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Is Southland in need of another trauma center?
Activists decry disparity of high-level care in region

Sunday, June 06, 2010
SouthtownStar
by Maura Possley

The helipad is quiet as Dr. Steven Salzman walks onto the roof of Christ Medical Center in Oak Lawn.

In minutes, a helicopter arrives from Indiana, carrying an unconscious middle-aged man suffering from bleeding in his brain.

Salzman and the helicopter crew rush their patient down an elevator and snake the stretcher between nurses and beds and into the hospital's emergency room.

This new patient joins a toddler in a car crash, two men with head injuries, and two men who were shot. Other patients still lie in the ER from the night before, and six more people in need of trauma care will arrive in the next few hours.

It's a typical day for Salzman, a trauma surgeon in the Southland's only trauma center.

Two years ago, St. James Hospital said it would close the doors of its Level 1 trauma center in Olympia Fields, due in large part to the cost of operating it, leaving Christ as the area's only hospital with a Level 1 designation.

While all hospitals have emergency rooms capable of treating seriously injured patients, Christ is the region's only facility equipped to provide the most sophisticated level of trauma care.

There's no evidence patient care has been compromised, but paramedics and doctors say it now takes longer to get the most critically or seriously injured patients to the trauma care they need.

Community activists continue to push politicians, hospital executives and anyone who will listen for another trauma center in the Southland.

In 2009, the first full year after St. James ended its trauma care, Christ saw nearly 3,000 trauma patients, up from 2,800 the year before.

It's constant, said Salzman, whose role as trauma surgeon is one requirement for a hospital to be considered a Level 1 trauma center.

"We're seeing more patients, and certainly we see more transfers," he said recently. "It keeps everyone sharp. It becomes this routine - business as usual - as opposed to this all-hands-on-deck attitude, chaotic."

Christ officials said they have embraced the challenge of serving as the only trauma center in the Southland. Joliet has two Level 2 trauma centers - St. Joseph Medical Center and Silver Cross Hospital. The new Silver Cross under construction in New Lenox will be a Level 2 trauma center.

Impact on trauma patients

But what has it meant for patients?

Paramedics, depending on the time of day and traffic, are now often opting to first get them to the closest emergency room for stabilization before transferring them to Christ.

And that's meant some patients - particularly those in southeast suburbs such as Chicago Heights, Crete and Monee - face delays in getting the sophisticated care a Level 1 trauma center provides.

"Not that local emergency rooms aren't doing an admirable job, but it's definitely delaying care for the acutely sick patients," said Jack Daley, owner of Bud's Ambulance Services. "It's not as rapid a response. But then again, if we travel with a patient too far in the ambulance (to get to the trauma center), that's delaying care as well."

If an ambulance can't reach Christ generally within 20 to 30 minutes, or if a patient cannot breathe, they'll be taken to the closest emergency room to be stabilized and transferred to Oak Lawn.

"It's a rare case that we're able to go to Christ hospital under that timeline," said Monee Fire Protection District Chief Carl Nieland. "No doubt that while that patient is in the emergency room he is being treated and stabilized further. It just may not be the definitive (trauma) care such as going into the operating room and having an internal bleed taken care of."

Despite the long distance Christ poses for many south suburban residents, hospitals and paramedics say local emergency rooms - providing less sophisticated care than a Level 1 trauma center - have risen to the challenge in care for trauma patients who arrive there before heading to Christ.

"It's never good when you lose a very good resource," said Dr. Bernie Heilicser, an Ingalls Memorial Hospital emergency physician and medical director for the South Cook County Emergency Medical Services System. "Every one of (the emergency rooms) has worked to be prepared for trauma patients."

Poor communities ignored

Community activists decry what they see as a lack of high-level trauma care here and point to northern suburbs where trauma centers are more abundant.

But the question lingers: Is trauma care in the Southland so lacking that patients are at risk?

Community activist Apostle Carl White Jr. says yes, though he can't point to any specific evidence that proves it.

He says the south suburbs are being given the shaft, a reflection of poor communities being ignored.

