A Cry for Trauma Care

Last Christmas, a 5-year-old girl was shot in the chest during drive-by shooting in front of her house in West Covina. She needed the specialized care of a trauma center. But there is only one such unit in the San Gabriel Valley, and it could not accept the girl.

Worried that summoning an emergency helicopter for a ride to a trauma center in Los Angeles would take too much time, police officers carried her to their cruiser and drove her to the nearest hospital.

Paramedic Larry Whithorn, who arrived at the hospital to help, watched in dismay as hospital workers made phone call after phone call for at least 30 minutes to find a surgeon who could treat her.

“I was thinking how frustrating it is to have someone critically ill and they need to have a certain physician trained in that and you have to call them in,” he said. “That kid could’ve definitely benefited from a trauma center.”

Shortly after the girl was taken into surgery, she died.

Los Angeles County’s trauma care system has been the subject of much debate in recent months as officials closed the trauma unit at Martin Luther King Jr./Drew Medical Center. The number of centers countywide -- those that take care of patients critically injured in car accidents and by gunshots -- has gone from 23 units in the 1980s to 13 today.

But nowhere has the loss been felt more greatly than in the San Gabriel Valley, a 300-square-mile area webbed with seven freeways. Huntington Memorial Hospital in Pasadena, at the west end of the valley, is the only trauma center in a region of more than 2 million people.

“The system is upside down,” said George Hunter, a councilman in Pomona and the head of a San Gabriel Valley Council of Governments task force on trauma service. “We’re looking for medical justice ... I think there’s no question that the residents of this area are underserved and will continue to be underserved until we have a trauma center here.”

Los Angeles County voters in 2002 approved a property tax increase to boost the trauma system. But despite talk at the time of establishing new centers in Pomona and the West Covina area, none has been opened.

Police and fire officials in the area say this shortage puts public health in jeopardy, though they have no data to back it up.

Transport times for trauma patients in the San Gabriel Valley are longer than many other parts of the county, but there is no evidence of a higher mortality rate for patients from this region, said Carol Meyer, director of the county’s emergency medical services agency.

Most trauma patients in the San Gabriel Valley make it to a trauma center within the county’s guideline of 30 minutes, she said. Calling a helicopter for transport does add time, but it still would be faster than driving patients through traffic, she added.

It takes about 30 to 40 minutes for helicopters to power up, fly to a location, pick up a patient and land at a hospital, said Deputy Chief Michael Dyer, whose duties include overseeing the helicopter trauma transport for the Los Angeles County Fire Department.

About 24% of the patients requiring trauma care were shuttled by helicopter to a trauma center, according to county data from 2002-2003, the most recent complete set available. About 72% were driven by an ambulance.

Meyer and other county officials contend that the trauma system provides adequate care despite the lack of units in the San Gabriel Valley.

“It would be optimal to have [another] one in the San Gabriel Valley,” Meyer said. “But if there isn’t one in the San Gabriel Valley, trauma service is still being provided.”

Others aren’t so sure. Frank Wills, the police chief of West Covina, doesn’t think helicopters are enough.

“It’s frightening what’s going on,” he said. “I’m scared to death if one of our officers gets shot or a firefighter suffers significant trauma. To be able to get someone to a trauma center in five minutes is better than having to wait for an airship to come.”

Whithorn, the West Covina paramedic, isn’t satisfied either.

He often cites a case six years ago to illustrate his concerns. He responded to a call and found a 2-year-old girl bleeding profusely from a gunshot to her abdomen. Huntington Memorial Hospital could not take her. A dispatcher told fire officials she should go to Childrens Hospital Los Angeles, 25 miles away.

Whithorn could not schedule a helicopter to pick up the girl for at least 20 minutes. So he and other rescue workers packed her into the ambulance and headed down the San Bernardino Freeway. The girl died en route, with the paramedic unit stuck in traffic, he said.

“I felt extremely frustrated,” Whithorn said. “I’m not saying she would’ve made it if we made it to a trauma center. But would her chances have increased? Absolutely.”

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The San Gabriel Valley used to be home to three trauma centers, including one at Pomona Valley Hospital Medical Center and another at Citrus Valley Medical Center-Queen of the Valley Campus in West Covina.

Trauma care can be costly because it requires special equipment and teams of specialists, healthcare officials said. They said the heavy financial burden of handling uninsured patients has caused some hospitals to scratch their trauma centers.

Huntington Memorial, the valley’s lone trauma center, accepts patients from eight cities and one unincorporated area. Severely injured patients in the valley’s other 23 cities and numerous county unincorporated areas have to be taken by ambulance to County-USC Medical Center or by helicopter to a rotating list of trauma centers, among them Long Beach Memorial Medical Center and St. Francis Medical Center in Lynwood.

Despite its large geographic size, the San Gabriel Valley represents only a small portion of all Los Angeles County trauma cases. About 1,300 people in the valley require trauma care every year, among about 17,000 trauma cases yearly across the county, officials say.

The area is more suburban than Central Los Angeles, and there are fewer gunshot victims who need trauma care. Still, there are some pockets of the valley -- notably the Pomona area -- where shootings are more common.

“My big concern is Pomona’s unfortunate history of gang violence,” said Hunter, the Pomona councilman. “Being surrounded by freeways, we get a lot of trauma from the freeways, as well. Sometimes people have to be taken to the closest hospital, whether it’s a trauma center or not.”

Hunter and other San Gabriel Valley leaders are disappointed that the 3-cent-per-square-foot tax on buildings, approved by voters in 2002 to fund bioterrorism response and emergency medical services, has not improved the local trauma situation. Many officials said they supported the tax, called Measure B, because they thought it would bring a new trauma center to the area.

The San Gabriel Valley contributes about $33 million a year to the tax, about 19% of the amount collected countywide.

“We realized we’re paying for a significant portion of the trauma care, but we’re really not receiving what we should be,” said Steve Johnson, a councilman from La Verne who is on the task force.

“When they can fly, La Verne is served well by helicopters, but if for any reason the helicopters don’t fly, then we’re in trouble, especially depending on traffic,” he said. “We have the furthest to go to any of the available trauma centers.”

Officials have launched a campaign for another trauma center. Pomona Valley hospital is the leading candidate because its leaders have expressed interest in making the costly move.

Kathy Roche, a Pomona Valley spokeswoman, said the hospital is studying the feasibility of creating a trauma center. The board of directors has not yet seen a report on the subject.

The hospital has taken the initial steps of meeting with local council members and county health officials and determining that they will probably need at least 38 more nurses in the emergency room, intensive care unit and medical-surgical wards to support a trauma center.

The hospital officially withdrew from the trauma network in 1988 but has continued to see a significant number of patients with of gunshot wounds and other kinds of penetrating trauma, Roche said.

The hospital also stabilizes patients who have been in car accidents or have suffered other kinds of blunt force trauma before they are taken to other facilities, she said.

Roche said this was part of the consideration and the hospital intended to do a careful financial review. “It’s estimated two-thirds of California hospitals are in the red,” Roche said. “We are not, but it’s not real far into the black.”