April 8, 2015
Trauma Care, Unavailable to Many, Suffers Inconsistent Quality and Inadequate Capacity
BY Mary Mahoney
Nearly 45 million Americans do not have access to a Level I or II trauma center, even though treatment of serious injuries at such a facility can lower the risk of death by 25 percent, according to the Centers for Disease Control and Prevention.
Lack of availability, primarily attributable to distance from the nearest center, is compounded by inconsistent quality and inadequate capacity, notes Kenneth W. Kizer, director of the Institute for Population Health Improvement at the University of California, Davis. Worst, some seriously injured people are not treated at trauma centers even when they are within reach.
So, do we need more trauma centers, better trauma centers or better directions to a trauma center? And what makes a trauma center superior to a standard hospital emergency room?
A trauma center is defined as a specialized treatment center capable of handling the most critical injuries, with specialists available 24 hours a day, seven days a week, state-of-the-art resuscitation rooms and helicopter transport. Orlando Health’s Orlando Regional Medical Center offers the only Level I trauma center in Central Florida.
Speed is critical component of trauma care. The “golden hour” refers to the first 60 minutes after an injury when appropriate intervention can mean the difference between life and death.
Advances in military field surgery have also had a big impact in civilian trauma care. “At no time in history have there been so many promising new treatments as during the global war on terrorism,” said EMS World in a recent issue, citing better tourniquets, devices that stop bleeding – notably QuikCLot Combat Gauze – and procedures developed by the U.S. military as part of its Tactical Combat Casualty Care program.
First responders are seeing success with such new technology as stasis foam, developed by the Pentagon’s Defense Advance Research Projects Agency, which expands rapidly in body cavities where a tourniquet could not be applied, stopping bleeding and hardening into a “cast” that can eventually be removed in the operating room.
Despite recent advances in trauma care, there is room for improvement. Failure to send seriously injured patients to trauma centers is a problem, said Kizer of the Institute for Population Health Improvement. “Unfortunately, our ability to understand why under-triage occurs so often is hampered by fragmentation in the systems of care, inadequate data management systems and lack of trauma care performance reporting by non-trauma center hospitals.”
Some institutions are exploring how to make their trauma centers more flexible and improve inter-department coordination. Cedars-Sinai hospital in Los Angeles is designing a futuristic operating room and already has developed a simulated version, supported by a Defense Department grant and consultation with military surgical teams in Europe and the U.S.
The very layout of the Cedars-Sinai trauma center operating room is different. The architecture firm CannonDesign created the space to be “endlessly reconfigurable, by implementing a gridded trolley system on the ceiling that allows the surgical lights, equipment booms and the glass walls to be repositioned or removed altogether.” There are color-coded trauma bays and whiteboards to easily access patient information.
The Cedars-Sinai model has cut the time it takes to capture first radiological images by more than 10 percent and the time to draw blood for first lab tests by more than 20 percent. That may not seem like much, but in the world of trauma care, it can the difference between life and death.