News, Patient Care, Trauma

Panel Sees Flaws in Trauma System

COLUMBUS, Ohio — When some of the state’s top emergency medical experts got together this spring to rate Ohio’s 6-year-old trauma system, they flunked it with a grade of 33 percent.

The state trauma committee — made up of physicians, nurses, paramedics and hospital administrators — measured 13 indicators based on federal recommendations of a model trauma system.

They agreed on what’s been working since the law took effect in 2002: EMS workers are getting severely injured patients to the hospitals best equipped to treat them.

But they found flaws, including:

* The Ohio Emergency Medical Services board, which oversees the system, has no authority to enforce the law, especially when it comes to hospitals.

* Trauma training required of emergency workers is not required for doctors, nurses and other hospital staff members who treat severely injured patients.

* No one keeps records on severely injured patients who die at the accident scene.

* There are no trauma centers in southeastern Ohio, making it more difficult to transfer and treat severely injured patients within 60 minutes, which experts call the “golden hour” for best outcomes.

Fixing these problems, experts say, will require either changing the law to give the Ohio EMS Board more authority, moving the trauma system to another state agency that has oversight power or creating a new state agency with statutory control.

“There’s no lead agency that has a say over the entire state trauma system,” said Kathy Haley, vice chairwoman of the committee and trauma program coordinator at Nationwide Children’s Hospital.

Trauma is the leading cause of death of people 1 to 44 years old, she said.

Before Ohio’s law passed in 2000, emergencymedical experts estimated that about 900 critically injured people died unnecessarily each year across the state because they were not taken to trauma centers.

It took more than a decade of fighting for a system before a bill was introduced.

Since the law took effect, the number of severely injured people taken to trauma centers has increased while fewer of these patients are dying in nontrauma centers. That’s a sign that things are working, experts say.

But they are quick to add that there is room for improvement.

“What we don’t have is teeth in the law,” said Dr. Sidney Miller, a trauma committee member and director of Ohio State University Medical Center’s burn center.

“There’s no mandate from the legislature to look at what goes on once the patient gets to the hospital door.”

The law allows hospitals to call themselves trauma centers as long as they are verified every three years by the American College of Surgeons, which sets national standards in trauma care.

But Miller said there needs to be a state designation as well, and a system to make sure hospitals stay equipped and trained to treat the most severe injuries.

For example, if a verified trauma center loses a neurosurgeon, the hospital doesn’t have to report the loss or replace the doctor until it’s time to reverify.

“Nobody in this state has any input on the hospitals, and that’s the problem,” said Jason Kinley, a paramedic with the Xenia Fire Division and a committee member.

Dr. John Crow, a pediatric surgeon and chairman of the trauma committee, agrees.

“The (American College of Surgeons) verification process is a private company coming in and assessing,” he said. “That is not public knowledge.”

Other states with trauma systems vary in their oversight. Haley said Pennsylvania’s system is a good model.

The Pennsylvania Trauma Systems Foundation accredits all trauma centers, said Juliet Geiger, executive director, and each trauma center is inspected annually.

And Pennsylvania trauma centers provide patient data to the foundation and pay annual fees of as much as $45,000 for the oversight.

The foundation, however, doesn’t oversee emergencymedical workers. That job belongs to the Pennsylvania Department of Health.

Giving an Ohio agency trauma-center oversight would require changing the current law, which would be no easy task. Small hospitals feared the law would cause them to lose patients they otherwise would treat.

In 2000, before the law was enacted, there were 16 verified trauma centers in Ohio. Now, there are 43 trauma centers.

Bridget Gargen, vice president of state policy and advocacy for the Ohio Hospital Association, said her group does not advocate creating additional hospital oversight.

And Mark R. Burgess, who directs the Ohio EMS Board, said he’s in no hurry to ask lawmakers to change the trauma law.

Burgess, who is fire chief in Ashland, in northern Ohio, said he doesn’t expect that the board will discuss any changes until its annual retreat in January and predicts that it could be five years before any changes in the law are made.

“Trauma surgeons don’t want EMS regulating them,” Burgess said.

Rep. James T. Raussen, chairman of the House Healthcare Access and Affordability Committee, said advocates of changing the trauma law should have all parties on board — including the hospital association — before they come to see him.

“They need to have a coordinated voice and have everything agreed upon, the better chance we can make the necessary changes,” he said.