LITTLE ROCK — The emergency department at the UAMS Medical Center was busy on a recent Friday afternoon, with patients being wheeled in one after another with various injuries and ailments.
By 3 p.m., nearly every room in the department was full.
Then a call came in – a man involved in a serious car crash would soon be arriving by ambulance.
The charge nurse who took the call immediately activated the hospital’s trauma team. When the man arrived four minutes later, more than a dozen doctors, nurses and specialists were on hand to treat him.
“Everything’s about the time,” said Terry Collins, UAMS trauma program manager. “The clock’s ticking, and we want to get him to definitive care.” A bill creating an Arkansas trauma system to speed up how quickly trauma patients throughout the state get the care they need was signed into law by Gov. Mike Beebe on Friday.
It’s expected to save 200 to 600 lives a year and could prevent as many as 2,000 people injured in Arkansas each year from becoming permanently disabled, state health officials have said.
But first, the system must be put in place. The process is expected to take two years.
The first steps will be to approve hospitals for the system, set up a registry to track trauma patients throughout the state, develop a call center to coordinate cases statewide and begin issuing grants to hospitals and other medical facilities participating in the system, said Dr. James Graham, chairman of the Governor’s Trauma Advisory Council.
Regional trauma advisory councils will also be created to oversee the trauma system and identify needs in different parts of the state.
“Now we transition to actually putting it together,” said Graham, an emergency physician at Arkansas Children’s Hospital. “The plan is to move quickly.”
GETTING TRAUMA CENTERS
Officials with the Arkansas Department of Health are busy outlining the five-step process by which hospitals that choose to participate in the system will be designated as trauma centers, meaning they meet national standards for emergency care and staffing.
Donnie Smith, director of the Health Department’s center for health protection, said they plan to have the process set by May 1 and begin taking applications from hospitals in May and June.
“Then early into next year, we’ll be able to begin responding to those by creating the first contracts with hospitals,” Smith said.
Hospitals will be designated as Level I-IV trauma centers, depending on the level of emergency care they can provide.
Level I centers, for example, must be able to provide the highest level of care, with general and specialized surgeons at the hospital 24 hours a day ready to treat patients.
By contrast, Level IV hospitals aren’t required to have any surgeons on hand, but must have an emergency physician on call to provide initial care and stabilize a patient before he moves on to another hospital, if needed.
The Trauma Advisory Council approved the first-year’s $25 million budget for the trauma system Thursday. It includes $5 million for emergency medical services, including defibrillators.
It also sets aside $13.5 million for startup grants to hospitals. Hospitals will be awarded differing amounts, depending on the what level trauma center they will be, Graham said.
Officials expect two to three hospitals to apply for Level I status, including UAMS Medical Center and Children’s Hospital. Those hospitals would likely get $1 million each in startup grants.
The Regional Medical Center in Memphis, which treats about 2,000 Arkansans a year, is already designated as a Level I trauma center in Tennessee. It’s set to receive $500,000 from Arkansas for the first year but could get more in future years as Arkansas’ system becomes more established, Graham said.
Half of the grant money would be given to hospitals to help them get started after they submit letters of intent to become trauma centers, and the rest of the money will be given after they’ve met certain requirements, Smith said.
The Arkansas Hospital Association and the Arkansas Medical Society have agreed that about 75 percent of grant money should go to hospitals, while 25 percent will go to physicians for things like on-call pay or additional support staffing, said Bo Ryall, executive vice president of the Arkansas Hospital Association.
Many hospitals, including Children’s Hospital, have already established committees and begun planning for the review process. Many are eager to take the next step, he said.
“I think some hospitals will begin applying as soon as the applications become available,” Ryall said.
COORDINATING CARE
Trauma surgeon Dr. Justin Regner has been at UAMS for six years. He said it’s impossible to predict how many trauma patients the hospital will get on any given day.
“I’ve been on call Friday the 13th and nothing happens, and I’ve been on call the 4th of July and you get 11 calls in six hours,” Regner said.
The biggest problem he sees is not how often seriously injured patients come into UAMS, but how long it takes them to get to there. Sometimes patients come in with multiple injuries 15 hours after the initial accident, he said.
The more time that passes, the harder it is to treat a patient’s injuries, he said.
“Even if you save their life, they may not be as functional as they could have been,” Regner said.
Having a statewide trauma system will mean severely injured patients who need the level of care provided at a facility like UAMS will get there faster, said Dr. Michael Roman, an emergency medical physician who has been at UAMS since 1993.
There would also be less duplication of services because patients won’t be bounced from one hospital to another, as they are now.
“If we had a system in play, we could get them a lot faster and get things to be a lot more efficient,” Roman said.
Under the current system, there’s really no coordination among hospitals, physicians and emergency responders for trauma patients’ care, Smith said.
Last July, Beebe set aside $200,000 for a “trauma dashboard,” a system that allows hospital officials to see on a single computer screen what level of care hospitals statewide are able to provide at any given time.
Before the system came online in November, emergency-room personnel had to call hospitals individually to find the one best able to treat a patient, which often took hours.
While the system has made hospital-to-hospital transfers easier, the state still needs a way for paramedics and other emergency responders to get similar information at an accident scene, Smith said.
Another drawback with the current system is that whether an ambulance or helicopter goes to the scene is typically determined by which company is called first.
“There really is not a system per se right now,” Smith said. “A person may make a local 911 call, and in many cases it may be who that operator happens to call that goes to the scene.” Over the next several months, the Health Department plans to set up a central call center with access to the dashboard information. Call center staff would know which hospitals can do what and which emergency responders are available, Smith said.
They’ll work with the state’s 176 ground ambulance companies and 25 air ambulance companies to make sure the fastest and most appropriate form of transportation gets to the accident scene, Smith said.
“The concept of a trauma system is coordinating communication and coordinating those services to best respond to the individual situations that our first responders have to deal with,” Smith said.
Last week, Beebe released $300,000 to pay for software for another key component of the trauma system: the trauma registry.
Health officials will use the trauma registry to track patients from the time they’re picked up at an accident scene to the time they finish rehabilitation.
It will provide data the state and regional trauma advisory councils need to know about where trauma patients are being treated and the kind of care they’re getting, Smith said.
“What you hear in many cases are anecdotal stories,” Smith said. “We really need to have hard data to look at.”
