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Release: Dec. 28, 2000

UI part of new, coordinated statewide trauma care system

IOWA CITY, Iowa -- On Jan. 1, all hospitals, physicians and emergency medical service personnel will implement a new statewide system that coordinates the services required to provide optimum care for the seriously injured trauma patient. From the emergency medical technicians providing life-saving interventions at the scene of an injury to staff members at rehabilitation centers helping to restore normal function, the new system will affect all health professionals who provide trauma care in Iowa.

"Trauma is a very serious public health issue in Iowa," said Andrew Nugent, M.D., interim director of the Emergency Treatment Center at University of Iowa Hospitals and Clinics. "It's the leading cause of death among Iowans between the ages 1 and 44. About 300,000 of our citizens need emergency medical care annually."

The goal of Iowa's trauma system is to match injured patients' needs to existing resources for optimal trauma care. The system is designed to organize personnel, facilities and equipment in order to provide efficient and effective coordinated trauma care.

"A well-coordinated statewide trauma system saves lives," said Patrick Kealey, M.D., UI professor of surgery and director of Trauma, Burns and Critical Care Services at the UI Hospitals and Clinics. "In addition, coordinated trauma care reduces medical costs, as well as the indirect costs to society from disability and deaths that are associated with severe injuries."

The roots of Iowa's statewide trauma system began to grow in 1995 when state legislators passed the Iowa Trauma Care System Development Act. That legislation designated the Iowa Department of Public Health, through its Bureau of Emergency Medical Services, as the lead agency for trauma care system development and implementation.

The all-inclusive system was designed to take into account the rural nature of the state.

"Epidemiologists studying mortality in injured patients have known for quite a while that the risk of death from trauma is about twice as high in rural environments than it is in urban or suburban settings. At least part of that excess risk can be attributed to the kinds of injuries we deal with, but part is also related to the difficulty in providing the proper care quickly to those most in need," said Alfred Hansen, M.D., an emergency medicine specialist at the UI. "Iowans should be proud of the fact that the leaders in trauma care in this state devoted a great deal of time and effort to establish a comprehensive system that involves all the required components. I think it took real vision to adopt this approach and not focus exclusively on the biggest hospitals in the more urban settings. There is still a lot of hard work to do to bring about full implementation and to work out the bugs, but the blueprint is sound and seems to place the needs of the patients first."

Out-of-hospital emergency medical services are vital links in any trauma system. The new Iowa trauma care system goes into operation at the scene of the accident, when trained first-responders and EMTs arrive on the scene. They evaluate the patient's injuries and begin treatment. That treatment is continued while they transport the patient. The emergency care team will remain in contact with the hospital as they transport the patient.

"Communication between the ambulance crew and the hospital provides valuable information about the patient's condition and enables the activation of the appropriate response from special trauma teams at the hospital," said Jeffry Gauthier, administrative associate in Emergency Medical Services at the UI Hospitals and Clinics.

University of Iowa Health Care specialists will support the Iowa Statewide Trauma System by providing around-the-clock physician coverage, two AirCare helicopters for rapid transport of severely injured patients and resident physician training. UI Health Care also has established a partnership for resident training with the R. Adam Crowley Maryland Shock Trauma Unit at the University of Maryland, a center that specializes in treating penetrating trauma, such as gunshot wounds. The Emergency Medical Services Learning Resource Center at the UI Hospitals and Clinics also played a role through its training programs for emergency medical technicians, paramedics, nurses and physicians throughout Iowa. That training included instruction in Advanced Trauma Life Support (ATLS), the "gold standard" of trauma care.

All hospitals in the state participate in the trauma system through a process of categorization and verification as trauma care facilities. There are four levels of trauma care facilities in Iowa: community, area, regional and resource. The system is based upon having the local ambulance service assess the patient's injuries, and to then rapidly stabilize and transport the patient to the hospital that can best serve the needs of the patient.

"We firmly believe that as partners in this system for trauma care that we can enhance the outcomes of trauma cases," said Carol Scott-Conner, M.D., Ph.D., UI professor and head of surgery.

"Not only will the patients benefit, but all Iowans will reap the benefits of having more of those patients recover and return as contributing members of society."

The role of a community trauma care facility is to provide initial evaluation and stabilization of the severely injured patient. They have the necessary equipment and diagnostic resources to initially resuscitate severely injured patients. Stabilization may include immediate surgical intervention. Most patients who require surgery and specialized care will be transferred to resource or regional trauma care facilities.

An area trauma care facility also provides comprehensive inpatient services to patients who can be maintained in a stable or improving condition without specialized care. Critically ill patients who require specialized trauma care are transferred to a resource or regional trauma care facility.

The role of a regional trauma care facility is to provide comprehensive care for the severely injured patient with complex multi-system trauma. An organized trauma team is available to meet the patients arriving at the emergency department, with a broad range of physician specialists who are "on-call" to promptly provide care or consultation. Regional trauma care facilities also serve as resources for continuous quality improvement activities in the region.

The resource trauma care facility provides the most comprehensive trauma care for patients with complex multi-system trauma. An organized trauma team is available to patients immediately upon arrival in the emergency department, with a broad range of physician specialists also "on-call" for prompt care or consultation. In addition, resource trauma care facilities serve as a resource to all other trauma care centers for continuous quality improvement activities.

The Emergency Treatment Center at the UI Hospitals and Clinics is one of two resource trauma care facilities in the state. "This is an exciting development for Iowans," Nugent said. "Without a doubt, this new trauma care system enhances the treatment of injured patients across the state."

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.