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Four legal-length pages filled with bulleted facts highlight lessons learned, needs, value of, and next steps toward achieving the statewide trauma care system legislators authorized nine years ago.

Bill Oliver, chairman of the board of the Southeast Mississippi Trauma Care Region, urges legislators to support trauma, to fund trauma systems, and to increase money appropriated to functional trauma systems. Money — particularly to ensure participation by more hospitals and physicians — must be available, he said.

"An emergency room plus an ambulance does not a trauma system make," Oliver emphasized. "Having a functional trauma system requires full-fledged commitment, adequate and appropriate resources, and complete coordination."

That's a message he and other trauma system proponents took to Senate Public Health and Welfare Committee members in early January; they aim to continue to press for strengthening the statewide system throughout the 2007 session, expecting introduction of several bills to achieve that purpose.

"Mississippi's trauma system has already resulted in saving lives and reduced the severity of those injured through traumatic events," he pointed out. "We've had success in some parts of the state and can achieve that statewide, but our system is fragile for lack of commitment and adequate resources."

Some legislators will say the trauma system doesn't work, Oliver admitted.

"But it does in southeast Mississippi," he said. "The trauma system requires a lot of people and a lot of hard work, but we've been committed from before the beginning of the statewide volunteer system, and we're making a difference. Lives are changed."

The Trauma Care In Southeast Mississippi report published in late 2006 shows that from 2001 through 2005, the percentage of traumatically injured people who die has steadily dropped — from 3.3 percent in 2001 to just 1.83 percent in 2005, said Wade N. Spruill Jr., chief executive officer of AAA Ambulance Service in Hattiesburg, which manages Southeast Trauma Care Region.

"Failure or collapse of the system for any reason would result negatively on everyone," said Spruill, who directed emergency medical services with the Mississippi State Department of Health when legislators authorized a statewide trauma system. He retired from state service in 2000.

The Trauma Care Law in 1998 gave Mississippi its first stable chance to improve problems associated with severely injured people. Severe trauma refers to a major injury to one or more body systems and requires immediate medical, and often surgical, care to prevent permanent disability or death. Trauma leads causes of death among people from age 1 through 44 years, occurring without discrimination and potentially affecting everyone. Society suffers years of productive lives lost and also incurs the serious burden of high-cost disability and rehabilitative care.

Mississippi designed a regional approach to developing the statewide trauma system. Within a year, seven regions initiated active trauma programs designed to develop better methods for response and care of all traumatic injury victims. As lead agency, State Department of Health developed and the Board of Health approved The Mississippi Trauma Care System Regulations (available at http://www.ems.doh.ms.gov/pdf/trauma_regs_05.pdf.)

Designation levels set specific criteria and standards of care that guide hospital and emergency personnel to determine the level of care a trauma victim needs and whether that hospital can care for the patient or transfer to a trauma center that can administer more definitive care.

All trauma centers have transfer agreements in place to assure getting the "right patient to the right hospital in the right amount of time." Level IV trauma centers provide initial evaluation and assessment. Level III trauma centers must offer continuous general surgical coverage and can manage the initial care of many injured patients; Level IIIs must also provide continuous orthopedic coverage. Level II trauma centers must be able to provide initial care to the severely injured patient, with a full range of trauma capabilities, including emergency department, a full service surgical suite, intensive care unit, and diagnostic imaging. Beyond, Level I trauma centers must also have a residency program, ongoing trauma research, and provide 24-hour trauma service in their facilities.

"But people still don't understand trauma," said Oliver, who also is president of Forrest General Hospital in Hattiesburg and of the Southeast Trauma Care Region (SETCR) Board of Directors. "Trauma is about being ready."

Trauma system advocates see both pluses and minuses. They proclaim the state's law is well-founded, financial support as originated through the Trauma Care Trust Fund is exemplary, and state leadership has trauma system authority to develop system regulations, with flexibility to adjust for resource limitations.

In September, State Health Officer Brian Amy said Mississippi's trauma care system is "falling apart." He told lawmakers that problems with the system include under-funding, a lack of some hospitals' participation, and infrastructure problems caused by Hurricane Katrina. As executive director of the state Department of Health, Amy said his agency needs $35 million for the system in the fiscal year that begins July 1.

Oliver and colleagues in other functional trauma regions agree the statewide system needs more money.

"Coordination and planning are not where we need it to be," Oliver emphasized. "But with additional money, gaining physician support and participation, and having hospitals commit to the huge cost of cooperation and coordination, we can continue to improve, to reduce injury and death from trauma."

Oliver and colleagues said strengthened infrastructure can boost a limited system to also include large, populous areas of Mississippi not adequately covered for trauma care. He mapped coverage available, with Level I care only at University Medical Center in Jackson and The Med in Memphis. Four Level II trauma centers exist: Delta Regional Medical Center, Greenville; Baptist Memorial Hospital-Golden Triangle in Columbus; North Mississippi Medical Center, Tupelo; and Forrest General Hospital, Hattiesburg.

Just seven other trauma centers exist at Level III to which the other 61 Level IV hospitals can "feed" transfer patients: Singing River Hospital, Pascagoula; Ocean Springs Hospital, Ocean Springs; Baptist Memorial Hospital-North Mississippi, Oxford; Clay County Medical Center, West Point; Gilmore Memorial Hospital, Amory; Oktibbeha County Hospital, Starkville; and South Central Regional Medical Center, Laurel.

Trauma system proponents frequently decry large hospitals, particularly in Jackson, which will not participate at any level, even though Jackson's physician staffs include doctors most often needed for trauma care; many hospitals statewide also elected to participate but at a level of commitment below their real, "committed" capacity.

"Money needs relate to one of the most limited resources, physicians," Oliver said. "Our biggest gap is lack of physicians' commitment, buy-in, and coordination with other providers. We've learned that trauma occurs 24/7 with victims representative of all demographics. If we're going to care, we should be willing to invest.

"That starts with the doctor. We must have physicians available, trained, competent, and in a ready state. A traumatic Alpha injury — trauma so severe that the victim requires immediate life-saving intervention — requires that the entire trauma care team be standing ready when that patient arrives at the trauma center. When the Alpha call comes from emergency medical technicians on-site to the response, everyone on the trauma team gets the alert simultaneously and moves to await the arrival and provide the care. Being ready — that's what saves lives.

"Such readiness costs tremendously," he admitted. "But we must be willing to commit and to pay the cost to save lives."


February 2007

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