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Trauma-care access still an issue in Ohio

Trauma is the leading cause of death among people 1 to 44 years old, according to the national Centers for Disease Control and Prevention

By Suzanne Hoholik
The Columbus Dispatch

COLUMBUS, Ohio — Ohio’s trauma law is a decade old and, by all accounts, has saved lives.

The law created a triage system so emergency medical workers can clearly identify trauma patients. It helped double the number of verified trauma centers across the state.

The law also developed a network of experts who share ideas, and it created a registry that contains data on every trauma patient in the state.

Trauma is the leading cause of death among people 1 to 44 years old, according to the national Centers for Disease Control and Prevention.

Before 2000, trauma experts estimated that about 900 people died each year in Ohio because they weren’t taken to verified trauma centers, where the most- qualified staffs treat the most-severely injured patients.

Despite the successes, there are problems.

Ohio’s trauma system hasn’t matured the way experts expected. For example, there aren’t enough state workers to analyze the patient data, so no one knows how that 900 number has changed.

“I don’t know that I can tell you much more than we knew in 2000,” said Kathy Haley, a pediatric trauma nurse and chairwoman of the state’s trauma committee.

“We have more data, but no linkages between those systems to tell us about the system.”

The committee wants to link the trauma registry to the existing emergency-medical-services and rehabilitation databases so a single patient’s experience can be tracked for quality and outcome from the point of the injury to the end of their recovery or death.

Other problems include:

* Trauma centers are mostly clustered in urban areas, leaving rural residents far from the hospitals with the best staffs and equipment.

* No lead agency oversees the system — from paramedics to hospitals to rehabilitation centers.

The law designated the Ohio Emergency Medical Services division within the Ohio Department of Public Safety to operate the trauma system. But the Emergency Medical Services board — made up mainly of paramedics, firefighters and physicians — oversees only emergency medical workers. Its authority stops at the hospital door.

“There’s no one really looking over the whole trauma system — except us as a committee — but we have no power,” said Dr. John Crow, an Akron pediatric-trauma surgeon and member of the state’s trauma committee. “There’s no checking.”

Crow said he would like to see a new agency that reports directly to the governor. It could be funded by trauma centers, similar to how Pennsylvania’s system runs.

There could be resistance from the Ohio Hospital Association, which successfully stalled passage of the trauma law for several years.

“While we weren’t opposed to a lead trauma agency, we asked them to be very cautious about who they appointed,” said Carol Jacobson of the hospital association.

The trauma committee has decided to start small and has requested that at least five new people — including an epidemiologist and statistician — analyze the trauma data.

In a memo to the state EMS board, the trauma committee compared its registry with those in other states.

There are two people assigned to the trauma registry and its 38,000 annual cases. In comparison, a staff of 14 handles the state cancer registry, which has about 6,400 cases each year.

The trauma law requires annual reports on the system, but the most recent report, on 2003 data, was finished in 2005.

“We don’t know if what we’re doing is having the best outcomes,” said Nancie Bechtel, a trauma committee member and executive director of the Central Ohio Trauma System.

Bechtel, a trauma nurse, said there’s a financial incentive for lawmakers to improve the trauma system. In Franklin County alone, the annual total cost of trauma injuries and fatalities is $750 million, much of which is paid by the state’s Medicaid program, she said.

William Schuck, the former lawmaker who sponsored the bill, said trauma experts need to pick leaders within the legislature and incoming administration to improve the system.

“The trauma data is so important to making the system work,” he said. “Having all that data and not using it doesn’t make any sense.”

But with an impending $8 billion shortfall in the state’s next two-year budget, hiring more state workers could be a pipe dream.

State Rep. John Patrick Carney, vice chairman of the House health committee, said he wants to meet with experts to learn about the system.

“Then we can make the argument to the public: If this is one of your family members, you want to be sure they have access to the care they need if they have an accident,” said Carney, a Clintonville Democrat.

And despite the creation of a system that more than doubled the number of centers from 21 to 43, as of July, access to trauma care remains an issue.

“A significant portion of the state’s population live in rural areas where hospitals can’t afford to be a trauma center,” said Dr. Steven Steinberg, a trauma surgeon at Ohio State University Medical Center.

Steinberg said he’d like 85 percent of the state’s population to be able to get to a trauma center within 15 to 30 minutes by ground. He said an agency that oversees all parts of Ohio’s trauma system would help accomplish this.

The largest expense for trauma centers is maintaining the staff, which includes orthopedic surgeons, anesthesiologists and neurosurgeons.

The Cleveland Clinic announced this fall that it plans to drop the Level II trauma status at its Huron Hospital in East Cleveland.

This year, the Southeastern Ohio Regional Medical Center in Cambridge dropped its Level III trauma status despite being verified through May. It blamed the high costs.

However, Marietta Memorial Hospital became a Level III trauma center last year, and Adena Regional Medical Center in Chillicothe is working to gain the same status.

“There’s an obvious need for a trauma center in a community like ours,” said Jennifer Offenberger, spokeswoman at Marietta Memorial.

Dr. Kevin Doherty, medical director of the emergency department at Adena, said: “It’s definitely a cost burden for the system, but as a regional (hospital), we don’t have the luxury of having multiple hospitals. We’re the only one.”

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