Kadner: It’s no mirage: Trauma center deserts exist in America
BY PHIL KADNER email@example.com July 23, 2013 10:42PM
Advocate Christ Medical Center in Oak Lawn. | Larry Ruehl~Sun-Times Media
Updated: August 25, 2013 6:21AM
If a child is seriously wounded in a shooting at 58th Street and Western Avenue in Chicago, he’s likely to end up at Christ Medical Center in Oak Lawn.
Should a woman suffer a life-threatening brain injury in a car accident near Merrillville, Ind., she’s also likely to end up at Christ.
Christ Medical Center, on 95th Street between Cicero Avenue and Pulaski Road, has become the Level 1 trauma center for shooting and stabbing victims and anyone seriously injured in an auto or industrial accident from Chicago’s South Side, through all of the south suburbs and into northwest Indiana.
This week, U.S. Rep. Bobby Rush (D-Chicago) announced an initiative (the Trauma Act) to obtain $100 million in federal funds for what he called “trauma deserts.”
The Southland certainly is that.
“A couple of years ago a young man was shot near the University of Chicago (on the city’s South Side) and died while being transferred to Northwestern (Memorial Hospital, downtown),” said Dr. James Doherty, director of the trauma and critical care services at Christ.
“That raised new awareness to a problem that has actually existed for a long time.”
That problem is that very few hospitals today offer Level 1 trauma care due to its cost.
“Those tending to need trauma care the most are often children and people without insurance,” Doherty said.
While many hospitals have emergency rooms, few offer the highest level of care for people with the most serious, life-threatening injuries.
In most cases, a local hospital emergency room might initially treat such a patient and stabilize them, but ultimately they would be transferred to a Level 1 trauma center.
Depending on the nature of the injury and the number of patients at any given Level 1 facility (say there’s a bus accident involving a large number of people), the treating hospital might not transfer the patient to the closest Level 1 facility.
A Level 1 trauma center is required to have certain doctor specialists and support medical staff on duty 24 hours a day, seven days a week.
For example, Christ has a neurosurgeon, orthopedic surgeon and anesthesiologist on duty 24/7 and also has certain medical equipment available for immediate use, such as a CAT scan, when the patient arrives.
The University of Chicago Medical Center and Michael Reese Hospital used to have Level 1 trauma units, but Reese has closed its doors and the U. of C. closed its trauma center due to increased costs.
St. James Hospital in Olympia Fields also had a Level 1 trauma center that it closed a few years ago.
The only remaining Level 1 trauma centers in Chicago are Northwestern Memorial, Illinois Masonic Medical Center, Mount Sinai Hospital (on Chicago’s West Side) and John H. Stroger Jr. Hospital of Cook County on the near South Side.
“I can’t give you a precise figure on the additional cost (of a Level 1 trauma center); that’s very difficult to determine,” Doherty said, “but it’s fair to say that it costs millions of dollars.”
Advocate Medical Group, which owns Christ and Illinois Masonic, also has Level 1 trauma centers at Lutheran General Hospital in Park Ridge and Condell Medical Center in Libertyville.
“You have to have two things to operate a Level 1 trauma center: the will and the financial resources,” Doherty said.
“Advocate has a very firm commitment, a very strong will, to do this. There has been no talk since I’ve been here about closing the trauma center.”
The key question, of course, is just how essential such trauma centers are to saving lives.
A recent study by Dr. Marie Crandall, associate professor of surgery at Northwestern University, suggests that at times they can make the difference between life and death.
A transportation difference of 5 miles can have an impact on patient mortality, Crandall determined, in the most serious cases.
The Centers for Disease Control and Prevention states that for the seriously injured, there’s a 25 percent reduction in deaths for those who receive Level I trauma care.
Doherty said that the time and distance traveled and their impact on patient outcome is not as clear-cut as Crandall’s study might suggest.
He said the study has “some flaws” in that it included a rather small sample of the most seriously injured Level 1 trauma patients.
Doherty said that the Christ trauma team has conducted its own studies for years and “has not found a link” between time and distance traveled and patient outcomes.
“Intuitively, however, you know that the faster a patient receives treatment the better his chances,” Doherty said.
Doherty said the 31 hospitals in Region 11 of the emergency response network of Illinois (which includes most of Chicago’s hospitals) are in the process of conducting their own study on the impact of time and distance traveled on Level 1 trauma center patients.
The Christ trauma center treats about 4,500 patients a year, with 20 to 25 percent of those being gunshot victims.
“We like to think the faster patients get to us, the better they do,” Doherty said.
“It just makes sense that the sooner they get to you the sooner you can start medical treatment.”
Doherty believes Rush’s initiative to attract federal dollars to establish Level 1 trauma centers could help.
“Finances are almost always a factor when trauma centers close,” Doherty said. “And I am sure some hospital would consider opening some Level 1 units if there were federal money available.”
Rush acknowledges that his trauma center initiative, even if it passes out of the Republican-controlled House, would provide very little of the seed money that’s needed.
But the fact is that even the CDC acknowledges that there are “trauma deserts” in this country.
Raising public awareness is always the first step to building congressional support.
Unfortunately, as the democratic process inches forward, some people may die waiting.