As it establishes its trauma system for coordinated emergency care, Arkansas continues to recruit or encourage participation of out-of-state hospitals to provide levels of care or specialists lacking in certain pockets of the state.

CoxHealth, a Springfield, Mo.-based hospital system, is the latest outside group to apply to the state for participation in its system. Its proximity to parts of northern and Northwest Arkansas is key.

It is expected to seek the highest designation as a Level I provider.

“There are parts of the state that are probably underserved by higher level hospitals, like the Level Is and IIs, so that it would be closer for them to go to, say, the [Regional Medical Center] in Memphis or St. John’s in Springfield,” said Bill Temple, branch chief for injury prevention and control with the Arkansas Department of Health.

Having more hospitals in the system could help when a hospital such as Washington Regional Medical Center in Fayetteville, a Level II facility, is swamped.

“If they’re overburdened in a given moment, it’s nice to have that Level I facility sitting up there in Springfield that could take those patients,” Temple said.

The variety of specialists also is a factor, said Jamin Snarr, chairman of the Northwest Arkansas Trauma Regional Advisory Council, one of seven regional trauma councils that serve as local advisers for the Governor’s Trauma Advisory Council.

“We would like to have all our patients stay in Arkansas so they can be near their families,” Snarr said. “But not all hospitals have the specialty areas, so we share those. Whoever has the specialty will often take the patients.”

Even before the trauma system is fully functioning, he said, Arkansas hospitals sometimes take patients other states can’t serve. Hecited examples that other regions turn to Northwest Arkansas hospitals when hand surgeons are needed, and Arkansas sends pelvicfracture cases to hospitals in Tulsa.

NORTHWEST NEED

Jami Blackwell, trauma program manager for Cox-Health, said it applied inMarch to become part of Arkansas’ trauma system, seeking a Level I designation.

“If you take a look at the layout of the Level I trauma centers in Arkansas, it appeared there was a need, particularly in the northern and northwestern part of Arkansas,” Blackwell said.

Around the same time, the Missouri group applied in its own state to progress from its longtime Level II status to a Level I, she said.

The health system includes Cox Medical Center, which has a north campus and south campus in Springfield, more than 60 physician clinics and a cancer center, said CoxHealth spokesman Yvette Williams.

The system’s primary service area includes eight Missouri counties, she said, while 12 Missouri counties and Arkansas’ Baxter and Boone counties are in its secondary service area.

Level I and II centers must have general and specialized surgeons available 24 hours a day and be able to treat patients with the most complex injuries.

Blackwell said that while trauma physicians’ expected response times are the same for Levels I and II, Level I facilities must have physicians on the campus 24 hours a day, not just on-call.

“The trauma surgeons do not have to be on campus 24 hours a day for Level II- they can go home,” she said.

Level I centers also must have research, educational and community outreach programs, something that usually only teaching hospitals can provide.

“We do have some research, and we are in the process of expanding our research capabilities - particularly targeting trauma,” Blackwell said.

Level III centers are required to offer fewer specialists and Level IV centers are required to have only a trauma-trained nurse and a doctor on call.

The Missouri not-forprofit health system would be the second Springfield hospital group to join Arkansas’ system.

Of the five hospitals that Arkansas has designated as Level I, offering the highest level of service, three are from out of state: St. John’s Regional Health Center in Springfield; and Regional Medical Center and Le Bonheur Children’s Hospital, both in Memphis.

The other two Level Isare Arkansas Children’s Hospital and the hospital operated by the University of Arkansas for Medical Sciences, both in Little Rock.

All five Level II designees are Arkansas hospitals, whereas the 17 Level IIIs so far include two Texarkana, Texas, hospitals and all 28 Level IVs are withinthe state.

FATALITIES HIGH

Arkansas is among the last states in the country to develop a fully operational system to coordinate injuryrelated medical treatment, state health officials have said.

A tobacco tax increase signed into law in 2009 has financed the Arkansas trauma system’s training grants, hospital improvements and ambulance upgrades.

According to a state report dated Tuesday, Arkansas’ injury-related fatality rate is 29 percent higher than the national average - and 64 percent higher from motor vehicle accidents alone thanks to the state having the 12th-largest rural road system in the country.

“Injury is the No. 1 killer of Arkansans between the ages of 1 and 44,” the report said.

Furthermore, it said, a 2008 study by the American College of Emergency Physicians concluded Arkansas had the worst emergency care system in the nation.

Snarr, chairman of the northwest trauma group, said its members were happy to learn recently that St. John Medical Center in Tulsa had expressed an interest in joining Arkansas’ trauma system.

Though he said there is not much difference in helicopter flight times for Northwest Arkansas patients transported to Springfield compared with Tulsa, the drive time is often significantly shorter for families iftheir loved ones are taken to Tulsa.

A spokesman for St. John, Joy McGill, wouldn’t confirm whether her hospital had been in talks with Arkansas officials about joining its trauma system.

“At this time, St. John wishes to decline comment,” McGill said, adding this could change later “if a point formalizes where more information is available.”

A spokesman for the Arkansas Department of Health, Ed Barham, said it is still working out how it will finish out the trauma system’s out-of-state component.

“We were fortunate in the beginning to have the cooperation of the major players in our system from out of state very early on,” he said.

Northwest Arkansas, Pages 13 on 07/08/2012