Archive for the ‘Emergency Medicine’ Category

Dog Days of Summer Bring Pool Parties and Cookouts but Increase Your Risk for Heat-Related Injury

Monday, July 11th, 2011

The dog days of summer are upon us and with that heat and humidity comes an increased risk for injury.

Recently I ran a 7 miler race through the streets of downtown Baltimore on a hot and humid morning.  During that race, I saw at least one person suffering from what appeared to be heat exhaustion.  Luckily for that runner there was race support nearby and EMS on its way.  Had there not been race support there to cool the runner down with bottles of water he may not have survived.  Running is not the only outdoor summer activity that can result in heat exhaustion or heat stroke.  Any outdoor event in this heat can lead to an emergency situation.  It is important to know how to prevent such heat-related injury from happening but it’s also imperative to know what to do should someone suffer from heat exhaustion or heat stroke because if not properly treated death can occur.

What is Heat Exhaustion?

Heat Exhaustion usually develops after several days of exposure to high temperatures and inadequate intake of fluids. The elderly and people with high blood pressure are prone to heat exhaustion as well as people working or exercising in the heat. Heat exhaustion symptoms include heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea, vomiting, and/or fainting. With heat exhaustion, a person’s skin may feel cool and moist.  Cooling off is the main treatment for heat exhaustion. Drinking cool, non-alcoholic liquids may help as well as taking a cool shower, bath, or sponge bath. Getting into an air-conditioned environment will also help. If the conditions worsen or have not subsided within an hour, seek medical attention. If heat exhaustion is not treated, it may lead to heatstroke which needs immediate emergency medical attention. Call 9-1-1.

What is Heat Stroke?

Heat Stroke is the most severe of the heat-related problems. Like heat exhaustion, it often results from exercise or heavy work in hot environments combined with inadequate fluid intake. Children, older adults, obese people, and people who do not sweat properly are at high risk of heatstroke. Other factors that increase the risk of heat stroke include dehydration, alcohol use, cardiovascular disease and certain medications. Heatstroke is life threatening because the body loses its ability to deal with heat stress. It can’t sweat or control the body’s temperature. Symptoms of heatstroke include rapid heartbeat, rapid and shallow breathing, elevated or lowered blood pressure, lack of sweating, irritability, confusion or unconsciousness, feeling dizzy or lightheaded, headache, nausea, and/or fainting.  If you suspect heatstroke, call 9-1-1 immediately. Then try to move the person out of the sun and into a shady or air-conditioned space. Cool the person down by spraying them with cool water or wrapping them in cool damp sheets. Fan the person, and if possible, get the person to drink cool water.

Tips for Prevention

An article on the Active.com website highlights 10 tips to prevent a heat-related injuries:

1.  Acclimatize – It takes your body time to adjust hot and humid weather.  Just because you can run a 10-miler at an 8-minute pace, doesn’t mean you can do the same when the dog days of summer approach.  The same goes for any outdoor exercise! The American Running and Fitness Association recommends that on your first run in the heat, you should cut your intensity by 65 to 75 percent. Then over the next 10 days, slowly build back to your previous level.

2.  Check the Index – Before you leave the comfort of your air conditioner, check the heat index and air quality index.  The Air Quality Index (AQI) is an index for reporting daily air quality. It tells you how clean or polluted your air is, and what associated health effects might be a concern for you. The Heat Index tells you what the temperature feels like when combining the air temperature and the relative humidity.  Both indexes should be checked before heading outdoors.  Your health depends on it!

3.  Hydrate! Hydrate! Hydrate! – Always remember to rehydrate after outdoor exercise! But it’s even more important to be well-hydrated BEFORE you exercise or spend time outdoors.  Hydration during your run depends on the temperature and the length of your run.  Don’t wait until you feel thirsty to drink. If you’re thirsty, that means you’re already low on fluids. Also, as you age, your thirst mechanism isn’t as efficient and your body may in the early stages of dehydration and you may not even feel thirsty. After 60 minutes of outdoor exercise, you will need to start using a sports drink or supplementing with a sports gel or a salty food such as pretzels. After 60 minutes, you begin to deplete vital electrolytes (i.e., sodium, potassium, etc.). Sodium is needed in order for your body to absorb the fluids you are ingesting and depleted potassium levels can increase your chances of experiencing muscle cramps.  Also, packing an extra bottle of water during outdoor exercise to pour over your head can help increase the evaporation-cooling effect.  Lastly, when you finished exercising, you need to replace the water you’ve lost.

