Of the 58 counties in California, Ventura is one of two without a state-approved emergency medical plan for treating victims of shootings, car crashes, kidney failure and other trauma.
“That’s a bad thing. Trauma is an essential public service,” said Dr. Robert Mackersie, a California state emergency medical services commissioner. “Not having a trauma system is like not having a fire department, not having a police department.”
After off-and-on debate over several years, county officials and other healthcare leaders are putting together a plan that would lead to the designation of at least one area hospital as a trauma center. People with internal life-threatening injuries would be taken by ambulance or helicopter to that center rather than to the nearest hospital. Trauma patients at other hospitals in the county would be stabilized and transferred.
Surgeons who specialize in trauma, neurology and orthopedics would always be available as part of a team focused on saving people who likely would have died, known as “unexpected survivors.”
“Do trauma systems save lives? The answer is yes, unequivocally yes,” Mackersie said.
Ventura County’s official planning began Wednesday with a committee meeting including hospital administrators, doctors, ambulance company officials and county emergency medical service officials. It could take more than a year to decide how a trauma system would work and then figure out the roles of various hospitals. And it likely won’t be easy.
Any plan and system would have to be voted on by the Ventura County Board of Supervisors. At least one observer predicts that means the county hospital will be chosen, though recommendations would be made by an outside group and more than one hospital could be chosen.
Five hospitals want to be designated as trauma centers of varying levels, far more than can be sustained by the county’s approximately 1,400 traumas a year.
If a hospital were certified as a trauma center, it would run the financial gauntlet that has caused some California hospitals to shut down trauma units. Hospitals can face as much as $2 million in annual costs, depending on staffing needs, with the best scenario involving enough revenue from trauma patients to break even.
The hospitals would likely gain the satisfaction of providing better care and a prestige that can attract doctors and patients of all kinds.
“It places a star at the top of your facility for the level of services you provide. Consider this the good housekeeping seal for hospitals,” said Jim Lott, executive vice president of the Hospital Association of Southern California.
He described trauma centers as emergency rooms on steroids.
“You have a full army, at full dress waiting for the war to happen. Whether it happens today or next week, they’re there and they have to be paid.”
One reason the county didn’t adopt a trauma plan several years ago is there wasn’t enough trauma to justify designating a trauma center, emergency medical services officials say.
The status quo also hasn’t revealed any glaring deficiencies. Trauma patients already get good, fast care, said Dr. Angelo Salvucci, a leader of the county’s emergency medical services department.
Every California county except for Ventura and, in Northern California, Solano County, has an individual trauma plan or is included in a regional plan. But some counties haven’t implemented the plans, Salvucci said. Others have systems that call for the transfer of trauma patients to hospitals in other counties.
Ventura County already operates an organized system for treating severe heart attack victims, drastically reducing the time it takes to treat patients. The cases are taken to one of three hospitals.
State officials say counties with populations of about 350,000 and no less than 1,200 traumas can sustain a high-level center. Ventura County’s population is more than 800,000. And in 2003, about 1,400 patients with traumas ranging from sudden illnesses to injuries from freeway accidents were admitted.
Mackersie said counties without trauma plans find ways to treat severely injured patients, but studies show organized systems that involve a trauma center can bring more than a 20 percent reduction in the number of patient fatalities.
“Are they way behind the rest of the state and the country?” he said of Ventura County. “Yes, they are.”
Los Robles Hospital & Medical Center in Thousand Oaks, Simi Valley Hospital, Community Memorial Hospital and Ventura County Medical Center in Ventura, and St. John’s Regional Medical Center in Oxnard all want to be trauma centers.
St. John’s, VCMC and Los Robles want to be Level 2 centers and treat virtually all types of trauma. They would likely have at least eight surgeons and specialists on call. Community Memorial and Simi Valley want to be Level 3 centers. They would treat certain kinds of traumas but stabilize and transfer complex injuries to other hospitals.
Level 1 trauma centers are the highest ranked, and there are only 12 in the state.
Some healthcare providers argue the county should have two trauma centers, one in the west county and another in the east. Others argue for one Level 2 center and as many as three Level 3 centers.
But there’s a danger of having so many centers that none of the hospitals see enough trauma to break even financially or gain the experience that brings the highest level of care, said Mike Williams, a consultant who has worked with trauma systems for 30 years. He thinks the county’s population warrants one trauma center.
The competition can be fierce. Two Sacramento hospitals competed in a recent battle that involved an appeal, lawyers and full-page newspaper ads calling for one hospital to be chosen over the other.
Officials at different hospitals in Ventura County promise friendly competition. They offer strikingly similar arguments, saying they already deal with everything that comes in their doors.
“Realistically, we function as a trauma center now,” said St. John’s President T. Michael Murray, arguing Oxnard is the best location for such a center. “The bulk of the trauma comes out of our ZIP (codes).”
Los Robles President Jim Sherman worries if his hospital isn’t chosen, it will lose patients to whatever hospital is picked. But he wants a better understanding of the exact costs and benefits.
“If it’s very clear that it’s a money-losing proposition, then we’re not going to pursue it,” he said.
If the choice comes down to more than two hospitals, an outside review board will make an independent assessment and recommendation. The final vote belongs to the Board of Supervisors.
That means the county-run hospital, Ventura County Medical Center, will win, said Dr. Mark Ghilarducci, an orthopedic surgeon from Oxnard and former president of the Ventura County Medical Association.
“If the county wants to be the trauma center, they’ll be the trauma center,” he said.
Read entire article at: Ventura County Star
Story by Tom Kisken
Ventura County Star (California)
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