Without a trauma center, NWI out of time on 'golden hour'

If the tragic Jan. 8 shootings that killed six in Tucson and wounded 12 others, including U.S. Rep. Gabrielle Giffords, had occurred in Northwest Indiana instead, the outcome would probably have been very different, Indiana health care officials predicted.

That’s because Northwest Indiana has no Level I or Level II Trauma Center to provide advanced trauma care.

When someone is severely injured in a highway or factory accident or suffers life-threatening gunshot wounds, local hospital emergency rooms must first stabilize, then transfer those patients to trauma centers across the Illinois border, or to South Bend or Indianapolis, often sacrificing precious time.

It took only 38 minutes to transfer the severely wounded Giffords from the suburban mall shooting site to a surgical operating room bed at University Medical Center’s Level I Trauma Center, a move most health experts think saved her life.

Indiana Health Commissioner Greg Larkin, M.D., said Giffords, who is recovering well from a gunshot wound to the head, likely would not have survived if she was in Northwest Indiana.

“That doesn’t mean existing local hospitals don’t provide good care,” Larkin said. “It’s just that they are not set up for mass trauma events, like 15 or 20 shooting victims. A normal community hospital would simply not have the staff so readily available to handle this load. Time would be wasted.”

Larkin said studies indicate that patients treated by regional trauma centers enjoy a greater chance of survival and better recoveries, as much as 25 percent, according to the American College of Surgeons, the national expert body that defines the levels of trauma center care and certifies centers.

 “In trauma care they talk about the ‘golden hour’ that patients suffering trauma have to be treated appropriately before getting worse,” he said. “For those traumatized in Northwest Indiana and other areas without trauma centers, the patients and their family members end up going quite far away, adding to the injury afflicted and some loss to the local economy from money leaving,” he said. “I’m more interested in better outcomes. I’m advocating for the existence of more trauma centers.”

Expensive, but attractive

Trauma centers are hospital emergency departments either designated by a state or other authorities or verified by the American College of Surgeons as capable of providing advanced trauma services.

Larkin, who heads a statewide trauma task force created by Gov. Mitch Daniels, said most of western Indiana, including the Northwest part of the state, lacks access to Hoosier trauma centers. Indiana only has certified trauma centers in Evansville, Fort Wayne, Indianapolis and South Bend. He said the task force is exploring how to create a statewide trauma system. Two years ago, an ACS review team came to Indiana and recommended creating more regional trauma care centers. Larkin acknowledged that the proximity of a trauma center is expanded by helicopters.

“But half the time medical helicopters can’t come to the scene due to weather or lack of staff availability,” he said. “Helicopters should not be viewed as a surrogate for a trauma care center.”

Larkin said some states subsidize trauma center care through funding streams financed by license fees or taxes, but noted Indiana does not. And while he said trauma centers are expensive to maintain, they attract top quality physician specialists to the center.

“But primarily, it would assure better outcomes for those subjected to multiple traumas,” he said, “And it may create a magnet for attracting a broader physician specialist community and stem the loss of revenue from local patients having to leave the area to receive trauma care.” 

Larkin speculated that having a trauma center in Northwest Indiana would not only benefit the community in which it is located, but the entire region, local ambulance services and area hospitals. “Trauma centers offer training opportunities to local medical schools and where providers train often determines where they live and practice, so it could create a larger physician community.”

He also noted that Illinois trauma centers are becoming increasingly selective about the patients they agree to accept, sometimes necessitating transfers to South Bend or Indianapolis.

Could Methodist be a trauma center?

State Rep. Charlie Brown, D-Gary, said there are ongoing discussions and meetings about certifying Methodist as a Level II Trauma Center.

“Methodist has been serving as a trauma center even though it has not been certified,” Brown said. “They are usually able to stabilize patients, but have to ship them out to higher level trauma centers in Chicago, South Bend and Indianapolis.”

Brown said Methodist must rise to meet the qualifications to become eligible to be certified as an ACS trauma center. He said the state needs to be more actively involved in making sure there is a facility here to provide full trauma care services.

“It is something needed locally and the state has not provided the resources and funding to accomplish that,” he said. “I think it should be a state obligation. It would save lives not just in Gary, but throughout Northwest Indiana.”

Nick Johnson, M.D., a board certified emergency medicine physician at Methodist Hospitals Northlake Campus, said his ER could expand to become a Level II trauma center.

“We have the physicians and ER space. And the nurses and staff here are more than capable,” Johnson said. “All we would need is funding to help pay for the advanced specialty care required to qualify for certification as a Level II trauma center. The only thing standing in the way is a few million dollars.”

Johnson said Methodist’s ER would receive the same patients it does now, but also referrals from neighboring hospitals and from bordering counties. For Gary trauma patients and their families, it would mean that instead of transferring to trauma centers one to two hours away, they could be treated near home.

Level I trauma centers provide the highest level of surgical care, offering a full range of specialists and equipment available 24 hours a day and must treat a minimum required number of severely injured patients annually. They must staff surgeons and anesthesiologists and have other specialists, like neurosurgeons, orthopedic surgeons and plastic surgeons available. They typically require minimum case volume, research and residency programs.

Level II trauma centers provide comprehensive care in collaboration with Level I centers and must provide around the clock availability of essential specialties.

A Level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients.

Joanne Conroy, M.D., Chief Healthcare Officer of the Association of American Medical Colleges, said more than 60 percent of advanced level trauma centers are located in teaching hospitals. “It’s one of the special things teaching hospitals do, and one of the reasons they are so successful is they have specialists available 24/ 7.”

Doug Leonard, president of the Indiana Hospital Association, said it would be difficult for Methodist alone to launch a Level I or II Trauma Center independently. “Methodist would have to lead a collaboration of local hospitals and other entities to do that. Trauma centers need to staff surgeons around the clock and that’s increasingly difficult to do in communities where the depth and strength of the medical staffs are not as great,” Leonard pointed out. “Usually trauma care has to be subsidized somehow.”

He said many hospitals offering advanced trauma care also offer high tech expensive specialty care services, such as transplant programs, that subsidize the trauma services. It takes a large sphere of influence and critical mass to create something like that. It would be a great thing for Northwest Indiana, but you can’t take lightly the obstacles in getting it done.”

Gene Diamond, CEO of the Northern Region of the Franciscan Alliance, which operates five hospitals in Northwest Indiana, said there is a genuine need for a Level I or Level II Trauma Center in Northwest Indiana.

“It is true that downtown Chicago trauma centers are refusing to accept Indiana Medicaid patients,” said Diamond. “And having a local trauma center in place would mean better, quicker and more comprehensive care for certain kinds of trauma patients. I don’t think local hospitals would oppose it. Overall, it would improve the quality of care and save lives if a local trauma center would treat our patients.”

But Diamond cautioned that a regional trauma center is costly to maintain and questioned whether there are enough severe trauma patients with insurance to sustain the infrastructure. He said his system’s sister hospital, St. James, closed its trauma center in 2009 because it could no longer afford to operate it. He said staffing trauma centers with top notch surgeons and nurses can financially strain a hospital.