Dealing with the trauma

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The calls come: a gunshot victim, a car accident, a fall off a ladder. And they respond – ambulances first, then trauma nurses in the emergency room, then sometimes surgery performed by specially trained doctors.
So far this year, American Medical Response has answered 5,800 trauma calls, with about 116 critical cases.
In each of those critical cases, patients went to Colorado Springs’ two trauma centers, Memorial Health System’s central location and Penrose-St. Francis Health Center.
“Depending on where they are, and the severity of the illness, they also call for Memorial’s Star Flight or Penrose’s Flight for Life,” said Tawnya Silloway, community relations coordinator for AMR.
The paramedics and EMTs are the first responders: their job is to stabilize the patient and get them to the county’s trauma centers for treatment, she said.
“Depending on the injury, there are a number of things we do,” she said. “We put them on a spinal board with collars to keep their body stable. That’s the one thing we do on the scene. Everything else is in the ambulance en route to the hospital.”
That treatment depends on the patient: one or two IVs to increase blood volume or blood pressure, intubation if the patient is having trouble breathing, on a cardiac monitor.
To which trauma center the patient is sent depends solely on where in the city the accident occurs – the fire department and AMR have divided the city in half. In the south, they go to Memorial. In the north, they go to Penrose.
The hospitals and ambulance service have a cooperative agreement that allows for quick diagnosis and quick response for patients.

Colorado trauma levels

The state has five levels of designation for trauma centers and specific criteria for Regional Pediatric Trauma Centers:
Regional Pediatric Trauma Center
Provides the highest level of definitive and comprehensive care for pediatric patients with complex injuries. Emergency physicians, nurses and surgeons are immediately available to the pediatric trauma patient. Regional Pediatric Trauma Centers are responsible for research, professional and community education, prevention and consultative community outreach services and programs statewide.
Level I
Provides the highest level of definitive and comprehensive care for patients with complex injuries. Emergency physicians, nurses and surgeons are immediately available to the trauma patient. Level I Trauma Centers are responsible for research, professional and community education, prevention, consultative community outreach services and programs statewide.
Level II
Provides definitive care for complex and severe trauma patients. Emergency physicians and nurses are in-house and immediately available to the trauma patient to direct patient care and initiate resuscitation and stabilization. A surgeon is available upon patient arrival in the emergency department. A broad range of specialists, comprehensive diagnostic capabilities and support equipment are available.
Level III
Provides initial evaluation and stabilization (surgically if appropriate) to the trauma patient. Comprehensive medical and surgical inpatient services are available to those patients who can be maintained in a stable or improving condition without specialized care. Emergency physicians and nurses are immediately available, and surgeons within 20 minutes, to assess, resuscitate, stabilize and initiate transfer as necessary to a higher level trauma care service.
Level IV
Provides initial evaluation, stabilization, diagnostic capabilities and transfer to a higher level of care. May provide surgical and critical care services as defined in the service’s scope of trauma care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the emergency department.
Level V
Provides initial evaluation, stabilization, diagnostic capabilities and transfer to a higher level of care. May provide surgical and critical care services as defined in the service’s scope of trauma care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the emergency department. The facility must have an after-hours trauma response protocol, if not open 24 hours daily.

Colorado Department of Public Health and Environment

That cooperation is imperative to keeping emergency and trauma costs down, said Mike Fisher, Regis University assistant professor.
“A fragmented system – one that doesn’t offer continuity between the first responders or air flight and the medical responders – can be very expensive in terms of doing unnecessary procedures or wasted time,” he said. “They all need to be interconnected and the trauma centers need to be part of the hospital community.”
The cooperation between all the organizations responding to a trauma lends itself to a systematic approach, he said. That approach can improve the quality of care, as well as reduce costs.
Both hospitals in Colorado Springs have level-two trauma centers, a designation that means the centers offer round-the- clock care, with specialty staff available, but not necessarily staff equipped to handle major trauma.
The state certifies trauma centers with five designations: levels one through five, with an additional designation of Regional Pediatric Trauma center for childhood injuries.
Level one is the highest, and the state’s level-one facilities are in Denver. Obtaining the designation is time consuming and expensive, Fisher said.
“The difference between level one and a level two is that level one has the equipment and specialty surgeons at the hospital 24 hours a day, seven days a week,” he said. “On days when there isn’t a trauma situation — that can get expensive.”
Hospitals designated level one also have some degree of teaching and research capability, said Memorial Health Center spokesman Chris Valentine.
Level two programs offer the same services as a level one, but without the research segment. Emergency physicians are in house and immediately available to the trauma patient. A surgeon is available upon patient arrival in the emergency department, and the hospital “offers a broad range of specialists, comprehensive diagnostic capabilities and support equipment,” according to the Colorado Department of Public Health and Environment, the agency responsible for credentialing the trauma centers.
Memorial is the busiest level-two center in the state, and the second-busiest trauma center overall, said Dr. Andy Berson, assistant director for trauma services at the hospital.
“We admit about 2,000 patients a year,” he said. “Only Denver Health is busier than we are.”
The center recently underwent an additional verification, obtaining level-two status with the American College of Surgeons’ program.
“The new verification covers quality of care issues, something that the state doesn’t rate,” Berson said. “Getting this verification shows that we are providing a very high quality of care. Not every center even attempts to get the verification, and we’re the only center in Colorado Springs that has it.”
Memorial sees all sort of emergency care situations: blunt trauma, falls and car accidents. About 20 percent of its patients are “penetrating injuries” – gunshot or knife wounds.
Penrose sees about 1,200 patients a year, and also has a cooperative agreement and training with the region’s emergency medical personnel, said Eric Schmidt, director of education for Penrose’s trauma center.
The hospital checks daily for trauma patients, ensuring they are receiving treatment according to the state-issued protocol. The group also participates in and sponsors a regional conference in Limon called the Plains to Peak conference, which provides training for EMS first responders throughout the region.
Amy.Gillentine@csbj.com