Orange County’s Trauma Care System Called ‘Very Successful’

Contrasted with Los Angeles County’s crippled trauma care system, doctors and paramedics in Orange County say their trauma care network runs like a well-oiled machine.

That is not to say there aren’t problems, however. Doctors at the four hospitals that make up Orange County’s trauma care system all grumble about not getting enough reimbursement from either the state or county for care of uninsured indigent patients.

And there are “very rare” circumstances, they say, when paramedics may have to rush to another hospital because a crucial piece of operating equipment is shut down for refurbishing work at one of the trauma centers.

But paramedics spending 45 minutes searching for an available emergency room? Critically injured patients stacked up and awaiting care in trauma rooms? These kinds of medical care horrors, common in Los Angeles, are practically unheard of in Orange County, where the Board of Supervisors on June 7, 1980, inaugurated Southern California’s first trauma care network, and one of the first in the nation.

‘Successful System’

“It’s really run darn well for us,” said Rob Patterson, a paramedic and training officer for the Orange County Fire Department. “You just don’t hear about people getting turned away.”

“We have a very successful trauma system,” agreed Betty O’Rourke, program manager for Orange County Emergency Medical Services, which oversees the trauma system.

In Orange County, a trauma patient with life-threatening injuries is transported by paramedics past the nearest hospital emergency room to the nearest available of four specially staffed and equipped trauma centers: UCI Medical Center in Orange, Fountain Valley Regional Hospital and Medical Center, Western Medical Center in Santa Ana and Mission Hospital Regional Medical Center in Mission Viejo.

Perhaps the key to Orange County’s comparative success, however, is the huge difference in volume of injuries generated by the two counties, doctors at the Orange County trauma centers said.

Los Angeles County, with more than 8 million residents, generates “100 to one” more trauma cases than Orange County, which has 2.2 million residents, said Dr. Thomas Shaver, trauma director at Mission Hospital.

Types of Injuries

A difference in types of injuries in the two counties also accounts for the comparatively severe economic problems seen in the Los Angeles system, Orange County doctors said.

The bulk of Orange County’s trauma cases, for example, involve people hurt in motor vehicle accidents, said Dr. Kenneth Waxman, trauma director at UCI Medical Center, which treats more than 1,200 trauma cases annually. Los Angeles County has many more gunshot and stabbing injuries.

Gunshot and stabbing victims are statistically far less likely than traffic accident victims to have medical insurance that can reimburse the hospital, Waxman said.

So in Orange County, “we are not making money, but we are holding our own,” he said, in contrast with Los Angeles County’s severe economic crunch.

Dr. Donald R. Dicus, associate administrator at Western Medical Center, said another key difference between the two trauma networks is that Orange County’s was the better organized. In Orange County, the Board of Supervisors divided the county into five geographic areas for the five trauma centers that initially participated in the network.

Anaheim Memorial Hospital, one of the participants, dropped out for economic reasons several years ago, he said, but the others have a sufficient volume of calls to “keep skills up and justify staffing.”