The key part of taking care of a patient injured in an accident is getting them to a medical facility within the “golden hour,” when a patient has the best chance for survival.
But transferring them to just any medical facility may not be enough to save that patient’s life.
“If we can get patients moved to the right hospital where they can do a good job of resuscitating the patient, they’ll do better and have a higher chance of surviving,” said Jim Craig, the state emergency medical services director.
In order to get those patients to the right hospitals, the Mississippi Trauma Care System must be fully established and the entire plan then submitted to the federal government for approval. For now, only transfer agreements have been set up between hospitals to make transfers from one hospital to another easier with less time involved.
Craig is hoping that the State Department of Health will have all the regional plans in by October, and that 30 to 60 days from that time the state’s plan will be finalized. Plans are set to deliver the package to the federal government by January.
“We’re hoping it’s fairly expedient,” he said of the process.
Before the Trauma Care System began, there were no transfer agreements between hospitals.
In the 1998 legislative session, Mississippi lawmakers passed HB 966 to authorize the State Department of Health to develop the Mississippi Trauma Care System. Legislators in that same year also established the Trauma Care Trust Fund using additional traffic violations fines that were expected to raise about $2 million annually. Legislation also established the Mississippi Trauma Advisory Committee (MTAC) by expanding the EMS Advisory Council with trauma professionals.
The 1999 legislative session led to the addition of $6 million to the Trauma Care Trust Fund, making the total about $8 million per year. Legislators authorized annual funding for regional support and indigent trauma care as defined by the Trauma Registry through regional contracts with the Department of Health.
“The money helps offset losses some hospitals would have regarding uncompensated care for trauma,” Craig said.
The seven trauma care regions developed include Central, Coastal, Delta, East Central, North, Southeast and Southwest Trauma Care Systems.
By 2000, the first hospitals received Level I and Level II trauma center designations. Level I offers the highest level of trauma care in the state; Level II offers services similar to Level I, but also includes a residency program and a research component. Level III hospitals offer stabilization to trauma patients so that they may then be transferred to a Level I or Level II hospital if need be; whichever is closest. Level IV hospitals are more rural hospitals that do not have the surgeons or the capabilities to handle trauma care patients.
“By having transfer agreements made up before the patient gets there it’s just a matter of making a phone call,” Craig said. “That significantly reduces the amount of time it takes to move a patient from one place to another. As the system matures, the three hospital ambulance services will be given some triage services and they can make some determination to get the patient to the hospital the patient needs to be taken.
“Once the state has the regional and state plans approved by the government, it replaces that (federal plan).”
The federal plan requires that ambulances take trauma patients to the closest hospital, which may not always be the best choice for the patient. But the state plan, when approved by the federal government, will overrule the federal government’s plan.
“That’s where you’re going to see the biggest benefit, when you can get patients moved much faster,” Craig said.
Currently, the seven trauma care regions in the state are putting the finishing touches on their plans. Once finished they will be sent to the Center for Medicare and Medicaid, where officials there will sign the documents so that Mississippi patients can use the state’s plan, not the Emergency Medical Treatment and Active Labor Act, the federal law.
“If the state has a better plan for their constituency they must have that plan formalized, agreed upon by stakeholders and submitted to the federal government,” Craig said. “So we’re just exercising that provision in the Act.”
Dr. Ed Thompson, state health officer of Mississippi, said although not all the hospitals in the state are participating in the system, all that were expected to be participants already are.
In fact, according to Craig, 87% of all hospitals in the state are involved with the system.
“I have traveled to a couple of meetings around the country and some are amazed we’ve been able to mature a system as fast as we have, but we still have a lot of work to do,” Craig said.
Equally important to providing care, Thompson said, is the collection of data.
“We’re collecting data to allow us to get a better sense of what kinds of trauma we’re seeing and what can be done to prevent that kind of trauma. With a registry we’ll know more about nonfatal trauma. This will allow us to look at trauma on a much broader scale with an eye toward preventing it.”
Contact MBJ staff writer Elizabeth Kirkland at firstname.lastname@example.org or (601) 364-1042.