A fight in the parking lot of a Milford bar leaves a young man lying on the asphalt, his throat slit. His friends rush him to Bayhealth Milford Memorial.
The Bayhealth trauma team is paged immediately. It quickly evaluates the patient’s condition, then begins treatments as he is wheeled to the operating room.
By the time the patient arrives in surgery, the trauma team has restored his airway and stopped the bleeding that had left his blood pressure and heart rate dangerously low. In the operating room, the surgical team is already prepped to repair the bleeding blood vessel.
After a successful surgery, the patient is stabilized, then transported to a Level I trauma facility, where he continues to improve and, finally, is discharged.
Milford Memorial is a Level III trauma facility, part of what is formally known as an Inclusive Trauma System in Delaware. Inclusive means all eight hospitals in the state belong to the system. Each provides resources to achieve one of the four levels of care required to qualify as a trauma facility. Delaware is one of only a handful of states with such a system.
“With his throat slit the way it was, that patient would most certainly have died had he not been in the close proximity of a Level III trauma facility,” says Dr. Pam Demnicki, a surgeon and trauma director for Bayhealth Milford Memorial who repaired that patient’s blood vessel that evening.
Because Delaware’s trauma system is inclusive, we are all blessed to live near enough to some level of trauma care to have a positive outcome if critically injured. This is reassuring. Considered as a disease, trauma kills more people under the age of 40 each year than cancer and heart attacks combined.
And Delaware’s trauma care system may be the best of the best. “No other state has the integration we have from border to border,” says Dr. Edward L. Alexander, director of trauma service for Bayhealth Kent General. He points to mortality rates from trauma in Delaware that are consistently below the national average.
“In trauma there is a principle known as the Golden Hour, where you have approximately one hour to restore resuscitation to a patient before death occurs,” Alexander says. “In Delaware, we routinely beat that hour.”
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Before 2000, Delaware was served only by the Level I trauma facility at Christiana Care in New Castle County.
“Prior to implementation of an inclusive trauma system, trauma victims in either Kent or Sussex County had a 30 percent greater risk of death compared to New Castle County,” says Judi Muir, trauma program coordinator for Bayhealth.
In a July 2007 article in the Journal of Trauma Injury, Infection and Critical Care, Alexander, along with Christiana Care’s Dr. Glen Tinkoff and others, published results of a study comparing Delaware’s mortality rates from trauma before implementation of its inclusive trauma system and after.
The report concluded that mortality had decreased by nearly half (from 5.3 percent to 2.8 percent) in Kent and Sussex counties after the inclusive system brought Level III trauma care to all of southern Delaware by 2000.
Alfred I. duPont Hospital for Children, the only Level II facility in Delaware, has neurosurgical services available 24 hours a day. Christiana Hospital’s Level I trauma center staffs a trauma surgeon, three nurses, a respiratory therapist, and a lab and X-ray tech, all capable of responding to a trauma case within 15 minutes of a hospital-wide alarm.
All this means the risk of dying from traumatic injuries is diminished, no matter where you live.
“Even a Level IV trauma facility is still trained to understand the protocols and transfer agreements to get a patient moved to the appropriate level of definitive care as soon as possible,” Muir says.
The key elements to an effective inclusive system, Alexander says, are “time, evaluation and referral.”
Time starts with the system’s organization of first responders, the paramedics and emergency medical technicians, as well as specially trained helicopter pilots.
Carol Faedtke, critical care transport manager at Christiana’s trauma facility, says, “Patients are now getting to definitive care facilities faster and in a more stable condition as a result of education, collaboration and overall continuing improvements in the system.”
Those improvements include a second Lifenet helicopter, based in Georgetown, which cuts 20 critical minutes out of a transfer from downstate to upstate trauma facilities. (Lifenet is a private carrier contracted to provide air services for Delaware’s trauma system.)
In the short life of Delaware’s inclusive system so far, Tinkoff has seen a change in attitudes toward victims of trauma.
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“There was a time when the culture held that trauma was not preventable. ‘It happens. You die.’ That is no longer the case,” he says. “There are no accidents. All trauma is preventable. And the culture now is, ‘We can save those lives.’”
As proof, Tinkoff refers to a system-wide drop—from 45 percent to 20 percent—in mortality of critically injured trauma victims in the service area of Delaware’s trauma system (which includes portions of Pennsylvania and New Jersey).
As impressive as those numbers are, system managers and coordinators continue to look for ways to improve.
“We could use an additional Level II facility within the system,” says Mary Sue Jones, trauma system coordinator for the Delaware Office of Emergency Medical Services. “After that, we’ve probably reached the saturation point for the state.”
Trauma Centers: On the Level
The differences in services and resources between a Level IV trauma facility and Level I are vast.
- A Level IV facility—as at Nanticoke Memorial Hospital, Wilmington Hospital and St. Francis Hospital—lacks resources such as 24-hour staffing for general surgeons or other specialty surgical services such as orthopedics.
- A Level III facility, such as Bayhealth’s Kent General and Milford Memorial hospitals, as well as Beebe Medical Center, has sufficient surgical and resuscitative resources to stabilize a patient for transfer to a Level I facility.
- Alfred I. duPont Hospital for Children is the only Level II facility in Delaware. It has neurosurgical services available 24 hours a day.
- Christiana Hospital’s Level I trauma center staffs a trauma surgeon, three nurses, a respiratory therapist, and a lab and X-ray tech, all capable of responding to a trauma case within 15 minutes of a hospital-wide alarm.
