Human Side of Trauma System--Saving Lives

Four-year-old Michael Woods alternately fidgeted and slept on his parents’ laps Thursday, unaware that his presence at a press conference marking the first anniversary of San Diego County’s trauma care personalized the medical system’s success.

Without the year-old system, Michael--and hundreds of other victims of traffic accidents or falls or stabbings--would not be alive today, surgeons who run the system said Thursday.

The youngster was struck by a truck in front of his Escondido home in March, suffering a sliced liver, a damaged right kidney and a large hole in the main vein leading from the lower part of his body.

Helicoptered to the special trauma unit at Children’s Hospital, the boy was on the operating table for several hours as doctors worked feverishly to stop internal bleeding, repair his liver and remove the kidney. Even with the specialized surgeons available under the trauma system, Michael’s survival was touch-and-go. At one point, Dr. Frank Lynch told Michael’s mother, Glenna Woods, that the boy probably would not live.

Now as active as almost any kid his age, Michael perked up from playing with his monster robot Thursday only when Lynch presented his portion of the year-end review. The little boy smiled broadly at the man who had saved his life.

“The most significant impact of the trauma system has been (in reducing) the numbers of people dying at the scene or bleeding to death in the first hours,” said Dr. Brent Eastman, chief of trauma at Scripps Memorial Hospital. “The key is rapid evacuation to definitive care; the (reduction of) time from injury to definitive care determines the outcome.”

First-year statistics on the 3,258 patients treated at one of the county’s six trauma center hospitals were offered as proof.

If the system were not in place, the expected number of deaths would have been approximately 850, or 26% of the total, based on a 1982 county study that established the need for a county trauma system. The expected number of deaths with the functioning system, based on trauma center data nationwide, would be about 10%, or 325.

The actual number of deaths that occurred under the San Diego system was 244, or 7%.

And according to Dr. Steven Shackford, trauma chief at UC San Diego Medical Center, less than 3% of those deaths could have been prevented. Eastman added: “Those who do die now die on an operating table despite an all-out effort, instead of dying unattended in some side room while waiting for emergency care.”

“Without qualification I can say that we have the best trauma system in the nation,” said Gail Cooper, the county’s chief of emergency medical services. Cooper oversees the system, which began operation in August, 1984, after approval by the Board of Supervisors.

Six hospitals are designated as trauma centers, where surgeons and specialized equipment are on call 24 hours a day: UCSD, Children’s, Sharp Memorial, Scripps Memorial, Mercy and Palomar. Trauma patients are taken to those centers by either ambulances or Life Flight medical helicopter, bypassing hospital rooms along the way that are not equipped for trauma. At an accident site, patients are classified as trauma based on a quick judgment by paramedics or field physicians of the victim’s physiological shock and injuries.

Among the first-year findings presented Thursday were these:

- The majority of trauma patients are male and average 29 years old, with 82% under age 40.

- Nearly 75% were injured in traffic accidents, and half of those accidents involved alcohol. And 60% of the traffic deaths were alcohol-related.

- Of all child injuries in vehicle accidents--children being classified as patients 16 years old or younger--95% could have been prevented if the children had been in seat belts or car safety seats.

- Approximately half of all patients were transported from accident scenes to trauma centers by Life Flight helicopter, representing more than a doubling of Life Flight use since the system went into operation.

“It was pure speculation on our part that a trauma system would be successful in a civilian sector,” Shackford said, referring to the nation’s first trauma units, which were developed by the military to save wounded soldiers in Vietnam.

Shackford noted the system’s special medical audit committee, which reviews all trauma cases monthly, offering criticisms and suggesting improvements. Shackford said that the committee is attempting to better specify the criteria under which paramedics can remove a victim immediately from a site to a trauma center without field medical treatment first being necessary.

Cooper’s county staff is also trying to resolve a continuing dispute with North County coastal officials over the failure of Tri-City Hospital in Oceanside to receive trauma center designation, and the removal of a Life Flight helicopter from the hospital to Scripps hospital. North coast trauma victims are now taken to Scripps, located near La Jolla; critics say ground transport takes too much time and that Life Flight is not always available.

Cooper said Thursday that a special ground transport unit is now based at Scripps Hospital in Encinitas to help smooth possible problems. UCSD trauma system officials expect to have a final contract soon for basing a helicopter at Palomar Airport in Carlsbad, Dr. Bill Baxt, UCSD Life Flight director, said at the conference.

“I would stress that there have been no untoward events as a result of transport, whether in North Coast, East County or South Bay,” Cooper said.

Hospital representatives said their trauma centers are not money-makers, operating more as community services. “I can’t assure you that trauma centers are cost-effective for individual hospitals, but I can assure you they are very cost-effective for the community in saving lives,” Dr. F. Barry Knotts of Sharp’s trauma unit said.

The physician who first began pressing for a trauma system in 1979, Richard Virgilio of Mercy, added a personal note Thursday, putting the system into perspective by talking about “near-great saves.”

Virgilio recalled his disgust in 1977 when an 8-year-old boy died from what Virgilio said would clearly have been non-lethal injuries had immediate treatment been available. The boy’s death spurred his lobbying efforts.

“Less than 36 hours ago I had a young woman die in the operating room from multiple injuries suffered in an auto accident,” Virgilio said. “While walking down the hallway to give the news to the woman’s mother, my mind flashed back to the time I walked the hall to the boy’s mother.

“The boy’s mother had had every right to question the death of her son.

“In this case, the girl’s death could not have been prevented. Her mother was comforted in that her daughter had received state-of-the-art care, that the daughter would have never gotten to (such treatment) in the past.”