"Frankly, there is some institutionalized racism in this. To have four trauma units up on the North Side, and one mid-south and then (Cook County's) Stroger Hospital, there's no way that it's not about money and the poor communities," White said. "Where there's no money, we're seemingly not getting any trauma units put there. If you can get neurosurgeons on the North Side, why can't we get them in the south suburbs?"

But erecting a trauma center isn't just a matter of will.

In 2009, the tab for operating the Christ trauma center was $15.3 million, and the high cost of operating a Level 1 trauma center was among the reasons cited by St. James in closing the Olympia Fields facility.

Trauma care means more resources, specialized physicians and brings about more legal costs for a hospital, as patients with such severe injuries more often end up in court over their care or its cost.

Given these demands and timing - during a recession and a time of much uncertainty at the hands of President Obama's new health care landscape - there is little hope a new Southland trauma center will open its doors anytime soon.

"Running a trauma program is very difficult to do," said St. James President Seth Warren. "It's expensive, it's very labor intensive and it's very demanding of physicians. The question, I guess, is out there: Would they have died if they didn't have as far to go? No one can answer that."

SOUTHLAND TRAUMA CARE BY THE NUMBERS

Advocate Christ Medical Center in Oak Lawn, a Level 1 trauma center, is the only trauma facility in the Southland.

It has been two years since St. James Hospital closed its Level 1 trauma center in Olympia Fields, citing, in part, the cost for operating and staffing such a center.

Here's a look at the numbers behind Christ's trauma care operation:

• $15.3 million - Cost to run the center in 2009.

• 392.67 - Hours in 2009 when the hospital was on "bypass," or times when patients must go elsewhere because it's at capacity.

• 588.55 - Bypass hours in 2008.

Total emergency room visits, trauma care cases:

• 2007 - 81,007 ER, 2,921 trauma

• 2008 - 80,954 ER, 2,819 trauma

• 2009 - 86,128 ER, 2,966 trauma

WHAT MAKES A TRAUMA CENTER

All hospitals are capable of treating trauma injuries, but only certain ones are designated to specialize in this type of critical care. There are three types of hospital emergency departments, defined by the Illinois Department of Public Health. A hospital isn't required to be a trauma center, but if it is, it must meet certain guidelines.

Here's a look at some of the major requirements for emergency rooms:

LEVEL 1 TRAUMA CENTER

• Staff an in-house trauma surgeon.

• Sub-speciality surgeons available around the clock but not in the hospital.

• Resources like a trauma team and operating room, radiology and other capabilities along with certain equipment always ready.

LEVEL 2 TRAUMA CENTER

• Trauma surgeon or sub-specialist should see patient within 12 hours.

• Sub-speciality surgeons must be available, with reporting times slower than a Level 1 center.

COMPREHENSIVE EMERGENCY DEPARTMENT

• No requirements regarding an in-house surgeon.

• Deals primarily with handling general care, with the ability to take in trauma cases.

county proposes solutions

The Cook County Health and Hospitals System recently released its analysis of the availability of trauma care in the Southland. The study was done in response to concerns about a disparity in care raised by Southland community activists and ministers, who last fall convened a meeting to discuss the issue with Cook County Commissioner Deborah Sims (D-Chicago).

At that meeting, Sims suggested building a stand-alone trauma center on the campus of the county-run Oak Forest Hospital. But the county found the idea "prohibitively" expensive in its analysis.

To relieve the burden on Christ Medical Center, the county study suggested increasing the number of ambulances here and dividing the Southland to send certain patients to Christ and others to the trauma center at county-run Stroger Hospital on Chicago's West Side.

Those ideas were shot down, though, by Southland paramedics and doctors, who said more ambulances wouldn't change the problem of Christ's distance and that Stroger is farther away than Oak Lawn.

The analysis suggested increasing the time ambulances have to transport a patient to 35 or 40 minutes.

It proposes implementing a trauma center at an existing south suburban hospital, such as Ingalls Memorial in Harvey or South Suburban in Hazel Crest. But the high cost makes that option unlikely.

The analysis called for $81,000 to further look into the disparity of care, a proposal the health system's CEO, William Foley, is taking under advisement, a system spokesman said.



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