4. Know the Warning Signs – Dehydration occurs when your body loses too much fluid. This can happen when you stop drinking water or lose large amounts of fluid through diarrhea, vomiting, sweating, or exercise. Not drinking enough fluids can cause muscle cramps. When you’re dehydrated, you may feel faint, experience nausea and/or vomiting, have heart palpitations, and/or experience lightheadedness. Runners also need to be aware of the signs of severe dehydration such as heat exhaustion and heatstroke, not only for yourself, but so you’ll be able to identify the symptoms if a fellow runner is experiencing heat-related problems.

5.  Buddy-Up – In the severe heat, be sure to work-out with a buddy. That way you can keep tabs on each other. Sometimes it’s hard to tell if you’re starting to suffer the effects of the heat, but a buddy may be able to spot the signs before its too late.  Plus, working out is always more fun with someone else!

6.  Work-Out Early – If at all possible, get your work outs done in the early morning.  The hottest part of the day is typically around 5p.m.  So, if you can’t work-out until after work, wait until later in the evening.

7.  Go Technical – Wearing light-colored tops and shorts made of technical fabrics will keep you cool and allow moisture to evaporate more quickly.  Staying dry will also help prevent chafing.  Clothing made of Lycra, Nylon, CoolMax and Dry-Fit are some examples of technical fabrics. Be sure to hang dry your technical fabric clothes.  The fabric softener in dryer sheets can actually block up the fabric decreasing its moisture0wicking abilities.

8.  Change Your Route – If your normal running route or work-out spot is treeless, find one that provides more shade.  If this isn’t possible and you have access to a treadmill or gym, head indoors on really hot days.

9.  Lather It On – Be sure to wear sunscreen!! Use a sports sunscreen that is waterproof with an SPF of 15 or higher.  Also, be sure to wear a hat or visor.  This will help keep the sun out of your eyes as well as the sweat out of your eyes.

10.  Have a Plan – Let your family and friends know your running route or work-out location.  If you’re gone too long, they will know where to look for you.  If you are in a rural area or doing a trail work-out, you may even want to pack your cell phone.  Don’t change your plans at the last minute without letting someone know.  It’s better to be safe then sorry!

For additional information on heat related injury and illness, see the National Weather Services heat advisory information page – Heat Kills

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

Thursday, July 7th, 2011

Image from medgadget.com

How many times have you heard about someone entering the hospital healthy, or relatively so, and developing a dangerous infection while hospitalized? What about the number of times that you may have visited your own doctor’s office or your child’s pediatrician’s office and wondered whether the cold you got a few days later was coincidence or the result of having been in the waiting and exam rooms following other sick patients? Have you ever considered what cleaning procedures are done in hospital rooms when one patient is discharged before another takes their place?

In the past, Brian Nash and the other legal bloggers here at Eye Opener have written posts and made mention of the importance of hospital cleanliness and sterility, see the related posts below. We have been involved in cases involving the devastating results of infections. However, everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.

Well, there is news that may make keeping hospitals and other health care environments less germy in the future. Two recent articles have focused on seemingly simple solutions, copper and duct tape, that may have major impacts on infection control.

Copper Surfaces Dramatically Reduce Infections by Killing Bacteria

A Reuters’ article reports that a recent study “presented at the World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland” shows that “replacing the most heavily contaminated touch surfaces in ICUs with antimicrobial copper will control bacteria growth and cut down on infection rates.” According to the Reuters’ article:

[a]ntimicrobial copper surfaces in intensive care units (ICU) kill 97 percent of bacteria that can cause hospital-acquired infections, according to preliminary results of a multisite clinical trial in the United States. The results also showed a 40 percent reduction in the risk of acquiring an infection.

This news could have a profound impact on health-care costs, disease spread, and most importantly lives lost. If hospitals are able to replace some of their current surfaces with copper surfaces, at least in the parts of the hospital that are most frequently the source of infections, there could be a dramatic improvement in hospital-acquired infections.

Hospital-acquired infections (HAIs) are the fourth leading cause of death in the United States behind heart disease, strokes and cancer.

According to estimates provided by the Centers of Disease Control and Prevention, nearly one in every 20 hospitalized U.S. patients acquires an HAI, resulting in 100,000 lives lost each year.

From Reuters

Perhaps even more infections could be prevented if these changes could be made outside of just ICUs. For instance, perhaps copper surfaces could replace highly touched surfaces on sink handles, the doors to hospital rooms, hospital bed rails, or in out-patient surgery centers and long-term care facilities that are not housed within hospitals.

