CAPE COD, Mass. — New Mass. guidelines instruct responders to take patients with major injuries to state-designated trauma centers farther away from the scene instead of nearby hospitals.
Any patient could be taken directly to a trauma center if deemed necessary by the paramedics and the medical control physician at Cape Cod Hospital, according to David Faunce, executive director of the Southeastern Massachusetts Emergency Medical Services Council, according to Cape Cod Online.
“It’s a case-by-case basis for us,” said EMS Officer Mike Medeiros of the Hyannis Fire Department. “We’re still feeling out what the impact will be.”
Why trauma centers?
Trauma centers have a number of advantages over smaller facilities, said Alasdair Conn, chief of emergency services at Massachusetts General Hospital in Boston, including availability of staff, screening equipment, and academic connections.
“The first patient I managed was unconscious, both lungs were collapsed, all the ribs on one side were broken, a ruptured spleen - and a fractured pelvis,” Conn told Cape Cod Online. “You can’t take that into a community hospital at 2 a.m.”
The chance for recovery and rate of survival is 25 percent higher, according to Cape Cod Online, when a patient is treated at a trauma center, and state guidelines were adjusted to provide what emergency responders and medical professionals say is the best possible care for Cape Cod’s most severely injured patients.
Those patients are now likely to be taken to trauma centers in Boston or Rhode Island because the local hospitals are not what the state designates as Level 1 or Level 2 trauma centers.
Those levels have CAT scans on the premises, have surgeons 15 to 20 minutes away and can cover all the specialties; the difference between Levels 1 and 2 is the educational component, including staff who publish significant research, according to Conn.
And becoming a Level 1 costs money: keeping up with standards can cost millions of dollars a year.
But the guidelines don’t imply that the Cape Cod or Falmouth hospitals are bad, according to Bill Flynn, director of the Cape and Islands Emergency Medical Services System, Inc., the liaison between emergency responders and medical staff.
Challenges getting there
The Cape is a special location, Faunce said. Getting patients to a trauma center can be challenging due to the patient’s condition, weather and traffic.
“Technically the Cape is an island connected by bridges,” Faunce said. “There’s only one way on and one way off.”
A flight from the Cape can generally run up to $10,000, said Suzanne Wedel, chief executive officer of Boston MedFlight. During the past year, there were 325 calls for Medflight to the Cape, 200 of which were completed. Of those 200, only a small percentage were for trauma incidents.
‘Just guidelines’
Still, there has always been the option of going to the local hospital, said Lori Jewett, director of process improvement and ambulatory services for Cape Cod Healthcare, which owns Cape Cod and Falmouth hospitals. Even before the guidelines, the company was doing all it could to work with local departments and EMS responders through training and developing the on-call service EMS officers use during incidents.
And a physician has always been on call for emergencies related to trauma or patients in imminent danger, Jewett said.
The hospital currently meets some of the requirements to be a Level 3 trauma center and is assessing the possibility of becoming one.
But the guidelines, Faunce told Cape Cod Online, are just guidelines.
“Cape Cod hospital has always done a good job,” Bill Flynn said. “It’s just that these rules came down from the state, and we have to do everything we can to get a patient to a certified trauma center.”