Trauma System Report

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The American College of Surgeons has a new report out on Arizona’s hospital Trauma System. The report makes five major recommendations for improving our trauma system. Arizona Department of Health Services Director Will Humble will give us the details.

Ted Simons: The seriously injured in Arizona are most often treated at level one trauma centers. A new study by the American of college of surgeons shows improvement in the system but the report also suggests more can be done. Here to talk about the new study is Will Humble, director of the Arizona Department of Health services. Good to see you again. Thanks for joining us.

Will Humble: Thanks.

Ted Simons: And give me a better definition of the Arizona trauma system.

Will Humble: A trauma system is a network of trauma care. And it needs to really sort of balanced geographically, and the struggle that we had three or four years ago was that we had great level one trauma centers here in the valley. One in Tucson and one in flag, also. A level one meaning you have got everything in place to treat the most seriously injured folks. Where we were lacking is if you were to get hurt in say, you know, Payson or Prescott or Kingman, those places, we are out sort of in a rural area, a fair distance from a level 1 trauma center, there was not really a network of places that you could go to be really stabilized and resuscitated quickly. There is emergency departments out there, but there is a difference between an emergency department and a trauma center.

Ted Simons: What is the difference?

Will Humble: So E.D., the emergency department can treat quickly. They can treat some injuries, but a trauma center has the ability to have that more specialized care that they have got the resources, and the expertise in house to really stabilize, let's say you have a compound fracture, a trauma center is going to have the resources in place to really stabilized, where an emergency department can probably still do it, but not as quickly. And really, when you are seriously injured, time is of the essence, which is why it's really important to have an interconnected trauma system, so that you can move from the right level of care at the right time because that's really critical.

Ted Simons: So, the report, the same group a report in 2007, correct?

Will Humble: Right.

Ted Simons: And they found a bit of imbalance there. It sounds like there was, what rural hospitals in the system, there was not hardly any rural hospital in the system.

Will Humble: There was no trauma centers at all. Emergency departments but not any trauma centers in the rural parts of the state, so from 2007, 2008, 2009, 2010, 2011, 2012, all the departments were focused on getting the departments in the rural parts of the state up to standard, and at least level 4 trauma level. We have 16 now, where we had zero a few years ago. So, we're in much better shape in rural Arizona, and so the natural -- so, since we made so much progress in the rural parts, we started thinking, ok, now it's time to bring the American college of surgeon back out so that they can assess where we are today because we made so much progress in the last few years.

Ted Simons: And I know, as well, the state trauma registry was improved. What is that?

Will Humble: So that's a really critical piece of your trauma system because that's where, that's your hub of information where you collect the data, and there is an old saying, what measure is what you can improve. And that is an intervention in and of itself, so this trauma registry that we have, this data gold mine that's available for all of the trauma centers for our epidemiologists in-house to look at who is getting hurt, when where and how so you can do some real analysis about what's the best way to Matthew patients around the system. And one of the goals is not just to get people better care but more efficient care, cut down on the air ambulance rides that we have. If you get hurt in Prescott or something like that, the idea is, you get them to a level 4, you get them stabilized, and then instead of having a $25,000 helicopter ride, you are on a ground ambulance and stabilized and you can get to the level 1 down here in Phoenix, and you will be better, and it's all about timing.

Ted Simons: And this was back in 2007, the report, and these are the improvements that were made. And this report has just been released.

Will Humble: Yes.

Ted Simons: They are debuting it here on "Arizona Horizon." So, tell us, what kind of recommendations and improvements and what did the surgeons see this time?

Will Humble: So, they said, they complimented us on what we have done in the rural parts of the state, and they think that we need to improve a bit in terms of the rural areas so that we have got say a level 2 or a 3 trauma center. We don't have enough in Yuma. That's a weakness that we have. No trauma center as of yet. That would be a nice place to have a level 2 or 3. But, they also started moving attention to the valley. And that's where the controversy lies. Because we have got a network of level 1 trauma centers here in the valley. And some downtown. Scottsdale, Osbourne, and, you know, out on the east side, and one of the concerns is that, that if we get more level 1 trauma centers here in the valley, they say going to dilute the amount of level 1 care that the existing centers can handle. And so Chandler has expressed interest in becoming a level 1, what does that really do to the network to the entire system? So, that's, there is a whole host of, of issues that the report talks about in terms of giving us recommendations about, about where to go from here in the urban core.

Ted Simons: Basically, it sounds like they are saying hold off on some of these new trauma centers.

Will Humble: They basically said, one of the biggest recommendations, and I think that's getting the most attention, is it urges us to put a moratorium on new designations here in the valley until we get additional studies done, so I have got couple of advisory committees that advises me as the director, and they are going to weigh in on these things over time. And one of the complicating factors is that, you know, we don't have the statutory authority to say no. So, that's a real challenge. The report says, we urge to have moratorium, and, you know, our statutory authority says look if, they meet the standard they are in.

Ted Simons: Yeah. And what about meeting the standards for improving the two, three, and four centers.

Will Humble: That's the other thing about the urban core and what I was interested in getting from the ACS, who put this report out, is you know, give us an idea of what you think an urban core trauma system looks like? Because, let's say you put level 2 and 3s and scatter them throughout the valley. What it will do is to start siphoning off some business from the level one trauma centers, and the level one folks are saying look, we cannot maintain our expertise with a lower level of trauma. So, there you get it. We're starting to think of it, you are going to take my cheese kind of thing. And, but, but, the bottom line is, I think, for me, the focus remains where are the bodies? Where are the people getting hurt. Where are the bad outcomes, and that's still in rural Arizona. And let's face it, if you get, if you get, something happens to you here in the, in the valley, you are going to go to level one trauma center in a few minutes. EMS is going to take. If you get hurt in the rural parts of the state, I have you have got the struggle getting to the right place at the right time.

Ted Simons: So with that in mind, you have the recommendations now, and we have seen the improvements, and where do we go from here? What's next?

Will Humble: We have statutory committees and I will work with the stakeholders to see what they think, and work with the hospitals, and my team, do some additional data analysis but I'm still more interested in boosting the level of care that we see out there in rural Arizona before I tackle this sort of urban issue with the trauma centers because one of the issues in public health that I try to focus on with my staff is, let's focus on what's important most. Where we get the biggest bang if our buck? And the biggest bang for our buck is in the rural parts of the state.

Ted Simons: My goodness, well, all right, I'm glad got on the show for the debut of this report, and good luck handling it from here.

Will Humble:Director, Arizona Department of Health Services;

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