Rules Change for Transporting Mass. Trauma Patients

June 14--When Mashpee firefighters arrived at the scene of a head-on collision in March, they found one driver trapped inside his van with broken legs and an injured elbow.

The responders immediately decided the patient required the specialized careW of a hospital trauma center and called to check the availability of a medical helicopter to get him there. But weather did not permit an airlift, so he was taken by ambulance to South Shore Hospital in South Weymouth, about 50 miles from the scene.

That incident was possibly the first time Mashpee responders had to deal with new state guidelines that say patients with major injuries should be treated at state-designated trauma centers, rather than local hospitals.

Patients from Bourne, Sandwich and Barnstable, parts of Falmouth, Mashpee and a western corner of Yarmouth are now likely to be taken to South Shore Hospital in Weymouth or Rhode Island Hospital in Providence, R.I., by ambulance, or to a Boston trauma center by a medical helicopter, such as Boston MedFlight.

Patients from the Islands, the rest of Yarmouth and points east to Provincetown are either to be flown to an off-Cape trauma center, or taken to Cape Cod Hospital by ambulance.

Patients in an area south of Route 151 in Falmouth and east of Willow Street in Yarmouthport could go to either an off-Cape trauma center or Cape Cod Hospital.

However, David Faunce, executive director of the Southeastern Massachusetts Emergency Medical Services Council, said any patient could be taken directly to a trauma center if deemed necessary by paramedics and the medical control physician at Cape Cod Hospital.

Neither Cape Cod or Falmouth hospitals are what the state designates as Level 1 or Level 2 trauma centers.

The advantages

Trauma centers have a number of advantages over smaller facilities, including availability of staff, screening equipment and academic connections, Alasdair Conn, chief of emergency services at Massachusetts General Hospital in Boston, said.

"The first patient I managed was unconscious, both lungs were collapsed, all the ribs on one side were broken, a ruptured spleen -- and a fractured pelvis," Conn said. "You can't take that into a community hospital at 2 a.m."

A Level 3 trauma center, he said, is defined as a good community hospital with surgeons on call. Staff can deal with injuries such as a fractured femur or pelvis and similar injuries.

A Level 2 trauma center, he said, has a CAT scan on the premises, surgeons 15 to 20 minutes away on call, and can cover all the specialties.

A Level 1, such as Mass General, has all this, as well as an educational component, including fellows, residents and doctors who publish significant research, he said.

Becoming a Level 1 trauma center, Conn said, costs money. Keeping up standards can be millions of dollars a year.

The guidelines were adjusted to provide what emergency responders and medical professionals say is the best possible care for the Cape's most severely injured patients. The chance for recovery and rate of survival is 25 percent higher when a patient has been treated at a trauma center, they say.

But the guidelines, they also say, are just that: guidelines. And the Cape is in a special location, Faunce said.

Getting a Cape and Islands patient to a trauma center could be a challenge because of the patient's condition, traffic and weather.

"Technically the Cape is an island connected by bridges," he said. "There's only one way on and one way off."

And the guidelines are not an implication that care at Cape Cod or Falmouth hospitals is bad, said Bill Flynn, director of the Cape and Islands Emergency Medical Services System Inc., the liaison organization between emergency responders and medical professionals.

"Cape Cod Hospital has always done a great job," he said. "It's just that these rules came down from the state, and we have to do everything we can to get a patient to a certified trauma center."

Always an option

Lori Jewett, director of process improvement and ambulatory services for Cape Cod Healthcare, which owns Cape Cod and Falmouth hospitals, said even before the state guidelines, the company was doing all it could to work with local departments and EMS responders -- whether that be through training or developing the on-call service used by EMS officers during incidents.

There has always been the option of going to the local hospital, and a physician has always been on call for emergencies related to trauma or patients in imminent danger, Jewett said.

As it stands, the hospital, one of the busiest in the state, meets some of the requirements to be a Level 3 trauma center, including physician and surgeon specialities and coverage arrangements, blood bank requirements, operating room and intensive care unit capabilities, and emergency department physician coverage.

"It's not a shift in the care we provide. It's just a shift in the designation we require," Jewett said, adding the hospital is assessing the possibility of becoming a trauma center.

George Baker, the fire chief in Mashpee, said he understands the financial hardship associated with establishing Cape Cod Hospital as a trauma center, but it would be a bonus.

"I'd love to see Cape Cod Hospital as a regional trauma center," he said.

During the last year, there were 325 calls for MedFlight to the Cape, 200 of which were completed. Of those 200, only a small percentage were for trauma incidents.

The other 125 were called off, usually because transport was not needed.

It's difficult to compare costs between transport by air and ground because of several factors, including distance and type of injury.

A flight from the Cape can generally run up to $10,000, said Suzanne Wedel, chief executive officer of Boston MedFlight.

The cost to take the patient from the Mashpee accident to South Shore Hospital was about $1,600 -- about double the price it would cost to go to either Falmouth or Cape Cod hospitals, Baker said.

The new guidelines, he said, do put a bit of a strain on the department, since a trip to South Shore ties up an ambulance and crew longer than a local transport.

But an established system of coverage from other departments, and increased reimbursements negate those two drawbacks, he said.

The Hyannis Fire Department, the closest ambulance crew to Cape Cod Hospital, hasn't had any opportunities to follow the new guidelines yet, said EMS Officer Mike Medeiros.

"It's a case-by-case basis for us," he said. "We're still feeling out what the impact will be."

Yarmouth Fire Department EMS Officer James Roberts said he thinks the guidelines are in the patient's best interest.

"What if that's my daughter, my granddaughter, my wife or someone close to me? I want to have the best treatment possible," he said. "It can sometimes be the difference between life and death. How can you put a cost on that?"

Copyright 2012 - Cape Cod Times, Hyannis, Mass.