Duct Tape Warnings Keep Others Far Enough Away from Infected Patients

Image from ducttapesales.com

An article from Medicalnewstoday reports that some hospitals are using plain duct tape – just colored red – to achieve a reduction in infection rates from highly infectious patients without having to deal with the hassle and expense of all visitors or hospital personnel who enter the room having to rescrub and use new gowns every time they enter the room of an infected patient. The study looked at highly infectious diseases like C. diff that require isolation of patients and very careful hand washing to avoid spreading the infection. So how does duct tape help?

The Association for Professionals in Infection Control and Epidemiology (APIC) commissioned a study to corner off a three foot perimeter around the bed of patients in isolation. Medical personnel could enter the room unprotected if they stayed outside the perimeter. Direct patient contact or presence inside the perimeter meant a redo of the cleansing process. The concept, called “Red Box” employs red duct tape, a color used as it provides a strong visual reminder to those who enter the room to be aware.

The study found that 33% of all who entered the rooms could do so without the addition of gowns and gloves, saving the environment, hospital and patient costs, and time without compromising the patient or the medical personnel.

From Medicalnewstoday

How Else Can We Reduce Infections?

What ideas do you have for the use of copper surfaces? Do you think that copper surfaces or duct tape could make a dramatic difference in the safety of hospital admission? What about the cost? Do you think that hospitals would pay the upfront costs of replacing surfaces with copper to be able to dramatically cut infection rates? What about other low cost solutions like duct-tape around the perimeter of the bed? Can you think of other low-cost solutions that could minimize infections and maximize safety?

Related Posts:

New federal study finds ‘lax infection control’ at same-day surgery centers

FDA warning to healthcare professionals: use sterile prep pads!

Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Wednesday, May 4th, 2011

Did you know that approximately 20 million Americans suffer from asthma?  Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack.  About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.

Bronchospasm and inflammation: the key features of asthma

This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with bronchodilators such as Albuterol; whereas, airway inflammation is treated with corticosteroids. These two characteristics vary from patient to patient. Most asthma patients have elements of both bronchospasm and inflammation.

If you suffer from asthma, keep in mind that you are the one who best understands just how your problem manifests. You alone are in the best position to provide information to health care providers in order to alert them about a possible asthma exacerbation. This is particularly true when one considers that a physician may have relatively poor knowledge regarding management practices, social background and trigger factors of asthma, among other things.  In part, the difficulty in diagnosing asthma stems from the wide variability in its presentation. Any given patient with this condition can have some or all of the classic asthma symptoms. Asthmatics can have mild deterioration or a severe attack and anything in between.  Therefore, if you have asthma, you must be proactive and communicate all the information you can to your health care provider. To help you have “talking points” when you are having this discussion, you may want to consider including the following topics the next time you see a doctor about your asthma:

1. Appreciate  Your Unique Symptoms

Asthmatic patients will often present with a cough, chest congestion/chest tightness, wheezing, and shortness of breath. Some of these symptoms may be more pronounced than others. The symptoms can change or get worse over time. Some patients may present with only a cough. Depending on the severity of the asthmatic attack, some patients may even present with normal vital signs. On other occasions, some patients could have normal breath sounds and no wheezing or shortness of breath.  For these reasons, you must carefully identify those symptoms, which are characteristic of your asthma exacerbation.

2. Give Your Physician a Complete History

Once you have identified what defines your asthma attacks, make sure to communicate the complete history of your symptoms to nurses and physicians taking care of you.  Tell them when you began to experience symptoms. If you think you are having an asthma attack, say so.  If you had been experiencing asthma symptoms, but which happen to be gone at the time of your doctor’s visit, talk about your recent problems as well. If you are taking asthma medications, identify all medications, the dosage, and the method by which you administer those medications (inhaler vs. nebulizer), your frequency of use, and most importantly, advise your doctor if your symptoms are relieved when you use those  medications. Talk about each of your symptoms, identifying their pattern, triggers, severity, and whether they are relieved by any medications.  Tell your doctor if the quality of your life is impacted by your asthma symptoms.  You may also want to inform your doctor about previous asthma exacerbation, how they presented, and whether you sought medical attention. Whatever you do, don’t assume that the nurse or the doctor will spend the time to question you extensively and get this very important information from you. Take the time and the initiative to tell them yourself.

