New rule to send more Indiana patients to trauma centers

SOUTH BEND, Ind. (AP) - When patients are severely injured in the state of Indiana, emergency medical service providers often transport them to the nearest trauma center.

But not always.

A new triage and transport rule by the state's Emergency Medical Services Commission has changed that with an official written standard. Patients determined to have sustained severe trauma injuries, as defined by the Centers for Disease Control and Prevention, now must be taken to the nearest trauma center.

In St. Joseph County, that trauma center is at Memorial Hospital, one of only eight verified trauma centers in Indiana.

Some state officials said they believe the rule may lead to more hospitals becoming trauma centers so they can provide that service to the most critically injured people.

Greg Bingaman, director of trauma services at Memorial, said the rule's ultimate goal is to make sure the right patient gets to the right place in the right amount of time.

The rule aims to better provide critical quality care during the first 60 minutes following a traumatic injury, known as the "golden hour."

"Trauma centers save lives and it is important that the trauma patient is transported to the most appropriate facility in a timely manner," Bingaman said.

For a large majority of the state, transporting patients to a trauma center requires significant time by EMS personnel and is a difficult situation, Bingaman said.

There are exceptions to the new rule: if it takes more than 45 minutes to transport the patient to a trauma center, for example. Or if the patient's life will be endangered if care is delayed by going to the nearest trauma center.

Patients also have the right to choose, so they could tell EMS providers that they wish to seek medical assistance someplace other than a trauma center.

In any of these scenarios, the patient should be taken to the nearest appropriate hospital, as determined by the EMS provider protocols, the new rule states.

Trauma centers differ from traditional hospital emergency rooms in significant ways.

Emergency departments treat broken legs, concussions, lacerations and injuries resulting from some motor vehicle crashes as well as trips on the sidewalk.

Trauma centers, on the other hand, are verified by the American College of Surgeons to treat patients who have received multiple fractures and brain injuries, who suffer from paralysis, handgun and stab wounds and who have been in car rollovers and ejections.

Art Logsdon, director of trauma and injury prevention for the Indiana State Department of Health, characterizes the new trauma patient transport rule as "foundational" in creating a statewide trauma system.

Michigan's system is much more integrated than Indiana's, Logsdon said. "From what I've seen, they're probably a couple of years ahead of us in developing their statewide trauma system — maybe more," he said about Michigan.

When trauma patients are transported — by ground or by air — to trauma centers, the preventable death rates drop by 15 to 30 percent, according to the state Department of Health.

"We've got a lot of good elements of a system — ambulance providers, trauma centers, and hospital emergency departments," Logsdon said about Indiana.

"But all too often the right hand and left hand know little of each other. In the grand scheme time wise, we're maybe at a 3 on a 10-point timeline in establishing a statewide trauma system."

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Information from: South Bend Tribune, http://www.southbendtribune.com