News, Patient Care, Rescue & Vehicle Extrication, Trauma

Trauma Care Put On State’s Agenda

LITTLE ROCK — The Arkansas Department of Health will take stock of emergency medical facilities in the state over the next six months as it takes the first concrete step toward establishing a statewide system to coordinate trauma care.

Gov. Mike Beebe announced Thursday that he has set aside $200,000 from the $500,000-a-year Governor’s Emergency Fund to help pay for computer hardware and software to collect and store the information. The effort will provide definitive data to state legislators as they consider proposals to establish a trauma system during the 2009 legislative session.

Arkansas is the only state without a Level 1 trauma center and one of only three states without a trauma system.

“This is an exciting day when we begin to address a critical need across the state,” Joe Thompson, Arkansas surgeon general, said at a news conference Thursday at the state Capitol.

A statewide trauma system would save the lives of 200-600 Arkansans who now die each year because they can’t get emergency care fast enough, said Dr. J. Michael Gruenwald, director of the orthopedic trauma center at the University of Arkansas for Medical Sciences in Little Rock.

Arkansas health-care officials have talked about the need for a trauma system for more than a decade, but legislation to establish a system failed last year after a stalemate between the House and Senate over how to pay for it.

Kentucky and South Dakota – the two other states without trauma systems – are struggling with the same issues as Arkansas.

South Dakota Gov. Mike Rounds signed a bill into law March 12 to establish a trauma system there by 2012, but the bill did not provide any new funding for it.

A bill to establish a trauma system in Kentucky passed in a House committee Feb. 21 but only after its sponsor removed his original request for $1.8 million to pay for it, according to news reports.

In Arkansas, the $200,000 is a fraction of the estimated cost of a trauma system, which has ranged from $24 million to $40 million. But the most important element of Thursday’s announcement was Beebe’s support, said Gruenwald, also past chairman of the Governor’s Trauma Advisory Council.

“The dollar amount is not as important as the fact that the governor is taking this on as one of his issues,” he said.

How a trauma system will be funded will be up to the Legislature.

“It’s premature,” Beebe said.

Other states have used different means to pay for their trauma systems, such as extra fees on court costs or phone bills for 911 service.

A trauma can be any sudden injury resulting from an external force, such as a car accident, electrocution or gunshot.

Under Arkansas’ current system, it’s a daily race for emergency medical personnel to get critically injured trauma patients to hospital emergency rooms. All too often, patients are taken to the nearest hospital rather than to the nearest hospital best able to treat their injuries, he said. Lives are lost in the process.

“You don’t need to send the person who is in trauma to four different hospitals to figure out where to get them the best care,” Beebe said.

A trauma system would allow hospitals to coordinate and share information so that emergency responders know “with the press of a button” which hospitals have the facilities and specialists that their patient needs, he said.

“It’s all about getting the right patient to the right place at the right time,” said Dr. James Graham, chief of emergency medicine at Arkansas Children’s Hospital and acting chairman of the Governor’s Trauma Advisory Council.

Dr. Marvin Leibovich, chairman of the UAMS emergency medicine department, said Arkansas has some of the highest rates of death from injury in the nation. Many of the deaths might be prevented if patients were immediately routed to a place that could provide proper care.

“A soldier injured in a rice paddy in 1971 in Vietnam had a better chance of surviving than a person in an automobile accident in rural Arkansas,” Leibovich said.

Arkansas has the highest rates of motor vehicle accidents in the country at 27.4 per 100,000 annually, compared with a national average of 14.7 per 100,000, according to the Centers for Disease Control and Prevention.

The rate of children’s deaths from motor vehicle accidents in Arkansas is double the national average with 7.9 deaths per 100,000 residents, compared with a national average of 3.6 per 100,000.

“The leading cause of death of people between the ages of 1 and 44 in our state is injury,” said Dr. Paul Halverson, director of the Arkansas Department of Health.

In addition to establishing a central inventory of the state’s emergency medical facilities, the $200,000 will help the state Health Department pay for consultants from the American College of Surgeons and other agencies as it moves forward with developing a trauma system, Halverson said.

Part of the money will also be used to help develop a trauma registry. Medical personnel will use the registry to enter information about trauma patients at all stages of care, from initial response through treatment and recovery, he said. The state will then be able to analyze that data to identify needs.

Meanwhile the Governor’s Trauma Advisory Council is moving forward with developing proposals on how a trauma system would work in Arkansas. During a council meeting Thursday afternoon, members heard a presentation on how other states maintain inventories of their emergency facilities and their capabilities.

Representatives from Louisiana will meet with council members Aug. 18 to discuss what they’ve done there.

The council has developed criteria for hospitals to be designated as Level 1-4 trauma centers based on the level of emergency care they can provide.

For example, a small rural hospital with only a general emergency physician on staff might be a Level 4 center. But a larger hospital, such as UAMS, would be a Level 1 center because it has a variety of specialists, including neurosurgeons and orthopedic surgeons, able to treat patients with the most serious injuries.

Those criteria will be presented to the state Board of Health on July 24.