Arkansas' Trauma System Sees Improvement Since Inception

STAFF PHOTO Michael Woods • @NWAMICHAELW Dispatcher Amanda Kuykendall works Thursday at Central EMS headquarters in Fayetteville. The Trauma Dashboard, seen in the top right, gives dispatchers the status of area hospitals to help them decide the best medical facility to take patients.
STAFF PHOTO Michael Woods • @NWAMICHAELW Dispatcher Amanda Kuykendall works Thursday at Central EMS headquarters in Fayetteville. The Trauma Dashboard, seen in the top right, gives dispatchers the status of area hospitals to help them decide the best medical facility to take patients.

FAYETTEVILLE -- Even the best trauma center can only help patients who reach it, so weather often drives decisions about trauma care in Northwest Arkansas, organizers said.

"Most of the time, we're going to take a patient to Washington Regional Medical Center," said Becky Stewart, vice chairwoman of the Northwest Arkansas Trauma Regional Advisory Council and chief of Central EMS, the largest ambulance service in Washington County.

"We're lucky to have Washington Regional here," she said. Washington Regional is one of only three top-tier trauma centers in Arkansas outside of Little Rock. "They really did step up to the plate when the trauma system got started. Northwest Arkansas is not like other places where you always have to take one type of injury one place and another type of injury another.

"But sometimes, you have to go somewhere else," Stewart said.

Northwest Arkansas works with a hospital in Springfield, Mo., and with St. John Medical Center in Tulsa, Okla.

"If the weather's bad in the west and all right in the north, we can go to Springfield. If the weather's bad in the north and all right to the west, we can go to Tulsa," Stewart said.

Trauma centers are certified by the state as able to treat severe and sudden injuries, even specialized cases.

Arkansas was the only state without a trauma center five years ago when it started putting a system together. The Legislature passed a tax increase on tobacco in 2009 to pay for the system and other medical programs, providing about $20 million a year for trauma care.

Arkansas' rate of death from injuries fell by 3.6 percent from 2009 through 2011 while the national average went up by 3.3 percent, Arkansas Health Department figures show. The Arkansas system has treated more than 50,000 cases since January 2011, state records show.

Trauma care keeps a severely and suddenly injured person alive, and gets him to the appropriate treatment center as quickly as possible.

Which center depends on the injury and whether the needed specialists there are available. Head injuries might need the closest available neurologist, for example. Severe hand injuries are particularly complex and challenging, agreed administrators and emergency service providers. Very severe burns might require evacuation to the Burn Center at Arkansas Children's Hospital in Little Rock, the only comprehensive burn center in the state.

There are five Level I and five Level II trauma care centers that participate in the Arkansas system. All these upper-level centers provide top-level clinical care, but the Level I centers can also provide education and research facilities, such as the University of Arkansas for Medical Sciences in Little Rock.

Three of the Level 1 centers Arkansas relies upon are not in the state. These are Mercy Hospital Springfield, Le Bonheur Children's Hospital and the Regional Medical Center, both in Memphis.

Washington Regional decided to commit to being a Level II trauma center "because this part of the state needed one, and we're the ones who could do it," said Teri Hayden, director of emergency services for the medical center. "We had the specialists and the facilities."

Still, the hospital had to add to its facilities and equipment before it could meet state standards for a Level II. It has six dedicated trauma rooms in its emergency facilities, which have more specialized equipment and supplies at hand than average, said Karen McIntosh, the medical center's trauma program manager.

The state's annual contribution to the trauma centers helps, but it doesn't cover costs, Hayden and other Washington Regional administrators said. Level II trauma centers such as Washington Regional will each receive $522,694 from the state in the fiscal year ending June 30, 2015, state records show.

Washington Regional saw 730 trauma cases last year severe enough to be entered in the state's trauma system, said Terry Fox, spokesman. Each of those cases, by their very nature, were intensive and costly to treat.

"The state funding's not dollar-per-dollar, but it's necessary for us to be able to afford to be a trauma center," McIntosh said.

St. John Medical Center in Tulsa is in the process of becoming a recognized part of the Arkansas system, with Arkansas state inspectors expected to arrive by the spring, said Keith Veit, director of trauma care for St. John. His hospital's participation will provide better support for Northwest and western Arkansas, he said. Hospitals in the region already work together, but joining the Arkansas system will improve that coordination and allow St. John to get some compensation in return for patients it treats from Arkansas.

"As anybody who lives in Northwest Arkansas knows, the weather there comes from Oklahoma," said Veit, a former executive for Northwest Medical Center in Springdale. "By the time the weather is coming down there, it's already clear in Tulsa. It's passed through while it still could be blocking the way to Springfield."

There are also 19 Level III centers, which provide some trauma care, but not some specialties, such as a neurologist. They include Northwest Medical Center-Springdale, Northwest Medical Center-Bentonville and Mercy Medical Center in Rogers.

Another 40 Level IV centers can stabilize a traumatically injured patient and assess the nature of his injuries in detail, but usually have to forward a severely injured patient to another center.

Arkansas' late start in trauma centers proved to have at least one benefit, said Bill Temple, branch chief for trauma injury and violence prevention for the Health Department. The system was statewide from the start. Other states had regional systems with different approaches and procedures that had to be merged. Arkansas' was integrated from the beginning.

The "brain" of the state's trauma system is a piece of computer software known as the dashboard. It's a constantly updated list of what specialized medical services are available at the trauma centers. In practice, the dashboard works in something very close to real time, Stewart said.

A major part of the system and one of its major expenses is helping pay for medical imaging equipment for treatment centers around the state.

"If there's a patient with a hand injury, for instance, we have specialists who can be looking at the scans and images of the injury on a tablet wherever they happen to be," Temple said. "I use hand injuries as an example because they're very complex. It takes a specialist to tell you whether you need to get that patient into an operating room that treats those types of cases right away."

The trauma system has not added any new burdens to the emergency medical technicians and other responders, said William Coker of West Fork and Michael Means of Bentonville, who work for Central EMS. However, they have noticed a trend toward spending more of their time doing transfers.

Most patient transfers between hospitals do not require an ambulance equipped and staffed up to a trauma care level. However, a trauma patient often has to go to the nearest hospital for immediate life-saving care, Coker and Means said. That patient is still severely, traumatically injured when he's ready to go to a specialist at another hospital. That transfer requires a top-tier ambulance and crew.

Driving a burn victim, for example, to Little Rock can take an ambulance out of its service area for five hours. All this can strain schedules and availability, they said. The transfers can mean calling in staff at overtime pay rates and asking neighboring ambulance services for backup.

NW News on 08/08/2014

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