Leader Blues

Tuesday, July 22, 2008

TOP STORY > >Local legislators help with state trauma centers

By NANCY DOCKTER
Leader staff writer

Seeing the need for a statewide trauma care system is the easy part. Coming up with necessary funding will be the challenge, local lawmakers predict. The $200,000 released by Gov. Beebe earlier this month to pay for a computer system to get the system established is but a fraction of the anticipated total cost.

With injury and heart attack being two leading causes of death in Arkansas, having a system in place that would improve emergency care is essential to public health, state officials say. Although the system could cost as much as $25 million to implement, it could save the lives of 200 to 600 Arkansans every year, according to the state health department.

States with a trauma care system are able to send patients directly to the hospital which has the appropriate services and equipment needed to treat not only a particular type of injury but other medical emergencies, such as heart attack or complications associated with childbirth. It would also avoid delays in transport that can occur when patients are taken to hospitals that are extremely busy.

Arkansas is the only state without a state trauma-care system.

Rep. Sandra Prater, D-Jacksonville, who was a co-sponsor, in the 2007 leg islative session, of a failed bill to fund a trauma system, is excited about the renewed effort to move forward on the idea.

“It is a beginning point to see what is out there in the way of services needed in life and death situations,” said Prater, who is also a registered cardiac care nurse. “These are issues that as a state we must be looking at.”

Prater, who served on the committee where the 2007 bill originated, said that a lot of possible funding sources were explored, including revenues from various types of fines, but no one idea won enough support to get the bill out of committee.

Ideally, the trauma center should be supported by general revenue, says Sen. Bobby Glover, D-Carlisle, another strong proponent of a trauma-care system.

But, lawmakers are wary of taking on big-budget items, even when there is a revenue surplus, in order to avoid future program cuts in the event of a budget shortfall. Glover says lawmakers in the last session were mindful of five such retrenchments that happened during the Huckabee administration due to expectations that exceeded state revenues.

Glover says lawmakers were generally supportive of the idea of a trauma-care system, but arriving at an agreement on funding was the hard part. Because legislators last session implemented major tax cuts, the climate was not good for a proposal that would require considerable long-term funding.

“We had the biggest tax cut in the state history, $200 million, with $135 million cut in the grocery tax,” Glover said. “We tried and tried and tried to come up with the necessary funding, but every time a proposal would come up, we couldn’t get it out of committee.”

Glover said it was hearing from constituents in his district that had been affected by delivery of emergency care that made him such a supporter of a trauma-care system.

“A number of them who have had family members injured would have benefited if we’d had a trauma center in Arkansas,” Glover said. “Instead they had to send them out of state to get the care they needed. A trauma system is a very, very important step in being able to provide Arkansans with the services they need and are entitled to.”

Glover agrees that the challenge in moving forward on plans for the system, after the initial $200,000 is spent, will be identifying funding in the 2009 legislative session.

“That will be the sixty-four dollar question – coming up with funding for the trauma system,” Glover said. This is something that we are going to have to work on with the governor on in the next session.”

The first step towards achieving a fully functional trauma care system is to inventory existing emergency services available at each hospital in the state. The health department is currently talking with providers of computer hardware and software for setting up a database by the end of the year. This data would also help health officials assist closing gaps in emergency care statewide.

But much more than $200,000 will be needed to then establish a centralized communication center that will make it possible to route patients to the hospital with appropriate services and whose emergency room (ER) is able to accept patients at a particular point in time.

The plan is to eventually establish a statewide network of designated trauma-care centers classified according to level of care.

The highest, a level 1, is generally a hospital engaged in research and medical training that provides a wide range of emergency medical services, including numerous surgical subspecialties, as well as prevention and rehabilitation services.

Currently, the closest level 1 trauma center to central Arkansas is in Memphis.

“In that golden hour” right after a life-threatening event occurs, getting a patient to the best possible place for appropriate care is critical to saving lives, as well as the best long-term prognosis,” said Ed Barham, state health department spokesman.

“The system will help EMTs find out in real time where is the best possible place to take that person.”

Statewide coordination of emergency services will definitely enhance the current system that sorts out where patients go, according to Jon Swanson, executive director of Metropolitan Emergency Medical Services (MEMS). The greatest benefit for MEMS will be wider monitoring of incoming ambulances from outlying areas into metro Little Rock, which then impacts decisions by MEMS about what hospital to use at a particular point in time.

“The system will provide a more clear and expedited way to get patients to the appropriate care and as quickly as possible, not just trauma, but other significant medical events,” Swanson said. “MEMS already has a very clear set of rules and regulations – a protocol – used on every run, that every paramedic knows, and it works very well. But, a trauma system will make optimal use of existing services and will enhance those services with centers having designated levels of care.”

Swanson hopes that legislation to fund a trauma-care system will include provision for ambulance services which have experienced federal funding costs. Rural areas especially operate with minimal emergency medical-transport services, in some cases, with only two ambulances for an entire county, Swanson said.