3. If You Are Concerned About Your Condition, Ask For a Peak Flow Measurement

If you present with symptoms and your doctor rules out asthma without utilizing some objective measure of your respiratory ability, you should be very concerned. Remember that many of the symptoms of asthma can be associated with other non-asthma medical conditions. For example, a cough can be associated with asthma, but it can also be indicative of a cold. To avoid any ambiguity in what you may be suffering from, your doctor should perform a peak flow test. This test is performed with a peak flow meter, which measures a person’s maximum speed of expiration (breathing out).  It is a non-invasive test extremely easy to perform.  The test can objectively identify a respiratory obstruction. Demand this test if you are concerned about your condition! It could save your life.

4. If You Are Found to Have a Respiratory Obstruction, Don’t Leave Without Getting Treatment

If you are found to have a respiratory obstruction of any kind, do not leave your doctor’s office or the emergency department without receiving medical attention.  Generally speaking, you should be given albuterol, which is a bronchodilator. Your peak flow should then be reassessed after each albuterol treatment. Frequently, Albuterol is administered several times per hour with peak flow measurements taken after each treatment to determine your response to the medication. If you continue with a respiratory obstruction, corticosteroids should be considered and administered where indicated.  If you persist with a respiratory obstruction, additional steroids and bronchodilators may also be needed. You may even need to be hospitalized. Whatever you do, don’t leave your doctor or the emergency room if you continue to have a respiratory obstruction.

What’s your story?

If you have asthma, share with our readers the unique pattern of your symptoms.  Your information may well help others who suffer from this condition. Remember, there is not a uniform pattern of signs and symptoms with asthma. They can very widely from patient to patient.

If you would like to learn more about asthma, I strongly recommend reading the Asthma Prevention Guidelines published by the National Heart Lung and Blood Institute.  This publication is comprehensive and very informative. As we always say- the more informed you are about your own health, the better your chances will be in getting the right care.

 

Image from morningsundesigns.com

Clinics and Emergency Rooms: Helpful or Barriers to Good Pediatric Care?

Friday, April 15th, 2011

Image from: denverpost.com - (Photo: istock.com | Photo illustration: Linda Shapley, The Denver Post )

In my last post, I discussed the idea of a medical home and the comprehensive healthcare it is meant to provide. For families for whom insurance, work scheduling or other demands make seeing a doctor during regular office hours difficult, many turn to retail based clinics or emergency rooms to fill-in and provide care. Whether this is in addition to or instead of a primary care provider, it is a reality that many families are using clinics and emergency rooms to fulfill at least some of their healthcare needs.

The difficulty with receiving care in these settings, as opposed to a true medical home, is that the health care providers in these settings do not have a complete medical history or record. Each time there is a problem, a different health care provider is likely to provide care and therefore, the continuity of care is lost. Moreover, if there is a bigger problem or a bigger picture issue for the patient or family, the health care provider is really not able to help make the diagnosis and assist in formulating a care plan. Recently, I have come across a number of interesting articles,which examine some of the other pitfalls of using retail clinics or emergency rooms for care, particularly for children. Their observations and opinions are well worth sharing.

In a recent blog article on kevinmd.com, Dr. Roy Benaroch discusses a variety of reasons why – for good pediatric care – you should avoid retail clinics . He highlights the potential conflicts of interest that exist when a clinic is within a store that also sells prescriptions. He defines good pediatric care as:

Care that looks at the whole child, the whole history, and the whole story. To do a good job I have to review the history, the growth charts, the prior blood pressures, the immunization records, and more. Good care means I’m available for every concern—not just the sore throat, but the “Oh, by the way…” worries that are often more significant than the current illness. Things like “He’s not doing so well in school,” or “I think he looks clumsy when he runs,” or “What am I going to do about these headaches every day?” Every encounter is a catch-up on problems and concerns from before, to be reviewed and updated. Children are growing and developing, and every encounter is a snapshot of their over all well-being that can only make sense if it can be placed into a continuous album. At the retail-based clinic, the encounters are just a quick toss-off: an opportunity for genuinely improving health that’s thrown away.

He also points out the need for providers to be specialized in pediatrics and to be up-to-date on current medical recommendations. Providers in these clinics may be generalists and not up-to-date in the specifics of care for children.

A recent article in the New York Times highlights one potential hazard for children visiting emergency rooms for care – the increased use of CT scans. The article reports that the use of CT scans for children visiting emergency rooms has increased fivefold between 1995 and 2008, such that almost six percent of children visiting the emergency room for care are now receiving the scans. There are benefits and detriments to this increase:

…advances in the technology had resulted in improved image quality that can greatly aid diagnosis of childhood ailments. But the scans expose patients to high levels of ionizing radiation that can cause cancer in later years, and radiation is even more harmful for children than for adults.

