We Need Trauma Centers
Due to the advanced state of industry a number of devices and machines have come into common use which, often through intentional misuse, result in very serious injuries. Two examples are the automobile and the gun. When a serious injury results from something such as an automobile accident the victim usually has a very short period in which to obtain emergency medical intervention before the shock resulting from his or her injuries is irreversible. Usually this period of time is not longer than one hour, and is often less. If measures to treat shock and the cause of the shock, massive internal bleeding for instance, are not instituted within this first hour after the injury the mortality rate increases exponentially every fifteen to twenty minutes.
The state of emergency medical care currently practiced in this community involves an excellent pre-hospital phase under the jurisdiction of Los Angeles City paramedics. The paramedics have jurisdiction of about thirty-five emergency rooms to which their patients can be transferred after beginning medical treatment at the scene of the accident. This is where the problem occurs. To provide the best possible emergency care at the hospital, two factors play an important part. First, the staff must work on at least two to three severely injured patients daily to maintain their technical skill at top level. Second, surgeons and operating rooms must be available within 15 minutes notice, twenty-four hours a day, 365 days a year. In the San Fernando Valley, this level of care is not met anywhere. In greater Los Angeles, this level of care is met at less than six hospitals. The problem involves too many emergency rooms for the population. The cost of maintaining an operating room on fifteen minute standby day and night would put hospitals out of business, since even the busiest hospitals only receive three to four severely injured patients each week. The patient load would not support the very high cost of this service.
The best remedy to this situation would be to designate "Trauma Centers". Instead of having thirty five emergency rooms taking care of the critically injured patients three or four selected emergency rooms would be geographically designated to receive all of the critical patients. This would provide enough of a case load to justify the special equipment and staff that is required for such system. Most importantly however, the morbidity and mortality rates from serious accidents would be decreased because the equipment and staff would be available to immediately treat a patient's shock as well as the underlying cause of the shock. By providing a higher quality of care without duplicating the services of an emergency room only a few blocks away, the rate of rising health costs could probable be effectively checked in the area of emergency medicine.
This entire argument can probably be summarized by considering a hypothetical case study. A young woman falls asleep at the wheel of her V.W. bug and crashes into a telephone pole. Paramedics arrive finding her unconscious and in a sever state of shock, although she is showing no evidence of external blood loss the paramedics begin to treat the shock, but not the unknown underlying cause, and bring her to the closest trauma center. The emergency room team, having seen eight or ten cases similar to this in the last few weeks recognize the few possible causes of the patients shock and prepare to take her to the operating room while continuing to treat the shock. Within fifteen minutes a surgeon has evaluated his patient, received the results of the lab test and X-Rays, and is confident in his diagnosis of a ruptured spleen. The laboratory has twelve units of cross matched blood ready within twenty minutes of the patients arrival to the hospital. Within thirty minutes of her arrival the patient has been taken to the operating room, had her abdomen open and explored for injuries, and her damaged spleen removed. The cause of her shock has been treated within forty five minutes, the shock reverses, and the patient now has about a ninety five per cent chance of recovery. The cost of this to her has been about two thirds of the old system and her chances of recovery, if this accident had occurred between 10 p.m. and 8 AM are twice that of the old system. The overall asset of this newer system to society is obvious.
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