Slowing the bleeding 

The big picture of Arkansas's emerging trauma system, a statewide web of ERs and ambulances and doctors and nurses fashioned to save lives and improve outcomes for the injured, can be told in numbers.

Trauma deaths last year, 2,119; number of Arkansas trauma centers now, zero. Levels of care within the system, 1 (highest) through 4 (lowest). Hospitals wishing to take part in the state's new system, 69 ? five of them seeking the top Level 1 designation, including three from out of state.  Money to set up the system this year, $13.5 million. Money to sustain the system in 2011, $20.3 million.

Total state investment in the trauma system, $53 million ($25 million in 2010, $28 million in 2011). Where the money will come from, a new 56-cent tax on cigarettes legislated earlier this year.

A number that matters to Terry Collins, however, is one ? the boy that the trauma program manager at the University of Arkansas for Medical Sciences believes might be alive today had he gotten the right care at the right hospital quickly enough to stop the bleeding from his ruptured spleen.

In an interview earlier this year, before the legislature approved the tobacco tax and trauma system bills, Collins sounded anxious. “We've been fighting for this for 15 years,” she said. Who knows how many lives were lost needlessly, she wondered, while legislative attempts at creating a system went unfunded. Her words were echoed by Health Department director Dr. Paul Halverson at a recent meeting of primary care doctors. “A lot of people died who didn't have to,” he said.


 Based on data from other states that have trauma systems (Arkansas is said to be one of only three in the U.S. without one), a system could save anywhere from 200 to 600 lives a year, Dr. James Graham, chief of emergency medicine at Arkansas Children's Hospital, said.

Along with dollars for hospitals, the tobacco tax is expected to provide, over the next two years, $4.8 million for emergency medical services; $7.4 million for a central call center to direct patients to the appropriate hospital and to create a trauma registry, $1.5 million for rehabilitation programs and $425,000 for a performance review board.

The goal: Getting trauma victims to the right hospital within the “golden hour” after injury, assisted by a new law that allows ambulances to go to the most appropriate, rather than the closest, hospital; better access to the state's “dashboard” computer link between hospitals, and the paramedic call center to direct trauma traffic. Better-trained emergency personnel; beefed up ER staffs. A trauma registry that will show how and where people are being hurt and what their outcomes are. Coordinated rehabilitation services. A public better informed on how to prevent injuries in the first place.

“A lot of people think this is how [trauma care] is done now,” the Health Department's Halverson said. It is not, and when people learn that “they're disturbed.” But the state will be closer to that notion in two years, he says, when the trauma system will be up and running.

Some have questioned Graham's figures on lives saved, based on improvements seen in other states. Some are so cynical as to wonder if $53 million to save as few as 200 lives is worth it.

But better outcomes will be measured not just in terms of lives saved. For every death, Children's Graham says, there are three severe disabilities; if you've been treated for serious injuries at a trauma center, you've got a 1 in 5 times better chance of “walking out of a hospital independently and not having to use a wheelchair,” he says, than from a hospital that is not a trauma center. Reduced serious injury means fewer people will be out of a job, fewer will need state assistance.



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