The New York Times article goes on to explain that risks are low and the patients who need the scans should receive them. However, it raises an important question in my mind.

The article states that the scans are most often given for “children arriving with head injuries, headaches or abdominal pain.” Certainly, there are plenty of times when a child may visit an emergency room for a true emergency and a CT scan, if warranted, should be done without delay. But, I wonder whether there are also situations in which a child may be visiting an emergency room because of a headache or abdominal pain, which has been persistent and would likely receive a different approach to treatment if first presenting in the child’s medical home rather than an emergency room. In that setting, would a doctor, with the child’s complete history and without other emergencies pressing, chose alternative diagnostic options before ordering a CT scan. The CT scan might still be warranted, but perhaps not as frequently. I am not a medical professional and would not question the judgment of a medical professional, but generally speaking, the value of consistency of care with a primary provider seems prudent whenever it is an available option.

From a personal perspective, I understand that even parents who are the most attuned to the desire for continuous care may waiver when faced with a child in pain during off-hours. Parents who are unable to get their child to the doctor during work hours or whose child suddenly has pain at 9 pm (or 3 am) are faced with an unfortunate decision. While I certainly would take my child to an emergency room for a true emergency, I have chosen many times to wait for our doctor’s office to open in the morning rather than take them to a 24 hour clinic for a non-emergency case of extreme ear pain or similar problem. It is horrible to wait those hours with a child in discomfort; however, I know that in the morning a doctor who has the complete history of the problem will then address the problem. Just this week, I was grateful – again- that we are lucky enough to have a primary care pediatrician, who knows our child,  is comprehensive enough to care for our children, and by seeing “the big picture” can coordinate care immediately with specialists whenever that is warranted.

To me, a physician I can trust, coupled with great practice management, is essential to a pediatric practice where I can feel comfortable taking my kids.  What are some of the things you most value? What about adult primary care providers – are you using clinics and emergency rooms for your primary care or do you have and prefer the continuity of care provided by your personal primary care physician?

Failing Report Card for US Trauma Care: “fragmented, overwhelmed and under-funded”

Thursday, November 4th, 2010

From one of the country’s power trauma centers in San Diego California, Dr. Brent Eastman, Chief Medical Officer, Senior Vice President and Chair of Trauma at Scripps Memorial Hospital, as well as, Chairman of the Board of Regents for the American College of Surgeons (ACS) has sounded the warning alarms loud and clear.

Trauma Care in the US is fragmented, overwhelmed, and under-funded. High death rates in rural areas and a disconnect between existing trauma systems and regional preparedness adds to a bleak picture of the state of trauma care in the US.

Coordinated, regionalized, and accountable trauma systems are proven to get the right patients to the right hospitals at the right time. For victims of major trauma, access to timely,optimal care during the first golden hour has been proven to saves lives, restore function, and prevent disability.

Dr. Eastman is a national and international leader in the development of trauma centers in the US, England, Australia, Brazil, Argentina, Canada, Mexico, South Africa, India, and Pakistan. He has served as chairman on the CDC research steering committee, and the ACS Committee on Trauma Systems. He was a distinguished visiting surgeon in 2007 to the Combat Casualty Program at Landstuhl Medical Center in Germany. In 2009, he delivered the signature speech on trauma care the the annual ACS Clinical Congress. Dr. Eastman is a powerhouse with a powerful message.

  • US TRAUMA IS  FAILING.
  • THERE IS A SHORTAGE OF TRAUMA SURGEONS.
  • NEARLY 40% OF THE US POPULATION IS NOT COVERED BY STATE TRAUMA SYSTEMS. RURAL AND POOR AREAS ARE IN THE GREATEST NEED.
  • 38% OF STATES HAVE NO TRAUMA SYSTEM.
  • 62% OF STATES REPORT STATE FUNDING IS IN JEAPARDY; PROGRAMS ARE UNSUSTAINABLE.

The ACS has made 2 important databases available to the public. Their Committee on Trauma has published the listing of verified US trauma centers, and the National Trauma Databank Annual Report for 2010. Everyone should be familiar with their state’s data. If your state does not have a functional trauma care system during the best of times, then it surely will not function during more difficult times as in the event of a terrorist attack, earthquake, tornado, hurricane, serious fire with casualties, major multi-vehicle traffic accident, or other widespread disaster.

