Coordinated care in times of trauma

If trauma were a disease, it would qualify as the most devastating in the nation, and in Kentucky. It’s the biggest killer of young people, and although life-saving precautions such as the use of seatbelts and helmets can make a tremendous difference in outcomes, there is no hope for a comprehensive cure. But there is always opportunity for improved care, according to University of Kentucky Chandler Hospital trauma surgeon Dr. Andrew W. Bernard, and the state of Kentucky has taken a great leap in that regard with the development of its first official statewide coordinated trauma system.

During a trauma and emergency medicine symposium held at the Crowne Plaza Lexington in October, 10 hospitals were recognized as participants in the new Kentucky Trauma System. Bernard, who serves as chair of the State Trauma Advisory Committee, considers the new system to be the most significant advancement in the health of Kentuckians in the past 20 years.

“Trauma is the No. 1 cause of death in young Kentuckians under the age of 45. And we know that trauma not only causes deaths, but trauma costs our society more lost productive life years than cancer and cardiovascular disease combined,” Bernard said. “The system will reduce mortality, it will reduce deaths and it will improve outcomes, once it’s matured. It’s still pretty young.”

The new system establishes a network of four levels of trauma centers, based on the services that each center provides.

Level I trauma centers, which include UK Chandler Hospital and Kentucky Children’s Hospital in Lexington along with University of Louisville Hospital and Kosair Children’s Hospital in Louisville, Ky., provide the greatest extent of trauma care services. Level IV trauma centers offer high-quality initial care locally with efficient transfer to a higher level of trauma care as necessary. Level I, II and III trauma center designations are verified by the American College of Surgeons (ACS) Committee on Trauma based on the resources available at those centers, and the State Trauma Advisory Committee has established its own criteria for the Kentucky system’s Level IV centers.

In addition to the Level I centers listed above, the following Kentucky trauma centers have been recognized as part of the statewide system: Ephraim McDowell Regional Medical Center in Danville, Ky. (Level III); Taylor Regional Medical Center in Campbellsville, Ky. (Level III); Ephraim McDowell Fort Logan Hospital in Stanford, Ky. (Level IV); James B. Haggin Memorial Hospital in Harrodsburg, Ky. (Level IV); Livingston Hospital in Salem, Ky. (Level IV); and Marcum & Wallace Hospital in Irvine, Ky. (Level IV).

Kentucky lags behind many other states in the establishment of a statewide trauma system, which Bernard likened to the business plan of any successful company.

“You wouldn’t run a business without a business plan, so why would we do trauma without a plan?” Bernard said. “The trauma system legislation has simply established a plan, if you will, for how we are going to do trauma care in this state.”

In March 2008, the Kentucky legislature passed House Bill 371, which established the initial framework for the new system and encouraged the establishment of trauma centers and the drafting of written transport protocols for EMS providers to use in determining patient transfers. The new system will also offer better and more standardized education for providers ranging from paramedics to hospital administrators.

Bernard said that in addition to improving the coordinated response to trauma care in the state, he sees many opportunities for improvement in emergency care, particularly for acutely ill children and older patients.

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