“The emergency departments at those locations will continue to serve their communities with the same care from the same highly trained medical professionals as before,” said Sarah Hackenbracht, president and CEO of the Greater Dayton Area Hospital Association.
Miami Valley Hospital is the region’s only level I trauma facility for adults, and Dayton Children’s Hospital is the only level I pediatric trauma center in the region.
No significant changes to EMS deliveries by ambulance anticipated
Local EMS personnel are not anticipating much, if any, changes in their operations due to the lapsed trauma statuses.
With Soin Medical Center ceasing operations as a verified level III trauma hospital since mid-April, Beavercreek EMS has already been operating without that trauma center for about two weeks.
In areas where a trauma patient is closer to a level III trauma but still within 30 minutes of a level II or level I center, trauma triage guidelines in state law say EMS providers should decide whether the patient would benefit more from an immediate evaluation, stabilization and treatment at the level III trauma center, or from direct transport to a level II or level I.
The Greater Miami Valley EMS Council includes directives from state law in its prehospital protocol, which are the standing orders paramedics and EMTs follow in treating patients.
The city of Beavercreek and Beavercreek Twp. are within that consideration area, with both closer to level III centers, but within 30-minute transport of a level I or II center, said Fire Chief David VandenBos of the Beavercreek Twp. Fire Department.
“As a result, our EMS providers have always had both a level I (Miami Valley) and level II (Kettering) option for trauma patients. Additionally, there have always been, and continue to be well-defined exceptions to the Trauma Center requirement that apply,” VandenBos said.
For Beavercreek, over the past year, only about 0.8% of Soin Medical Center patient destination determination was due to protocol, VandenBos said.
“Assuming that they were all due to trauma protocol, and not other required protocol determinations (e.g. stroke), that represents about 20 patients annually that may be required to be transported to a designated trauma center,” VandenBos said.
Since the change, they have transported approximately seven patients per day to Soin Medical Center, which is the average for 2023, he said.
The 17 days since the change in trauma status is a small sample size, he said, adding, “(T)here hasn’t yet been a significant change in patient transports to Soin, nor do I anticipate one.”
No significant changes to EMS operations are being anticipated from Soin Medical Center or Miami Valley Hospital South’s changes in trauma status, he said.
“We’ll continue to transport our patients to the most appropriate facility for their needs, with appropriate consideration of protocol and patient choice,” VandenBos said.
Levels set by medical association for surgeons
The trauma levels and verification processes are established by the American College of Surgeons (ACS), a professional medical association for surgeons and surgical team members.
With any ACS-verified trauma center, there are expectations that the center is immediately prepared to care for injured patients and that verified centers routinely evaluate the quality of care they provide, the ACS public information team said.
The absence of verification is not meant to imply a center does not do this or does not have the resources, only that there are no assurances that they do, ACS said.
What the levels mean
Unintentional injuries are the leading cause of death for Americans aged 1-44 years old, according to the Centers for Disease Control. Suicide is now the second leading cause of death for this age group, and homicide is in the top five of leading causes.
The verified trauma levels indicate that services to treat patients are readily available at those trauma centers at any moment.
“Maintaining a level III trauma certification requires facilities to ensure 24-hour immediate coverage by emergency medicine physicians and trauma advanced practice provider, as well as the prompt availability of general surgeons and anesthesiologists,” Hackenbracht said.
Level I trauma centers must be capable of providing system leadership and comprehensive trauma care for all injuries, according to ACS. In its central role, a level I trauma center must have adequate depth of resources and personnel, such as prompt availability of general surgeons and care in other specialties.
In most trauma systems, designated trauma centers of different levels coexist with other acute care facilities, which ACS says should also be formal members of the trauma system. These facilities assist in caring for patients whose injuries are less acute and provide data for research programs and improving performance, ACS says.
Level II trauma centers are expected to provide initial definitive trauma care for a wide range of injuries and injury severity. These centers may take on additional responsibilities in the region related to education, system leadership and disaster planning, like level I centers.
Level III trauma centers may serve communities lacking quick access to higher levels of trauma care. Level III centers “fulfill a critical role in much of the United States by serving more remote and/or rural populations,” ACS says.
Level III trauma centers provide care to patients with mild to moderate injuries. These centers have procedures for prompt evaluation, initial treatment management and transfer of patients whose needs might exceed the resources available, ACS says.
Credit: Jim Noelker
Credit: Jim Noelker
‘Robust partnerships’ help commitment to care
The Dayton region’s hospitals have a longstanding commitment to emergency and trauma care by providing 24/7 services, Hackenbracht said.
“With robust partnerships between our region’s hospitals and EMS partners, the coordination and communication protocols are already in place to ensure that emergency and trauma patients are transported to the right facility for their medical needs,” Hackenbracht said.
The decision to operate as a trauma hospital is up to the facility, according to state law, which says nothing is meant “to limit in any way the ability of a hospital to determine the market area of that hospital.”
This decision can potentially save patients costs.
“Trauma activation charges are typically added for a patient when the support of the trauma team at a hospital facility is activated. When a trauma center is closed, the trauma activation fee is no longer applicable,” Hackenbracht said.
The strong growth in specific services such as orthopedics and oncology that Miami Valley Hospital South is seeing are part of what Premier Health says is driving its decision to cease its verified trauma status, according to a Premier Health spokesperson.
Miami Valley Hospital South sees three to four trauma patients per day, the spokesperson said.
“We have no plans to reduce or cease trauma operations at our other hospital campuses. We will continue to operate Miami Valley Hospital’s main campus as a level I trauma center, and Atrium Medical Center and Upper Valley Medical Center as level III trauma centers,” Premier Health said.
When the highest level of care is needed
EMS personnel do triage in determining the severity of a patient’s injuries or conditions, helping them determine whether or not they should be transported to the highest level trauma center available within the geographic constraints of the regional trauma system. Criteria is established by the American College of Surgeons.
The types of injuries or conditions that would call for the highest level of trauma care available include:
• Penetrating injuries to head, neck, torso and proximal extremities
• Skull deformity, suspected skull fracture
• Suspected spinal injury with new motor or sensory loss
• Chest wall instability, deformity, or suspected flail chest
• Suspected pelvic fracture
• Suspected fracture of two or more proximal long bones
• Crushed, degloved, mangled, or pulseless extremity
• Amputation proximal to wrist or ankle
• Active bleeding requiring a tourniquet or wound packing with continuous pressure
Patients who are unable to follow commands, are in respiratory distress and/or have an abnormally high or low heart rate for their age range are recommended to go to the highest level of trauma care available in their area.
When any level of trauma care will do
EMS personnel can take patients with less severe injuries or conditions to any trauma center, and they do not have to be the highest level available. The factors taken into consideration in that situation include:
• High-risk auto crashes
• Rider separated from transport vehicle with significant impact (eg, motorcycle, ATV, horse, etc.)
• Pedestrian/bicycle rider thrown, run over, or with significant impact
• Fall from height greater than 10 feet (all ages)
• Low-level falls in young children (age 5 years or younger) or older adults (age 65 years or older) with significant head impact
• Anticoagulant use
• Suspicion of child abuse
• Special, high-resource healthcare needs
• Pregnancy greater than 20 weeks
• Burns in conjunction with trauma
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