INJURED - Shepherd Center

trauma care
Crisis results from a race against time and
distance with no trauma system in place.
Crisis in Georgia
By Amanda Crowe, MA, MPH
Dialing 9-1-1 in some parts of Georgia, particularly the
rural south, may reveal a tragic reality that many may find
unthinkable in modern society. For people who sustain
catastrophic, potentially life-threatening injuries, there may
be no emergency medical care in the immediate area.
Even worse, there are large geographic areas that have no designated
trauma centers – hospitals with the resources and medical specialists
to handle the most severe injuries. Yet, rapid response from emergency
medical technicians by ground or air, and the distance to the nearest
trauma center are critical factors in saving lives and lessening the likelihood
of permanent disability.
“We don’t have a lot of time to make the right diagnosis and coordinate
care, and patients in these areas are being brought to hospitals with
not nearly the expertise that is needed,” says David Feliciano, M.D.,
surgeon-in-chief at Grady Memorial Hospital in Atlanta, one of only 15
trauma centers in Georgia that voluntarily meet guidelines from the state
and American College of Surgeons’ Committee on Trauma.
“Traumatic injury is random; it can happen to anyone at anytime,” Dr.
Feliciano says. “It’s a daily threat to everyone in a state without a system
in place.”
A small window exists during which traumatic injury can be successfully
treated to prevent premature death and disability. This “golden
hour,” as it is called, begins when the traumatic event occurs, and every
minute lost puts lives in jeopardy.
“If you get hurt in southern Georgia, the ‘golden hour’ of trauma
– which we know saves lives and gives better odds of a critical injury
having better outcomes – is stretched,” says Kathy Slonaker, B.S., R.N.,
Shepherd Center’s admissions liaison for south Georgia. “Every minute
and mile counts.”
A Public Health Threat
Trauma is a major public health problem. It is a leading cause of death
and disability worldwide, and the number four killer in the United
States behind cardiovascular disease, stroke and cancer. According to the
National Center for Injury Prevention and Control, traumatic injuries are
the leading cause of death among people under the age of 44. Georgia
has one of the highest death rates from traumatic injury; as many as 700
lives could be saved each year if the state’s death rate improved to the
national average.
Also, the trauma crisis seriously threatens rehabilitation outcomes for
catastrophic injuries, including brain and spinal cord injuries. For every
person who dies, many more are left with permanent, life-changing disability
because of delayed or inadequate trauma care, experts say.
“We absolutely need to focus on saving lives, but the tale not being
told is about the number of patients who survive. Their long-term prognosis
and outcomes are greatly compromised because they didn’t receive
emergency care quickly enough,” Slonaker says. For patients with possible
spinal cord injury, early immobilization and rehabilitative services to
minimize physical impairment is essential, she adds.
Trickle-Down Effect
As facilities drop trauma services, designated trauma centers are getting
more patients with traumatic injury and seeing a simultaneous increase
in the acuity level, says Grace Rozycki, M.D., director of trauma/surgical
critical care at Grady. Patient care is more complex nowadays because
people often have co-morbidities, are taking multiple medications, and
run the gamut of injuries and care needed. Hospitals have expanded their
intensive care units (ICU), but many still don’t have enough beds for
critically ill patients. This trend reinforces the importance of getting the
right patient to the right hospital at the right time, Dr. Rozycki says.
The trauma crisis in Georgia also has affected Shepherd Center.
“The loss of trauma units has placed an increased burden on hospitals
that offer (trauma) services and, in turn, Shepherd,” explains Andrew
Zadoff, M.D., medical director of Shepherd’s ICU. “Patients are arriving
at Shepherd sicker and sicker.”
What’s Needed?
Severely injured patients need immediate access to specialized surgeons,
physician specialists, anesthesiologists, nurses, and resuscitation and lifesupport
equipment.
“We need an organized, efficient trauma system so all citizens have access
to the best possible care,” says Dennis Wayne Ashley, M.D., chairman
of the Georgia Trauma Care Network Commission and chief of trauma
care at the Medical Center of Central Georgia in Macon. “And it’s not one
hospital, it’s not one stakeholder, this issue affects everyone in our state.”
In 2007, Georgia lawmakers created the Commission, and they are
likely to debate the trauma care issue in the 2009 legislative session.
Advocates for a statewide trauma system stress that uniform, coordinated
trauma services should be available, regardless of the severity of injury,
geographic location or population density.
12 Spinal column
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