have done.
dz? The availability of rehabilitation needs to be further integrated with other elements of the system. During the tour, local rehabilitation providers came forward to help address the issue moving forward.
dz? The Indiana Trauma Registry, which records incidents of trauma around the state, can be maximized to drive and evaluate trauma system performance improvement, as well as guide injury prevention/education efforts.
"We are so grateful to the individuals who shared their stories with us and to the organizations that came out to participate," said Art Logsdon, Assistant Commissioner of Health and Human Services at the Indiana State Department of Health. "One of the greatest successes of the trauma tour was likely getting trauma and EMS providers in one place to discuss common issues and challenges. Trauma is an issue that has touched many lives in Indiana and the conversations which took place as part of the tour demonstrate just how much a trauma system is needed."
A notable success in Indiana trauma care came with the passage of the Triage and Transport Rule earlier this year by the Emergency Medical Services Commission. According to the rule, emergency responders must take patients with severe injuries directly to a trauma center for treatment, unless the nearest trauma center is more than 45 minutes away or it puts the patient's life in danger.
The State Health Department is developing a trauma system workshop to assist hospitals in the process of becoming trauma centers, tentatively scheduled for early 2013.
For more information about trauma care in Indiana or to learn more about the Trauma Listening Tour, visit the Indiana State Department of Health's website at http://www.in.gov/isdh/19537.htm.