The ACS Committee on Trauma specifically verifies the presence of resources that are defined in Resources for Optimal Care of the Injured Patient. Trauma centers across the country voluntarily participate in the verification process. States where no trauma centers participated or where the resources were not sufficient to sustain even one verified center were Georgia, Florida, Maryland, Arkansas,  Hawaii, New York, Mississippi, Pennsylvania, South Carolina, Tennessee, and Washington.

If trauma centers in these states refused to participate, one must wonder why? Were they afraid of public disclosure of their shortfalls and/or financial troubles? Were they competitively afraid of not measuring up to other states? Perhaps it is poor coordination and communication within the state trauma systems as reported by Dr. Eastman? Or were they simply woefully underfunded and embarrassed?

In the NTDB Annual Report you will find 6 states had only 34% to 66% of the trauma centers submit outcome data. And 8 States had only 0% to 33% of the trauma centers submit outcome data. I have to wonder why there was not 100% participation. New York, Florida, Illinois, and Texas were among the under submitters. Other states included New Hampshire, West Virginia, Iowa, Oklahoma, Colorado, Washington, and Oregon.

It is surprising to me that New York, Florida, and Mississippi, where serious disasters have taken place and are at high risk for recurrence, have the least participation? I would think national trend data on trauma performance and needs would be critical to state and federal funding analysis and support?

As you scan the listing, you will see each state verified resources for Level I, II, and III trauma centers. The levels are determined by the ACS and defined as:

  • Level I – Treats a minimally required number of trauma patients each year. Offers 24 hour emergency treatment 7 days a week by a complete set of specialists including anesthesiologists, emergency and critical care, neurosurgeons, orthopedic surgeons, plastic surgeons, and other specialists. Offers full critical care services in addition to research, preventative, and outreach programs. Must be superior in injury prevention solutions, trauma education, and trauma recovery. Must be a major referral center for the neighboring regions.
  • Level II – Works in collaboration with the Level I center. May not have 24 hour availability of all needed specialists and professionals, but can provide the same trauma care and management as a Level I center. Does not have research or surgical residency programs.
  • Level III – Does not have 24 hour availability of specialists but can provide a comprehensive trauma care with emergency resuscitation, surgery, critical care required by most trauma patients.  Has transfer agreements with Level I and II centers for back-up of severely injured patients.

As you will see, Illinois has only 1 verified Level I trauma center. Alaska, Idaho, North and South Dakota, and Wyoming have no verified Level I trauma centers.

There was a Boston TV news expose in 2008 that revealed a state with some of the country’s finest medical facilities but who could not deliver the proper level of care.  There was a 2007 statewide survey where 62% of the state’s trauma patients didn’t get transported to a trauma center.  83% of patients who needed a helicopter transport didn’t have one called. In 1992 the National highway Traffic Safety Administration recommended Massachusetts set-up a state trauma registry. Data collection began in 2008, 16 years later and one month before the Boston news story broke.

Just do a search in your favorite search engine for trauma center in jeopardy and see all the articles that come up! Astounding.

Kudos to Georgia. I commend to you an article entitled, “The Quest for Sustainable Trauma Funding: The Georgia Story”, by Dennis W. Ashley, MD, FACS, FCCM in the October 2010 Bulletin of the American College of Surgeons. A fascinating read on how the state’s Trauma Services Study Committee responded to dismal 2006 performance and financial data. The Georgia trauma death rate was 20% below the national average; rural area death rates were much higher than the metropolitan rates; only 305 of trauma victims were treated in designated trauma centers; and the state was delivering $250 million in uncompensated trauma care annually. The death rate translated to 700 lives lost that could and should have been saved.

Dr. Ashley concluded, “It is imperative trauma surgeons do not try to develop a system or obtain funding on their own.” In Georgia the surgeons joined forces with the EMS, the Georgia Hospital Association, the Medical Association of Georgia, nursing associations, the Georgia Chamber of Commerce, state and local governments. With a unified directive, a statewide media campaign was begun to first educate the public on the issues, problems, and needs. Next,  the media and surveys were used to determine what Georgians were willing to pay for improved regional and statewide trauma care. These initiatives led to support for 2009 and 2010 legislative bills to fund improved trauma care.  Despite a terrible economy, adequate and sustainable trauma care in Georgia is finally becoming a reality.

It is a call to action in every community to be aware of your local community and region’s healthcare trauma needs and problems. Get involved, get the data!  It’s out there.