trauma
If trauma were a disease, it would qualify as the most devastating in the nation, and in Kentucky. It’s the biggest killer of young people, and although life-saving precautions such as the use of seatbelts and helmets can make a tremendous difference in outcomes, there is no hope for a comprehensive cure. But there is always opportunity for improved care, according to University of Kentucky Chandler Hospital trauma surgeon Dr. Andrew W. Bernard, and the state of Kentucky has taken a great leap in that regard with the development of its first official statewide coordinated trauma system.
During a trauma and emergency medicine symposium held at the Crowne Plaza Lexington in October, 10 hospitals were recognized as participants in the new Kentucky Trauma System. Bernard, who serves as chair of the State Trauma Advisory Committee, considers the new system to be the most significant advancement in the health of Kentuckians in the past 20 years.
“Trauma is the No. 1 cause of death in young Kentuckians under the age of 45. And we know that trauma not only causes deaths, but trauma costs our society more lost productive life years than cancer and cardiovascular disease combined,” Bernard said. “The system will reduce mortality, it will reduce deaths and it will improve outcomes, once it’s matured. It’s still pretty young.”
The new system establishes a network of four levels of trauma centers, based on the services that each center provides.
Level I trauma centers, which include UK Chandler Hospital and Kentucky Children’s Hospital in Lexington along with University of Louisville Hospital and Kosair Children’s Hospital in Louisville, Ky., provide the greatest extent of trauma care services. Level IV trauma centers offer high-quality initial care locally with efficient transfer to a higher level of trauma care as necessary. Level I, II and III trauma center designations are verified by the American College of Surgeons (ACS) Committee on Trauma based on the resources available at those centers, and the State Trauma Advisory Committee has established its own criteria for the Kentucky system’s Level IV centers.
In addition to the Level I centers listed above, the following Kentucky trauma centers have been recognized as part of the statewide system: Ephraim McDowell Regional Medical Center in Danville, Ky. (Level III); Taylor Regional Medical Center in Campbellsville, Ky. (Level III); Ephraim McDowell Fort Logan Hospital in Stanford, Ky. (Level IV); James B. Haggin Memorial Hospital in Harrodsburg, Ky. (Level IV); Livingston Hospital in Salem, Ky. (Level IV); and Marcum & Wallace Hospital in Irvine, Ky. (Level IV).
Kentucky lags behind many other states in the establishment of a statewide trauma system, which Bernard likened to the business plan of any successful company.
“You wouldn’t run a business without a business plan, so why would we do trauma without a plan?” Bernard said. “The trauma system legislation has simply established a plan, if you will, for how we are going to do trauma care in this state.”
In March 2008, the Kentucky legislature passed House Bill 371, which established the initial framework for the new system and encouraged the establishment of trauma centers and the drafting of written transport protocols for EMS providers to use in determining patient transfers. The new system will also offer better and more standardized education for providers ranging from paramedics to hospital administrators.
Bernard said that in addition to improving the coordinated response to trauma care in the state, he sees many opportunities for improvement in emergency care, particularly for acutely ill children and older patients.
Dr. Mary Fallat, professor of surgery at the University of Louisville and surgeon in chief at Kosair Children’s Hospital, has worked toward the establishment of the statewide trauma system for more than a decade. Also, through a grant funded by the Health Resources and Services Administration on behalf of the Kentucky Board of Emergency Medical Services, Fallett has been working to assess and improve the readiness of the state’s emergency departments to take care of children.
Currently, the only two verified pediatric trauma centers in Kentucky are UK Children’s Hospital and Kosair Children’s Hospital, Fallat said. All of the trauma centers in the new statewide system have to at least be capable of stabilizing and transferring a pediatric patient, in addition to having transfer agreements in place with a higher level of care to get patients transferred more expeditiously.
“Part of the future of this grant is to try to develop a tiered emergency system for children in the state, where we understand, just like trauma systems, where there are competent emergency departments to take care of children,” Fallat said.
Bernard said he would like to see more Kentucky community hospitals becoming Level IV centers, which means that the facility has been externally audited to verify that it meets the criteria and the established threshold for performance, and Bernard hopes to see a few more Level III centers as well.
“You don’t have a surgeon there [at a Level IV center]; that’s OK,” Bernard said. “If you turn up at a Level IV trauma center, they are going to know when you don’t belong there, which is just about as valuable as bringing all the resources to bear.”
As an example, Bernard pointed out that while Marcum & Wallace Hospital was establishing its qualification as a Level IV trauma center, it was able to cut its ER length of stay by 75 percent for patients who required referral to a Level I center.
Bernard said there are many examples of great and well-established trauma care in the state, but the new system will help to improve the consistency of that care across Kentucky and ultimately, to get
“the right patient to the right place at the right time.”
“Before, we had islands of excellence in a sea of unpredictability,” Bernard said. “The system is going to establish standard work for how we do trauma care in the state, and ultimately, that will save lives.”