New Statewide Trauma System has Big Impact

Patients transported to Arkansas emergency rooms with life threatening conditions now have a better chance of a positive outcome due to the development of the Arkansas Statewide Trauma System, and programs like “Arkansas SAVES,” the stroke telemedicine assistance program.

Until recently Arkansas was the only state without a statewide trauma system. The system is designed to ensure a coordinated response for accident victims resulting in more timely responses, cost-effective treatments and improved outcomes.

“We are extremely pleased with the progress made thus far in implementing Arkansas’ new trauma system,” said State Health Officer Paul K. Halverson, who is director of the Arkansas Department of Health. “During the past 18 months we have hired our complete staff, crafted policies and procedures for designating hospitals as trauma centers, designated 18 hospitals (four Level I; three Level II; two Level III; nine Level IV), put the Arkansas Trauma Communications Center in place, installed approximately 300 trauma radios to date in ambulances across the state, created seven Trauma Regional Advisory Councils throughout Arkansas, and contracted with a variety of entities to perform work to enhance the trauma system.”

For example, the University of Arkansas for Medical Sciences is engaged in a project to allow for electronic transfer of images such as MRIs and CT scans, thereby enabling faster delivery of appropriate trauma treatment and eliminating the need for rescanning patients at receiving hospitals. Future plans call for a review of trauma system progress by the American College of Surgeons, which will occur June 5-8, an education initiative for medical personnel involved with the trauma system, and contracting with a quality improvement organization to ensure the system is performing at an optimal level.     

“Arkansas is catching up with the times by joining other states that have ongoing trauma systems,” said Greg Hammons, MD, systems medical director for medical services, St. Vincent Health System, Little Rock. “The trauma system was rolled out in January of this year. Most larger hospitals will have these centers.”

Hammons said another trend in emergency medicine today is to develop specialty treatment centers. For example, hospitals will specialize in being a chest pain center or a stroke center.

“Patients with heart disease will get to an interventional cardiologist quicker,” Hammons said. “They will get to a cath lab and get angioplasty faster. The same thing is true with strokes. A neurologist will be with them sooner. The program Arkansas SAVES is a telemedicine network for smaller, rural hospitals that don’t have those specialists. Neurologists from larger hospitals can actually see the patients, and view patient studies like a CT scan in real time. It gets a specialist involved in the care much sooner, which is what needs to happen.”

In the past, a patient with a stroke would go to a rural hospital, and then be transferred to a large hospital to see a neurologist. It would be a minimum of an hour or two before the patient was seen by a specialist. Now specialists can be involved in their care in the beginning.

“A lot of people have heard that with heart attacks, time is muscle,” Hammons said. “Faster treatment can minimize the severity of the damage to the heart. It is the same thing with the brain. The sooner the treatment, the less damage to the brain. It minimizes the deficits they have from their stroke.”

There have also been advances made in the “door-to-balloon time” for heart attack patients.

“The most critical element in patient care is how quickly we can stop the heart attack,” said Donald E. Steely, MD, an interventional cardiologist with the Conway Heart Clinic. “That directly affects how much damage to the heart muscle occurs as part of a heart attack. The national door-to-balloon standard is 90 minutes or less from the time the patient walks into the ER to the time the artery is opened in the cath lab. That is a benchmark all institutions can be compared with. Our average door-to-balloon times are typically under 60 minutes.”

Every 30-minute delay equates to a 28 percent increase in mortality from heart failure.

The Conway Heart Clinic is able to achieve its under 60-minute response with innovations such as having the cath lab set up across the hall from the ER. Steely said their personnel live nearby and do an outstanding job of getting to the hospital quickly after hours. And they have focused on early recognition of chest pain symptoms and screening at the ER.

Another factor is if a patient who presents with heart attack symptoms is picked up by ambulance, the Metropolitan Emergency Medical Services transmits an EKG to the cath lab allowing an operation immediately after the patient arrives.

Further  innovation is the use of medically induced hypothermia to protect the nervous systems of some cardiac arrest patients.

“This has provided us with the opportunity to see favorable neurological outcomes almost double in frequency compared to previous approaches,” said

Wendell Pahls, MD, medical director of emergency services for Baptist Health Medical Center Little Rock.

He also credits the new trauma referral system with cutting the time required for arranging a trauma patient transfer to a larger facility capable of advanced trauma care from hours to a bare handful of minutes.

“Also, better antibiotics, safer pain management protocols and a multitude of other advances continue to help us serve the patients in the emergency departments around Arkansas,” Pahls said.

Simple, better attention to hand washing has also helped reduce infection rates at ERs across the country.

“There has been a big push for physicians to wash their hands before and after each patient,” Hammons said. “That has helped decrease the infection rates, as well.  It is amazing what simple hand washing can do.” 

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