By Tom Kisken
The Ventura County Star
VENTURA COUNTY — A motorcyclist is tossed from his bike on the 101 about one mile west of the church bell tower in Camarillo. He breaks several ribs and suffers enough back damage that he can’t feel his arms.
Instead of being rushed by ambulance to closer hospitals in Camarillo or Oxnard, the patient would be taken across the Conejo Grade, up Lynn Road, to Los Robles Hospital & Medical Center in Thousand Oaks, 12.1 miles from the original accident. Trauma teams of specialists and nurses would be waiting to provide whatever care is needed.
In the plan being recommended by the Ventura County Emergency Medical Services agency, Los Robles would serve as the east county trauma center with the Ventura County Medical Center assuming the same role in the west county. On an average of six times a day, patients who suffer gunshot wounds, head injuries, multiple fractures and similar injuries in need of immediate surgery would be rushed to one of the two hospitals.
The scenario is helping shape the selection of trauma centers into an open-ended soap opera but it makes sense to SallyJo Pickard. The 69-year-old Camarillo resident lives four miles from St. John’s Pleasant Valley Hospital. If she cracked her head against the steering wheel of her Mazda Protege and the ambulance bypassed her local hospitals and roared up the Conejo Grade so she could see a neurosurgeon, so be it.
“If it’s that severe and I need a trauma center, that’s where I need to go,” she said.
On Tuesday, the Ventura County Board of Supervisors is set to vote on Los Robles’ proposed designation as a trauma center. It’s the other side of the Conejo Grade where the t-word generates alarm and confusion. The EMS agency is recommending the Ventura County Medical Center be chosen as the west county trauma center. St. John’s Regional Medical Center in Oxnard is challenging the recommendation, contending it is the better choice.
The process has already gone through an administrative appeals panel and could eventually end up in court. The final decision will be made by county supervisors, though it’s not clear when they’ll vote.
As the designation of hospitals stirs debate, more is becoming known about what kind of injuries would require trauma care and where people in different communities would be taken.
Not every ambulance call would be diverted to trauma centers. People with simple fractures, back or head pain or relatively common injuries from car accidents would be rushed to the nearest hospital, trauma center or not. People who may not survive the longer trip would also be taken to the nearest hospital where they would be stabilized and then sent on to a specialized center.
The trauma hospitals would automatically see most people with multiple fractures to their ribs, legs and arms, according to a draft county EMS policy. Skull fractures, most spinal cord injuries, severe burns and falls of greater than 20 feet would also go to the trauma centers.
A survey of ambulance calls in Ventura County from 2006 shows about 10 percent of the total transports, or about 2,000 ambulance trips, would require trauma center care, said Steve Carroll, administrator of the county EMS.
Others suggest trauma calls are much more common. Dr. Brian Kimbrell, medical director of trauma services at St. John’s in Oxnard, predicted more than 70 percent of the hospital’s ambulance trips would be diverted if the hospital isn’t named a trauma center.
Judgments on the severity of injuries will be made by paramedics and there could be gray areas, said Dr. Gregg Hartman, a Simi Valley orthopedic surgeon. He predicted the new system will save lives because patients with the most critical injuries will see trauma surgeons in minutes. But he worries people with multiple fractures or crushed fingers who aren’t in jeopardy of dying will be diverted away from hospitals that could easily care for them.
“In most cases, I don’t know if that will make as big of a difference as we think,” he said.
The current system of taking patients to the nearest hospital is like blindfolded darts, according to Dr. Robert Winchell, a Maine trauma surgeon and part of the American College of Surgeons team that assessed Ventura County hospitals for their trauma capabilities. If the dart falls on a hospital equipped to care for that injury, the injured person is in luck. If not, patients who can’t wait do it anyway.
Trauma systems save lives by replacing luck with coordinated systems geared to provide immediate care, he said.
“I can tell you that having a system that tries to match patients to resources is a good thing for the population and is a good thing for patients,” he said.
A draft version of a map splits the county into halves based on driving time to the nearest trauma center. If the centers are located at the Ventura County Medical Center and Los Robles, people injured on Pacific Coast Highway near Mugu Rock would go to Ventura because the narrow canyon roads leading to Thousand Oaks take longer to navigate.
People in Ojai would go to Ventura, as would patients in Santa Paula and Fillmore. People in Simi Valley and Moorpark would be sent to Thousand Oaks.
Many of the trauma patients who currently are taken to St. John’s in Oxnard would be taken to Ventura, including residents of Oxnard and Port Hueneme. In Camarillo, the draft map will likely be tweaked so people living west of Las Posas Road would go to the county hospital and people to the east would go to Los Robles.
If St. John’s wins its battle for trauma center designation, most of the people headed to Ventura would go to Oxnard instead. Virtually all of Camarillo would go there too.
Maybe more than anything else, the map triggers reactions. Ask 78-year-old Emma Wilson about it at a medical plaza in Camarillo and she points at Pleasant Valley Hospital just across the road.
“I’d rather stay right here,” she said.
A debate on the trauma center brought 30 people to the usually empty city council chambers in Port Hueneme a week ago. A similar session is scheduled for the Oxnard City Council on Tuesday with the city considering sending a letter of support of St. John’s to the county supervisors.
In both communities, residents worry about having to bypass St. John’s, which already performs trauma care, in order to go to Ventura.
“What sense does that make?” said Oxnard Mayor Tom Holden. “Why would you want to transport the patient, when seconds are critical, another 10 miles?”
Debate has spread to the two hospital’s proximity to the 101, the number of intersections that have to be navigated and Oxnard’s rank as the biggest city in Ventura County.
Carroll said the same arguments about access and proximity would emerge from other parts of the county if St. John’s was chosen as the trauma center.
“We have to provide a system that provides access to Ojai and Oak View, Fillmore and Ventura just as much as we do Camarillo and Oxnard,” he said.
Some worried county residents think the solution is to fall back on the recommendation made by a committee of experts from the American College of Surgeons. That team recommended the county designate three trauma centers with St. John’s and the county hospital both sharing west Ventura County.
Carroll said county studies and participating hospitals including St. John’s have already determined that there isn’t enough trauma in the county to support three centers.
Maricela Morales, a Port Hueneme city councilwoman, focuses not on sustainability in arguing for two west county centers but on the 10 to 15 extra minutes it would take to rush someone from her city to Ventura.
“I think the nature of trauma is that every second, every minute makes a difference,” she said.
Copyright 2010 Ventura County Star