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Trauma center solution sought

July 07, 2002|by DAN KULIN /Staff Writer

dank@herald-mail.com

When Erica Loveland fell from the High Rock hang-gliding launch site in May 1999 there was no question she would be brought to Washington County Hospital. It was the closest hospital, and it was a trauma center, capable of providing the most critical emergency medical care.

As Loveland, now 22, was taken by helicopter from the scene of the accident in northeastern Washington County to the hospital in Hagerstown, her condition worsened. By the time she arrived at the hospital, Loveland was barely breathing.

If Loveland - who suffered a fractured skull, a broken jaw and severe bleeding - had been taken to a hospital farther away, "she would have died," said Dr. Thomas Gilbert, chief of emergency medicine at Washington County Hospital and the first doctor who treated her.

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The hospital was designated a trauma center based on the round-the-clock availability of surgeons and other trauma personnel. Effective June 1, the Hagerstown hospital no longer carries that designation. It was suspended because there were not enough trauma surgeons available to cover the hospital 24 hours a day.

Now, critically injured patients like Loveland - who are taken to the closest hospital to be stabilized - would still be transported first to Washington County Hospital, but would then be taken to a trauma center elsewhere for further treatment.

Hospital officials hope to restore the hospital to trauma status, and a community task force has been formed to look into the matter.

Meanwhile, there are public concerns about how emergency medical transport services are being affected by the rerouting of patients to trauma centers elsewhere, and about the potential impact on the patients.

Loveland's mother, Louise Loveland, believes her daughter would not have survived being routed to another trauma center - mostly likely the University of Maryland Shock Trauma Center in Baltimore.

"If she had gone to Shock Trauma, she would have died," Loveland said.

Time of the essence

Washington County Hospital was first designated a trauma center in 1981. In 1996, the hospital was designated a Level II trauma center, which means there is a trauma surgeon at the hospital at all times and other surgical specialists are on call 24 hours a day.

For a Level III trauma center designation, the hospital must have trauma surgeons and other surgical specialists on call at all times.

Robert Bass, executive director of the Maryland Institute for Emergency Medical Service Systems, said a key to good trauma care is getting patients into a trauma center quickly. The institute is the agency that designates trauma centers.

The goal is to get patients to a trauma center within the so-called golden hour, said Bass, who is also a member of the local task force.

"The golden hour means if a patient can get into care within an hour, the likelihood of a good outcome is better," said Maryland State Police Maj. Donald Lewis, commander of the aviation division that flies patients from accident scenes to hospitals.

Trauma patients from the Washington County area are now being taken to trauma centers in Cumberland, Md., Bethesda, Md., or Baltimore. Lewis said those trips take from 20 to 30 minutes longer - up to an hour altogether.

The time difference would be even greater if the helicopters were grounded because of bad weather and patients had to travel by ambulance.

"From Washington County to any of the trauma centers will take at least an hour," said Brigitte Heller, emergency medical services specialist for the Washington County Volunteer Fire and Rescue Association.

So far, ambulances have not been used to transport trauma patients outside county, she said.

"But with winter and bad weather coming, the helicopters will be flying less," Heller said.

Flights increase

For now, the helicopters are the fastest way to get a patient to a trauma center, and they are flying more.

Lewis said helicopters transported 41 patients to the hospital between June 1 and June 26. Twenty patients were flown to the hospital during the same time last year.

The increased flights and flying time are "not a big deal" for now, Lewis said.

"But if it goes on for nine months to a year, it could have an impact," he said.

He cited the need for more maintenance on the helicopters as among the concerns.

Bass said there has been little impact on other trauma centers.

Last year, about 750 trauma patients were taken to Washington County Hospital, and about 500 were admitted, he said. The remaining trauma centers have been able to absorb the additional patients.

The loss of the trauma center designation at Washington County Hospital can also affect patients' friends and family, Bass said.

Louise Loveland said her daughter's recovery benefited from all the visits from friends and family during the roughly six weeks she spent in the hospital.

"Hundreds of kids came through to see Erica, and I lived in the room for days," Louise said. "That, as much as the health treatment, helped Erica's recovery."

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