Trauma centers are hospitals that provide a high level of emergency care to severely and critically injured patients through immediate, around-the-clock availability of specialized personnel, equipment and services. Trauma centers save lives, but the added expense of providing 24-hour access to surgery and other specialized care has resulted in a shortage of trauma centers, particularly in rural south Georgia. In Georgia, trauma centers are designated by the state, through the Office of Emergency Medical Services and Trauma (OEMS/T). The Georgia Trauma Care Network Commission distributes funds to trauma centers and EMS providers to compensate for costs of readiness and uncompensated care related to trauma and to promote a state trauma center network to ensure injured patients receive care at the best available facility. Floyd Medical Center was the first state-designated trauma center in Georgia.
A trauma patient is an injured person who requires timely diagnosis and treatment to diminish or eliminate the risk of death or permanent disability. Trauma is the leading cause of death among children and adults below the age of 45, and it is the fourth leading cause of death for all ages. The most common causes of traumatic injuries are motor vehicle crashes and falls. Injuries include multiple fractures, paralysis, punctured lungs, stab wounds, and brain injuries.
Studies have shown that the preventable death rate among trauma patients can decrease by 10-30% if they are served within a coordinated, comprehensive injury-response network of facilities that have the capability to care for the injured. A trauma system helps ensure a trauma patient receives care as quickly as possible.
Trauma centers are essential to emergency care in Georgia. A 2006 survey found that that only 30 percent of major trauma injuries in Georgia were treated at a designated trauma center, and that the trauma death rate in Georgia was 20 percent worse that the national average. That translates to 700 lives lost annually.
However, operating a trauma center is expensive. Higher-level trauma centers must have the capability to provide emergency surgical intervention around the clock. This means hospitals must have a trauma surgeon and a surgical team on call or available at all times along with the ancillary support staff and equipment available to ensure a quick and rapid surgical response.
Meanwhile, the demand for trauma services is growing dramatically–from 11,600 trauma cases in 2007 to nearly 64,000 in 2011. While high-volume metropolitan-area hospitals are likely to provide trauma services, far fewer rural hospitals can afford to provide these services. As a result, trauma patients in rural areas, especially in south Georgia, often do not have access to trauma care. Funds for a statewide trauma network were first allocated in 2006, but as the need for trauma care rises, hospital leaders throughout the state continue to work together to identify opportunities to fund trauma care.
Georgia recognizes four levels of trauma care:
- Level I trauma centers offer the greatest level of comprehensive trauma care from prevention through rehabilitation. They have onsite 24-hour general surgery, and are responsible for trauma education, research and system planning.
- Level II trauma centers provide a high level of clinical care with on-call access to general surgery around the clock, but do not have an on-site general surgical residency program.
- Level III trauma centers provide trauma assessment, resuscitation, emergency surgery, and stabilization but will usually transfer patients requiring more extensive care.
- Level IV trauma centers provide advanced life support in rural areas where no higher-level facility is available. Patients are stabilized, then transported to a Level I or II trauma center.
In 2018, Georgia had 27 state-designated trauma centers. Still, there are areas of the state where residents are more than 50 miles away from a trauma center.
Hospitals seeking trauma center designation notify their Regional EMS Council and the OEMS/T of their intent, appoint a trauma medical director and coordinator and implement a trauma registry program for at least six months. After OEMS/T reviews the registry data, the hospital documents how it meets the American College of Surgeon’s (ACS) criteria for the designation it is pursuing. OEMS/T then reviews the documentation and sends a team to visit the facility. After the visit, the team can either recommend or not recommend state designation.
Trauma centers are inspected every three years to maintain their designation. They must also submit quarterly reports and data to the state trauma registry. Trauma centers may request to upgrade their designation level; this process is similar to the initial designation process.
While some funding is provided through the Georgia Trauma Network Commission through proceeds from the Georgia Super Speeder law, the vast majority of trauma care is funded by the hospitals that provide trauma care. The state’s Super Speeder law fines drivers who are charged with driving more than 75 miles per hour on two-lane roads or 85 miles per hour on four-lane roads. The fine is an additional $200 over and above the normal speeding fine.
Relevance to Floyd
Floyd Medical Center is a state-designated Level II Trauma Center and was the first trauma center in the state, providing trauma services continuously since 1981. In fiscal year 2018, Floyd Medical Center provided care to 8,912 trauma patients.
Floyd supports the expansion of the trauma system into under served areas, but opposes adding trauma centers when demand for services is not at capacity or when the addition would have a negative impact on either quality or access. Trauma centers must have surgeons, anesthesiologists and surgical staff on call around the clock. For example, unless specifically planned for, if hospitals depend on the same surgeons compete for trauma services, situations could arise where trauma patients need services at the same time at two hospitals. Physician resources would be stretched. Demand for trauma care after normal working hours is another problem. If one hospital is a Level II Trauma Center and the other is geographically close and a Level III Trauma Center, the level of available care may not be equal after normal working hours and on weekends. Typically, a surgical team and anesthesia are not available on site at a Level III Trauma Center. If trauma patients are transported to a Level III center after hours, they will not get the same rapid response available at the Level II center. This situation is not in the best interests of patient care.