Trauma care system improving, but additional funding needed

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Published: December 17,2007

Mississippi has made significant strides with its trauma care network in recent years. But, like the rest of the country, there is a shortage of trauma surgeons and nurses and providing the care can be a burden because of the large number of uninsured patients.

“The number of trauma surgeons produced every year and ones that are available are in short supply given the number of jobs and openings,” said Dr. John M. Porter, professor of surgery, University of Mississippi Medical Center (UMC). “So, it does make it difficult to recruit to Mississippi.”

Currently UMC, the only Level One Trauma Center designated by the state to provide a full array of trauma services, has three trauma surgeons in addition to general surgeons helping out with calls. UMC is also in the process of recruiting additional trauma surgeons and nurses so it can continue to be a Level One Trauma Center.

In addition to people hurt in the Jackson area and surrounding counties, UMC receives patients from throughout the state who are flown in for special care.

Due to legislation passed in 2007, a statewide task force was formed to access trauma care in the state. Porter said the task force report recently presented to the governor and the Mississippi Legislature details issues such as access to care, the number of physicians available, the number of hospitals with trauma centers (the number is greater than the number of physicians who can be recruited to staff the centers) and, most importantly, the need to increase funding so patients will continue to have access.

“About two thirds of the patients we see are from motor vehicle crashes,” Porter said. “Everyone drives, so everyone is at risk for trauma. It isn’t just people who are out in the night doing things they shouldn’t do. Most people are going to work, trying to provide for their family, and happen to have the misfortune of a tragic event.

“We are a service just like the fire department and the police. You would hate to call 911 when your house was on fire and have the fire department not available. It is the same thing when you call 911 for an ambulance and it has no trauma center to take you to.”

Healthcare, including trauma care, is important to businesses when they are considering relocating to a state. Porter said it is hard to recruit and attract new businesses to a state if the trauma system is not top notch.

“From a business standpoint, it is important for Mississippi to have a good trauma system,” he said.

Improvements seen

Bill Oliver, president of Forrest General Hospital in Hattiesburg, a member of the Trauma Care Advisory Council that recently made the report to state officials, said a key finding of the report is that since the creation of the trauma program since 2002, the coordination of trauma care, mortality rates and patient outcome have improved.

“However, the funding that has been created has not increased significantly, and some of the challenges to maintain this program are coming from the need to have additional funding,” Oliver said. “The recommendation is to secure more funding for the hospitals and doctors participating in providing trauma care and burn care. Currently, there is no special burn center in the state. The report does address how we take care of those patients and how burn care can be improved in the future.”

One consideration is how to provide the full scope of services needed from small to large hospitals. Coordination is critical, and trauma regions have been established to help coordinate that care.

“The real challenge has been the lack of hospitals and physicians who participate in trauma care,” Oliver said. “Very few hospitals participate, so the coordination of that care has not reached its maximum potential. What the task force is trying to stress is how to keep those involved that are already providing the services, and how to get others to participate. There are only three hospitals in Mississippi that have 24-hour, seven-day-a-week neurosurgery trauma coverage — the University of Mississippi Medical Center, Forrest General and the North Mississippi Medical Center.”

The strain on individual physicians for trauma care makes it difficult to keep the program going. Trauma doesn’t occur on a routine basis during regular office hours. Accidents often occur on nights and weekends. Many people don’t have insurance and aren’t able to pay for services.

“That is why many hospitals are not able to participate to the full extent,” Oliver said.

Approximately 58% of trauma care is related to motor vehicle accidents. The next biggest category is falls. Timely access to care can make the difference between life and death, and the difference between someone being able to fully recover or remaining handicapped the rest of their lives.

That first hour

“Clinically, an important aspect of trauma care is to provide care within an hour,” Oliver said. “Healthcare in general is important to businesses and their employees, and when accidents occur it is important to have treatment within an hour time frame to get the best outcomes. It is important to reach those patients during that golden hour. From the business perspective, many businesses use transportation. Their employees commute to work, and may use transportation to do their work. Since so many of these trauma cases relate to motor vehicle accidents, it is so important to have an effective trauma system that saves lives when these accidents happen, and reduces complications so we have good outcomes.”

Oliver said he believes Mississippi has been blessed with the trauma efforts that have taken place thus far, and is glad the Legislature and the governor’s office are anxious to find out ways to improve the trauma system and prevent future issues that could occur if trauma care is not adequately funded. Access to trauma care is a national problem, and he believes if Mississippi can address the recommendations made by the task force, it will be ahead of many other states in the country.

Evidence of the importance of the trauma care improvements made in recent years is reflected in mortality rates. For example, the overall mortality rate has dropped from 6% to 2% in the Hattiesburg region.

Trauma care places major demands on hospitals and staff providing the services. Many of the cases are very intense and require significant resources. Physicians and other staff can be called out in the middle of the night, and can be tied up for many hours providing care. Physicians must be on site within 30 minutes after a patient arrives, which can be very disruptive to the physician’s schedule.

“It really does place a major burden on staff and hospitals,” Oliver said. “I think more and more doctors and hospitals will have to see if they can continue to be involved in trauma care. It is very difficult to get the level of participation needed. Really, what trauma is all about is being prepared. You have to be prepared seven days a week, 24 hours per day. The outcomes are very much worth it, but there are undue hardships financially. A lot of these patients are uninsured. Many are required to have long stays. It does make it difficult for many hospitals to participate.”

Smaller hospitals effectively participate by being part of a trauma care region. Smaller hospitals have protocols and transfer procedures to get patients to the right facility as soon as possible. There are 10 hospitals in the Hattiesburg region, and Oliver said each hospital has an important role to play.

“The coordination of where patients go is very important,” he said.

On the Coast

Gary Marchand, CEO of Memorial Hospital at Gulfport, said the level of funding for trauma care in the state is unrealistic. Marchand said funding for trauma care in the state in the past five to 10 years has not increased even while healthcare costs have gone up substantially.

“One of the decisions that is going to have to made is the state is going to have to stop allowing every hospital to be some level of trauma center so they can get some level of trauma reimbursement,” Marchand said. “The state would do well to figure out what communities need to be served by trauma centers, and then designate trauma centers that the state will support. The state needs to go about the business of deciding how many real trauma centers it needs, and how it will support those trauma centers. That is the direction the state needs to be going. Then you can do a better job of targeting trauma support and funding.”

One concern on the Gulf Coast is that Gulf Coast Community Medical Center is closing its emergency room and hospital. The hospital that has operated on the Coast for 31 years is planning to re-open later at a location somewhere north of Interstate 10.

“We had seven hospitals in operation on the Coast, and will now have six,” Marchand said. “The hospital that is closing represents about 14% of our capacity. That is going to have an effect, obviously. We’re not sure how the community is going to absorb that both from the standpoint of the emergency department closing and the medical beds closing.”

The Gulf Coast Community Medical Center said its patient volume was down 40% since before Katrina. The location for the new hospital is confidential until land negotiations are completed.

Contact MBJ contributing writer Becky Gillette at bgillette4@cox.net.

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