Planned Ark. trauma system could save hundreds yearly

By Carolyne Park
The Arkansas Democrat-Gazette

LITTLE ROCK, Ark. — A statewide trauma system would save the lives of 200 to 600 Arkansans who die each year because they can't get needed emergency care fast enough, health officials told legislators Wednesday.

More than 2,000 people in Arkansas die each year from motor vehicle accidents, fires or other trauma-related injuries.

"The leading cause of death for people between the ages of 1 and 44 is injury," Dr. Paul Halverson, director of the Arkansas Department of Health, told the Hospital and Medicaid Study Subcommittee.

For emergency medical personnel, it's a daily race to get those critically injured patients to facilities best able to treat them within 60 minutes, said Dr. Samuel Smith, director of trauma at Arkansas Children's Hospital.

It's a race that's all too often lost because Arkansas doesn't have a statewide system for quickly routing critically in- jured patients to the nearest facility able to provide the best care, said Smith, who is also interim chairman of surgery at the University of Arkansas for Medical Sciences.

After more than 15 years of talking about it, it's time for Arkansas to have a trauma system, he said.

"Six patients die every day in the state because of trauma," Smith said. "We can't wait another five years." Arkansas is the only state without a Level I trauma center and one of only three states without a trauma system. South Dakota and Kentucky don't have trauma systems, but both states are considering legislation this year to establish them.

A statewide system is moving closer to fruition after efforts late in last year's legislative session failed over a stalemate between the House and Senate on how to pay for it, said subcommittee Co-Chairman Sen. Tracy Steele, D-North Little Rock.

"We pretty much ran out of time," he said.

Now the subcommittee of the Arkansas Legislative Council has eight months to evaluate the state's needs and develop a proposal for the Legislature. People on all sides of the issue agree that a trauma system is needed, Steele said. Legislators now need to know how it would work, how much it would cost and how it would be paid for.

"We all know the need," Steele said. "We've got to come together and do this." Arkansas has some of the highest fire-related and motor vehicle accident death rates in the country, said Dr. James Graham, professor of pediatrics at UAMS and chief of emergency medicine at Arkansas Children's Hospital.

According Centers for Disease Control and Prevention statistics, Arkansas also has the highest rates for motor vehicle accidents at 27.4 per 100,000 annually, compared with a national average of 14.7 per 100,000.

The rate of children's deaths from motor vehicles in Arkansas is double the national average with 7.9 deaths per 100,000 residents compared with a national average of 3.6 per 100,000.

"We know well that there are preventable deaths every day," Graham said. "Having a trauma system is about getting that severely injured patient to definitive care within that golden hour." Structurally, health care officials know how a trauma system would look, Halverson said. The Governor's Trauma Advisory Council has developed criteria for hospitals to be designated as Level I-IV trauma centers based on the level of emergency care they would provide.

Patients would be taken to the closest, most appropriate facility based on the level and type of injury.

"It's not one facility," Halverson said. "It's how everyone comes together that makes this work." Those criteria are now out for public comment.

The council's next task is to develop a funding proposal, he said.

Level I trauma centers would likely include UAMS, Arkansas Children's Hospital and The Regional Medical Center at Memphis, Smith said.

The Regional Medical Center, or The Med, is a Level I trauma center that serves patients from eastern Arkansas. The hospital treated 1,966 Arkansans last year, at an estimated loss of $10.5 million, said Sylvester Reeder, the hospital's chief executive officer. Reeder urged legislators Wednesday to increase reimbursement to the hospital to better keep up with costs. He estimated the hospital needs an additional $3 million to $5 million from Arkansas.

"No matter what you hear, The Med is an Arkansas hospital that is going to take care of Arkansas residents," Reeder said. "We're not going to abdicate that responsibility. We've made a commitment to Arkansas and we're going to continue that commitment." Aside from Level I centers, the bigger question would be what facilities would step up to be Level II and III trauma centers, responsible for providing about 90 percent of trauma care, said Dr. Charles Mabry, trauma surgeon at Jefferson Regional Medical Center in Pine Bluff. Mabry, a member of the Governor's Trauma Advisory Council, said hopes are there would be as many as eight Level II and eight Level III trauma centers in the state.

Arkansas' one advantage in having waited so long is that legislators can examine what has been done in other states, Halverson said.

"We don't have to reinvent the wheel," he said.