Let’s say a man has an accident while off-roading at the Oceano Dunes. He has a chest injury, an aortic disruption, and is bleeding internally. Paramedics arrive and quickly assess they have a trauma patient with multiple severe injuries. They load him into the ambulance, but instead of heading 3.5 miles down the road to Arroyo Grande Community Hospital, they hop on Highway 101 and drive 15.4 miles—about 20 minutes—to SLO County’s only official trauma center: Sierra Vista Regional Medical Center in San Luis Obispo.
Right now, no one knows which option is better. In the coming months, however, local health professionals will learn if designating a single, centrally located trauma center in SLO County is the best thing to do.
Nearly every health professional you ask about the plan will likely preface anything they say by noting their No. 1 priority is good patient care. But that’s not to say that there isn’t money to
be made.
According to the state Emergency Medical Services Agency (EMSA), there are reimbursement funds to offset the costs of upgrading a hospital
to meet trauma center criteria. And because of the nature of their injuries, trauma patients also generate higher bills than others brought for emergency care, according to local health officials and a state EMSA spokeswoman.
The people behind the trauma plan have faced criticism.
“Sierra Vista essentially runs the EMSA board,” Dr. Clint Slaughter, who works at Arroyo Grande, told county health commissioners on April 12.
Thomas Ronay is the SLO EMSA medical director—the top local official who reports to the state EMSA—and also practices emergency medicine at Sierra Vista. He hadn’t responded to a request for comment as of press time.
For two years, local emergency room doctors, hospital administrators, SLO County public health officials, paramedics, and a slew of other professionals have been hammering out the San Luis Obispo County Trauma System Plan. Opinions have been disparate, to say the least, particularly over a key piece of the plan that will designate just one hospital as a trauma center. The plan was recently shipped to the state EMSA with the controversial proposal intact.
“There has been an ongoing difference of opinion voiced by a few individuals who have come to the meetings as to what the negative consequences could be related to designation of a single trauma center in our county,” Public Health Officer Penny Borenstein said.
Currently, the writing seems to indicate that Sierra Vista is the top contender.
“We’ve been serving this capacity for many, many years, and we’d like the official recognition,” said Ron Yukelson, a spokesman for Sierra Vista.
Why would any hospital want to be trauma center?
Aside from outside funding perks, any local hospital designated as the trauma center would receive most, if not every, trauma patient in the county. Statistics on local trauma patients are fuzzy, because without an official trauma center there technically aren’t “trauma” patients. But according to the “best guess” of the consultants who compiled local data, there are between 200 and 300 trauma patients in the county each year.
The relatively small patient population (about one patient per 1,000 residents) is the limiting factor for a local trauma center.
“Trauma system care is a very specialized care, and in order to remain a trauma center, a trauma center has to have enough volume … they have to maintain their proficiency,” SLO EMSA Executive Director Charlotte Alexander said.
In other words, practice makes perfect for trauma specialists, and filtering patients to multiple trauma centers would mean less practice for specialists at each hospital.
Alexander assured that critical patients on the verge of death are “going to the closest hospital.”
With a designated trauma center, a patient’s ambulance bill could conceivably be more expensive. If, for instance, San Luis Ambulance—the county’s largest designated ambulance provider—picked up that theoretical patient at the Dunes and transported him to SLO instead of Arroyo Grande, the extra mileage would cost about $237 based on a rate of $19.85 per mile—on top of the base rate of $1,867.35—according to the county’s service rate schedule.
State EMSA officials still have to review the plan for approval, after which local officials will begin accepting applications and bids from Sierra Vista and possibly French Hospital to become the designated trauma center. It’s unclear, however, whether protests over the plan will stop.
This article appears in Apr 22-29, 2010.