Trauma Centers Effective : ‘It Worked From Day 1,’ Coordinator Says

Seven months after joining the network of county trauma centers, Daniel Freeman Memorial Hospital has pronounced the venture a success, despite a $250,000 deficit.

“It worked from Day 1, better than expected,” said Susan Linderblood, coordinator of trauma services. “We pulled together as a team and we have an effective system that has worked.”

Since the center was opened June 25 with round-the-clock surgical teams, it has seen 439 patients meeting county criteria for “critical trauma,” which mandates transportation by paramedics to the nearest designated trauma center. (This is about 10% of the people who suffer life-threatening injuries from traffic accidents, shootings, stabbings and falls, according to hospital and county officials.)

The South Bay’s second county trauma center, Harbor-UCLA Medical Center in Torrance, was one of the first to open, in December, 1983.

“It never occurred to us not to be a part of the county system because we are a teaching hospital with a training program for trauma surgeons,” said Dr. Robert Rothstein, chairman of the emergency medicine department.

Hospital officials said that as a county facility with a busy emergency room treating 95,000 patients a year, Harbor was already a trauma center without the designation. Rothstein said the hospital has always had a 24-hour surgical team--and up to 20 physicians working at the same time--and had to make only minor staff additions to meet trauma center requirements.

Dr. Stanley R. Klein, director of trauma services at Harbor, said the number of critical trauma cases may have risen from 350 to 600 as a result of the trauma center designation. The hospital is now doing a study to determine if there has been any significant change in patient survival, how trauma services have melded with the overall hospital system and what the costs are. “We get a lot of non-pays,” he said.

The trauma center network--which now numbers 21 and will eventually add one more--was approved in January, 1983, by the Board of Supervisors to improve the chances of the critically injured who would die without immediate care. It replaced the practice of taking all seriously injured people to the nearest 24-hour emergency room whether or not it had the staff on hand to perform immediate surgery.

“These people have to receive treatment fast or they die,” said Rothstein. “Some die no matter what.”

The two South Bay trauma centers receive qualified high marks from Virginia Price-Hastings, trauma program chief for the county Department of Health Services.

“They have not turned patients away and have certainly been able to handle the load,” she said, adding, “We have not as yet gone in and evaluated quality. This has to be done for the whole system.”

Quick Service

She said both Freeman and Harbor have met the crucial requirement that patients be transported to the hospital in no more than 20 minutes, from anywhere within service boundaries. (Freeman’s boundaries extend into metropolitan Los Angeles and to the Santa Monica Freeway on the Westside, while Harbor serves the southern half of the South Bay eastward to the Long Beach Freeway.)

“We are planning no changes in the South Bay system,” she said.

But two Westside hospitals--Brotman Medical Center in Culver City and Santa Monica Hospital Medical Center--are trying to compel a change that would affect the South Bay. Denied trauma center status last year, both hospitals have had appeals in the works for months and the issue is expected to be decided Feb. 12 by the Board of Supervisors.

Opponents include the county health department; the American College of Surgeons, which recommends standards for trauma centers; UCLA Medical Center, which is part of the county trauma system, and Freeman Hospital.

Price-Hastings said patient volume and travel times do not warrant adding the two hospitals to the system. “Trauma patients, except in very unique areas like Malibu, are getting to hospitals in 20 minutes,” she said. (Trauma victims in Malibu are helicoptered to UCLA.)

Number Too Low

The two Westside hospitals, however, contend that their services are needed and say their participation would enhance the county program. Gary Maier, associate administrator at Brotman, argues that the county has underestimated the number of trauma patients.

Freeman’s objections to adding the two hospitals hinge on money and quality of service, according to Stephen Goe, vice president for administration.

“We have to have an adequate number of patients to keep the surgeons and other professionals up to date,” he said. “And we also have to have a mix of patients who have some source of payment, and those who are indigent, to be able to justify our costs.”

He said the more affluent areas within Freeman trauma center boundaries are closer to Brotman and Santa Monica. “If this area were broken off, there would be serious doubt whether or not we could continue to operate the trauma center,” Goe said.

He said that so far about 50% of the patients have been indigent, and while there has been county reimbursement for many of these people, it has been “nothing near our costs.”

Goe said the hospital has invested $750,000 in the trauma center so far, and if the present level of operation continues, it will be at a break-even point by the end of June.

The clientele of South Bay trauma centers fall into two general categories: people mangled in automobile and motorcycle accidents and victims of violent crime.

“We’re pulling people off the freeways,” said Harbor’s Klein.

“The purpose of trauma care is to save lives, and that happens,” said Freeman’s Linderblood.

“System saves” is the term given to people who would not have lived without immediate surgery at a trauma center.

One of these people, according to the hospital, was an Inglewood attorney who was shot in August at point blank range in front of his home by an apparently disgruntled client. He had a blood pressure of zero when paramedics reached him, but in less that 20 minutes, he was in surgery.

Another Freeman “save” was a 14-year-old boy who suffered a collapsed lung and internal injuries when a pickup truck he and some other boys were riding in from a baseball awards ceremony overturned in El Segundo. He made a rapid recovery.

Organ Donations

Some people who have not been among the “saves” at Freeman have given life to others through organ donations by their families, officials said. So far, the trauma center has recovered 12 kidneys, 10 corneas, one heart and, two weeks ago, its first liver.

For the staff, trauma center duty can be monotonous--until a “code yellow” sends everybody into quick action.

“It’s 58 minutes of boredom and two minutes of terror,” said Dr. Alan Hollingsworth, a Freeman trauma surgeon. “When the patient comes in, you have three to five seconds to make a decision.”

Dr. Mitchell Major, an anesthesiologist on the Freeman team, said trauma is not a branch of medicine that allows planning: “The pressure is intense and you have only a few minutes to decide. I find it exhilarating.”