By Carolyne Park
The Arkansas Democrat-Gazette
LITTLE ROCK. Ark. — More than two-thirds of hospitals eligible to be part of Arkansas’ $25 million trauma system want to join.
They met the initial application deadline to be part of the system, which will connect emergency medical services statewide with the goal of getting patients the care they need as quickly as possible after a car accident, gunshot wound or other traumatic injury.
Arkansas Department of Health officials said they’re still taking applications and are pleased with the response so far.
“To have this many facilities that expressed an interest in participating early on is exciting for us,” said Donnie Smith, director of the Health Department’s Center for Health Protection. “We really didn’t know what to expect since we’ve never been through this process before.” Getting applications from hospitals is a key to getting the trauma system up and running, a process that’s expected to take about two years, he said.
The trauma system, signed into law by Gov. Mike Beebe on March 13, is being funded with an increase in state cigarette and tobacco taxes. The system has a $25 million budget for the fiscal year that started July 1, and $28 million for fiscal year 2011.
Other pieces of the trauma system are also in the works. The Health Department will begin taking bids soon to set up a centralized call center and has bought software and hardware to set up a trauma registry to track patients from the time of injury through rehabilitation.
“It really is a work in progress over a period of time.” Smith said. “We think this is an important first step.” If approved, the 63 hospitals that have applied so far will be eligible for grants of up to $1 million a year, depending on the level of emergency care they can provide. Ninety-one hospitals are eligible to be part of the system.
Each hospital will be designated as Level I, II, III or IV trauma centers, and Arkansas’ standards for each are based on national standards from the American College of Surgeons.
Level I provides highest care
Being a trauma center calls for the capabilities of an entire hospital, not just the emergency department.
Level I centers will provide the highest level of trauma care. They’re required to have general and specialized surgeons at the hospital 24 hours a day able to treat patients with the most severe and complex injuries. Level I centers also have to do research, outreach and safety education aimed at preventing injuries in their communities.
Level II centers 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 centers don’t have to have as many specialists on hand, but they must be able to provide emergency resuscitation, surgery and intensive care of most trauma patients.
Level IV centers are required to have a trauma-trained nurse at the hospital 24 hours a day, and an emergency physician on call. Their role is to stabilize patients injured in remote areas before they’re transferred to a higher level facility.
Five hospitals — including three from out of state — applied for Level I status. They are the University of Arkansas for Medical Sciences Medical Center and Arkansas Children’s Hospital in Little Rock; St. John’s Health System in Springfield, Mo.; and Le Bonheur Children’s Medical Center and The Regional Medical Center, both in Memphis.
Six applied to become Level II trauma centers, 19 for Level III, and 33 for Level IV status.
Those numbers are close to what was projected and provide a framework to begin building the trauma system, Smith said. All hospitals are expected to become part of the system, although all might not receive the level designation initially requested, he said.
Some hospitals still undecided
Hospitals that didn’t apply — including two of Northwest Arkansas’ largest hospitals — said they’re still weighing their options.
In Fayetteville, Washington Regional Medical Center officials said they don’t yet know if the 366-bed acute care hospital will be part of the trauma system.
“Washington Regional is still in active conversations with state Health [Department officials] on our level of participation in the new statewide trauma system,” Terry Fox, Washington Regional’s director of marketing said in a statement. “At this point a decision has not been made.” Northwest Health System has begun filling out application forms and plans to submit them in September, after the first round of hospitals are approved, said Greg Russell, the system’s marketing and community relations director.
The system has two hospitals, Northwest Medical Center-Springdale with 222 patient beds, and Northwest Medical Center-Bentonville with 128 beds. System officials are still deciding which level of trauma center designation to apply for, he said.
“Much of the paperwork has been done,” Russell said. “We still need to have some internal discussions before we commit to the state.” Smith, with the Health Department, said there’s still time. The initial deadline was July 1.
Officials will begin reviewing applications next week.
“Even after that review, we’ll have a process by which other hospitals can join in,” he said. “Our goal would be to have all hospitals participating.” Reviews are expected to take about six weeks, and Health Department officials hope to begin issuing “start-up” grants in September and October to help hospitals cover costs of meeting the state’s criteria.
Grants will be $1 million for in-state Level I trauma centers, $500,000 for Level II, $125,000 for Level III and $25,000 for Level IV centers.
Grant amounts TBA
The budget initially called for out-of-state Level I centers to receive start-up grants of $500,000, but Smith said those grants will vary depending on the volume of Arkansas patients treated at each facility.
“That dollar figure has not yet been determined,” he said.
The three out-of-state hospitals that applied for Level I are all already designated as Level I centers in their own states.
St. John’s in Springfield, Mo., saw 2,438 trauma and burn patients last year, including 356 from Arkansas, said Ted Shockley, the hospital’s director of trauma services.
While the start-up grant is just “a drop in the bucket” compared with costs of providing emergency care to Arkansas patients, it’s more than they get from the state now, Shockley said.
The hospital became a Level I trauma center under Missouri’s trauma system in 1999, and already meets the requirements under Arkansas’ system, he said.
Jamie Carter is chief executive officer of Crittenden Regional Hospital in West Memphis, which applied for Level IV status. He’s also a member of the Governor’s Trauma Advisory Council.
Located close to the intersection of Interstates 40 and 55, the hospital sees a lot of trauma patients, Carter said. They rely on trauma centers in Memphis to treat the most serious injuries.
“We very much depend on them being a part of this trauma network,” Carter said.
At Le Bonheur in Memphis, 130,000 patients were treated at the hospital last year and 6,400 were from Arkansas, said Maureen O’Connor, the hospital’s director of public policy. Of the total treated at the hospital, 900 were trauma patients and 77 were from Arkansas.
“We’re located in downtown Memphis, basically on the Arkansas border,” she said. “Our coverage area can extend as far as a 150 mile radius, which can include a good part of Eastern Arkansas.” Jefferson Regional Medical Center in Pine Bluff applied for Level II status, and already handles trauma cases from throughout southeast Arkansas, said Bob Atkinson, hospital president and chief executive officer. The center recently hired a medical director for trauma and plans to hire a trauma nurse coordinator in anticipation of being part of the new system.
Atkinson said he’s glad to see plans for a statewide trauma center moving forward. There’s not enough coordination now, and too often it takes too long to get patients to the hospital best able to treat their injuries, he said.
“It’ll get the patient there a lot quicker,” he said.
Copyright 2009 Little Rock Newspapers, Inc.