By Carolyne Park
The Arkansas Democrat-Gazette
LITTLE ROCK, Ark. — The Arkansas Trauma Advisory Council on Thursday approved 68 hospitals to begin the process of becoming trauma centers under the state’s new $25 million trauma system.
The unanimous vote means that the Arkansas Department of Health can move forward with getting legislative approval for start-up grants to those hospitals. The first grants, expected to be given in early November, will range from $25,000 to $500,000. The money will help hospitals pay for additional staff, training or equipment that they’ll need to meet state standards under the new system.
Thursday’s vote was an “important milestone” in building a trauma system, said Dr. James Graham, council chairman and chief of emergency medicine at Arkansas Children’s Hospital in Little Rock.
“Everybody is stepping up,” Graham said. “It’s really remarkable that the vast majority of hospitals in the state are going to participate in the system.” Signed into law by Gov. Mike Beebe on March 13, the trauma system will link hospitals, first responders and other emergency medical services with statewide communications systems and a common set of rules to guide emergency care. The goal is to ensure that patients throughout the state get the care they need as quickly as possible after a car accident, gunshot wound or other traumatic injury.
Now, patients in many parts of the state are taken to the nearest emergency room, even if they have severe injuries - such as head wounds - that can’t be treated at that facility.
Under the trauma system, patients will be routed directly to hospitals capable of treating their particular injuries.
The system has a $25 million budget for the fiscal year that started July 1, and $28 million for fiscal 2011. It’s being paid for through an increase in state cigarette and tobacco taxes that took effect March 1.
Getting much of the trauma system in place is expected to take more than a year, but emergency medical services in many parts of the state are already getting better, said Dr. Charles Mabry, a council member and trauma surgeon at Jefferson Regional Medical Center in Pine Bluff.
“We’re already seeing positive effects,” Mabry said. “I think the improvements around the state will be measurable over the next few months and the next two to three years.” Hospitals and other emergency responders are making changes as they review their operations and move toward meeting the state’s standards, said Jamie Carter, council member and chief executive officer of Crittenden Regional Hospital in West Memphis.
“It’s raising the bar in respect to care,” he said. “There’s a level of discussion that’s happening in the state that’s not been had before.” Hospitals participating in the new system will be designated as Level I, II, III or IV trauma centers, depending on the level of emergency care they can provide. Being a trauma center involves an entire hospital, not just the emergency department.
The designations are: Level I, which will provide the highest level of trauma care. These centers are required to have general and specialized surgeons 24 hours a day able to treat patients with the most severe and complex injuries. Level I centers also have to do research, education and community outreach aimed at preventing injuries.
Level II, which must also have general and specialty surgeons available around the clock but aren’t required to do research or have a surgical residency program.
Level III, which don’t have to have as many specialists on hand but must be able to provide emergency resuscitation, surgery and intensive care of most trauma patients.
Level IV, which are required to have a trauma-trained nurse 24 hours a day and an emergency physician on call. Their role is to stabilize patients injured in remote areas before the patients are transferred to higher level facilities.
Five hospitals are seeking Level I status, including three from out of state. Another five hospitals are seeking Level II status, 19 are seeking Level III and 39 are seeking Level IV status.
“We are very pleased with the number of hospitals that are participating,” said Bo Ryall, executive vice president with the Arkansas Hospital Association. “We wanted to have a statewide system, and that’s what we’re getting.” Carter with Crittenden Regional led the council subcommittee that reviewed hospital applications. All 68 that applied were approved. It was a process that took several meetings over the past month, he said.
Donnie Smith, director of the Health Department’s Center for Health Protection, said now the grants must be approved by a subcommittee of the Arkansas Legislative Council, which will meet in early October. Once approved, the Health Department will finalize agreements with the hospitals Nov. 1 and begin sending out the start-up grants.
Level I hospitals are eligible for $1 million, Level II for $500,000, Level III for $125,000 and Level IV for $25,000. The grants in November will be for half of those amounts - with the exception of hospitals applying for Level IV, which will receive the full $25,000. Hospitals applying for the other levels will receive the second half of the money once they meet state standards and undergo on-site reviews, Smith said.
Hospitals applying for Level I will have 18 months to meet the state’s criteria, while all other hospitals will have a year.
The Health Department will continue to take applications from other hospitals wanting to be part of the system. Ninetyone hospitals are eligible.
“The system’s goal is to have all hospitals be part of the system,” Smith said. “I can’t imagine there would ever be a time when we would refuse an application. That door is not closed.” In the meantime, the Health Department is developing a request for proposals for a central call center for the trauma system, which would field calls from around the state, help coordinate services and direct where trauma patients are sent. State officials are reviewing similar centers in other states and hope to begin asking for bids within about 60 days, Smith said.
The department is also hiring a branch chief to serve as administrative director of the trauma system and expects to have that position filled soon. Plans also call for hiring a medical director for the system, but Dr. Kent Westbrook, who’s already serving in that role, has agreed to stay on through the end of the year, Smith said.
A trauma registry - to track trauma patients from the time of injury through rehabilitation - is also in the works. The department has purchased the hardware and software for the registry, and is working with contractor Digital Innovation Inc. of Forest Hill, Md., with hopes of getting that equipment out and beginning training at hospitals around the state within the next few months, said Lynda Lehing, section chief for the Health Department’s hospital discharge system.
Each item is just one piece of a “big, big pie” that will ultimately make up the trauma system, Graham said.
“We have a long way to go yet, but I think we ought to be pretty pleased with our progress so far,” he said.
Mabry, with Jefferson Regional, said he’s glad to see widespread support for the system.
“When we started this process a few years ago, we didn’t expect this level of participation on the front-end,” he said.
Arkansas trauma system The Trauma Advisory Council on Thursday approved all 68 hospitals that applied to begin the process of becoming part of the state’s new $25 million trauma system. The system will improve coordination of hospitals and emergency responders statewide to ensure that patients are taken quickly to the closest facility best able to treat their injuries. Participating hospitals must now work to meet state standards and undergo site reviews before they can be formally designated as Level I, II, III or IV centers, depending on the level of emergency care they can provide.
Level I centers must be able to provide the highest level of care with general and specialized surgeons on-site 24 hours a day to treat people with the most serious and complex injuries. On the other end, Level IV hospitals must have an emergency physician on call and will be responsible for treating the least-serious injuries or stabilizing more serious patients before sending them on to a higher level center.
Copyright 2009 Little Rock Newspapers, Inc.