Surgeon at Scripps Seeks More Focus on Trauma Care Needs

The ambulances that delivered patients to Scripps Memorial Hospital’s trauma ward on Christmas carried an uncommon number of children who had suffered life-threatening accidents. One child was injured when she rode her new bicycle into the path of a car. Another accident involved an 11-year-old girl who was thrown from a car that overturned on a Mission Bay bridge.

Youngsters who suffer life-threatening injuries in San Diego County often are cared for by pediatric trauma experts at Children’s Hospital. But to Dr. A. Brent Eastland, who was on duty at Scripps on Christmas, the level of care offered by Scripps--or any of the county’s six trauma centers--proves that San Diego’s trauma care system works.

“We’ve got this incredible partnership,” said Eastland, Scripps’ director of trauma services and the incoming chairman of the American College of Surgeons Trauma Committee. “We’ve got a university hospital, four community hospitals, a children’s hospital and a county bureaucracy, but the (trauma care system) is working in San Diego County.”

Eastland was elected to chair the trauma committee largely because of his role in the creation and continuing operation of San Diego’s trauma system, according to trauma experts elsewhere in the country.

“The nominating committee was well aware that (Eastland) was instrumental in setting up San Diego’s trauma system,” according to Dr. Erwin Thal, professor of surgery at the University of Texas’ Southwestern Medical School in Dallas. “The San Diego system was put together with lots of thought and concentration, and Dr. Eastland is one of the people who were responsible for it.”

Lobbying Effort

Eastland intends to use the committee chairman’s position--and the resulting publicity--to focus attention on the need for improved trauma care. He intends to become active in lobbying at the state and national levels.

“There is an incredible void in the public’s understanding of what trauma is all about,” said Thal, the current committee chairman. “Everybody knows about cancer and heart disease, but I’m always impressed by how much lay people don’t know about trauma, which is any life-threatening injury.”

“It’s always seen as something that the other guy is going to (be hit with) or that is an inner-city sort of thing,” said Thal, chairman of the college’s trauma committee.

In reality, according to Thal, trauma is responsible for an estimated 25,000 unnecessary deaths annually in the United States because prompt, comprehensive care is not available. Trauma--largely in the form of car and motorcycle accidents, gunshot wounds and biking accidents--remains the leading cause of death for those under age 40. Because trauma so often affects the young, “the number of years of productive life that are wiped out by trauma, exceeds both heart disease and cancer,” Thal said.

Before the San Diego trauma system was established in 1984, nearly 20% of accident victims died because proper care was not available, Eastland said. That preventable death rate, which is based upon autopsies and medical treatment records, has plunged to just 1%, he said.

San Diego County’s 5-year-old trauma care system includes UC San Diego Medical Center, Scripps, Childrens, Palomar Medical Center, Sharp Memorial and Mercy hospitals. Each hospital has equipment and staff needed to provide the kind of care demanded by the trauma committee, which sets care guidelines for the U.S., Canada, Latin America and South America.

Trauma centers are “something like a firehouse,” Eastland said. “You don’t know when you’re going to have a fire, but when you do, you’ve got to have the engines, the firemen, the electronic communications system. Then you can go out and fight a fire.”

When Eastland becomes chairman of the college’s trauma committee in March, the Wyoming native will spend much of his time lobbying legislators and voters to find a more rational way to pay the high costs of trauma care.

Even San Diego’s program will deteriorate unless the costs of providing trauma care are restructured, Eastland said.

The system already has problems. Its six member hospitals lost $7 million during 1988, and doctors are increasingly wary of the time and financial demands of being associated with trauma centers.

“Our system will fail like everyone else’s,” Eastland said. “We’re very viable today, and we have a tremendous esprit de corps, but I don’t think any of us could continue to lose at the rate we’re losing.

“The question is, what’s going to happen?”

Bills Before Congress

Eastland believes legislators and voters will approve funding to ease financial pressures on member hospitals and individual physicians. Congress is considering a pair of trauma bills supported by Sen. Alan Cranston (D-Calif.) and Rep. Jim Bates (D-San Diego) and “things really look bright” at the state level, Eastland said.

Trauma centers will share in the $160 million in funds generated by Proposition 99, the cigarette tax passed in 1988, and Eastland believes that voters in November, 1990, will embrace an alcohol tax initiative that has been dubbed the “nickel-a-drink” tax.

If approved by voters, the tax would generate an estimated $800 million during the first year. About $200 million would be used for trauma center funding, and the rest split among several other health-related programs.

Surveys have suggested that nearly 80% of Californians will vote for the drink tax, according to Eastland, who noted that 65% of trauma-induced fatalities involve alcohol consumption.

“I can’t imagine that the public won’t say that (those who drink) ought to pay the bills,” Eastland said.

Eastland expects massive resistance from the alcoholic beverage industry, which is in the midst of its worst sales slump in 30 years. Trauma care advocates also will bump up against several other powerful lobbies--including gun owners, motorcyclists and the insurance companies--as they seek more funds, Eastland said.

“We’ve got to tangle with these people, we’ve got to get into the fray,” Eastland said. “Trauma has not been represented in the past because we don’t have a state lobby or a national lobby. We need to stand up and be heard. I expect a battle royal.”