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Published Wednesday, August 06, 2008 in Local

Photo by Sarah Fay Campbell

Dan Miears, who was paralyzed in a motorcycle crash nearly 20 years ago, has devoted his life to educating people about spinal cord injuries and the need for quality trauma care.

Experts: Hundreds die due to state's poor trauma network

By Sarah Fay Campbell

The Times-Herald

Each year, between 600 and 700 people injured in Georgia die because the state's trauma network isn't even average.

"Most of those deaths are clearly preventable," said Dr. Gage Ochsner, chief of trauma services and surgical critical care for Savannah's Memorial Hospital.

Memorial Hospital is one of four Level I trauma centers in Georgia.

"Many of those are patients that I get that are basically in irreversible shock by the time they get to me," Ochsner said.

Ochsner said he could think of at least 15 people, just this year, who had correctable, treatable injuries that "by the time they got to me, were beyond my capacity to rehabilitate."

That's because there are only 15 trauma centers in the state of Georgia. Six are in the metro-Atlanta area.

People in south Georgia have very few options when they suffer traumatic injuries. There are Level I centers in Macon, Savannah and Augusta, and a Level II center in Columbus.

But south of that, the only trauma center, a Level II, is in Thomasville.

People who live south of the Savannah/Macon/Columbus line have the same chance of dying in a traumatic injury that they had 40 years ago, Ochsner said. "People die of a bleeding spleen. And these are not rare occurrences."

The rate of deaths from traumatic injuries in Georgia is 20 percent higher than the national average.

Ochsner was one of several experts on trauma care who spoke Wednesday morning at a forum on the topic sponsored by the Andrew Young School of Policy Studies at Georgia State University in Atlanta.

While much of the discussion about the state's trauma network has focused on the Level I centers, what is really needed is more low-level trauma centers.

A Level II center has nearly everything a Level I center has. The only difference is a Level I center must have a residency program, ongoing trauma research and 24-hour trauma service.

"We need to have Level III's," said Ochsner. A Level III center, of which there are none in Georgia, provides trauma care, including round the clock orthopedic care, but might not have some of the specialty services the higher level centers have.

More Level III centers can really make a difference, Ochsner said. "They can handle the vast majority of trauma."

Level I centers "are hugely expensive," Ochsner said. "Regionalization is critical."

When it comes to major medical care, Georgia has the distinct disadvantage of being a very large state with a low population density in the South.

Maintaining a trauma center is expensive. There are fixed costs, such as having surgeons on call, that can never be covered by insurance payments from individual patients.

The trauma system got an infusion of cash from the Georgia General Assembly this spring, but there was no agreement on continued funding. A plan to add a $10 motor vehicle tag fee to fund trauma care in Georgia was a victim of fighting between the House and Senate over tax reform.

"It was a huge disappointment to me that because of political egos and agendas we did not get the sustainable funding," Ochsner said.

He's long thought that "it's going to take some awful disaster that is totally preventable before people are going to wake up and say we're going to fund it."

He thought the catastrophic explosion at the Dixie Crystals refinery outside of Savannah would have done the trick, but it didn't.

"I think the people of this state want it," Ochsner said. "I don't think the people in this state would mind a couple of extra bucks on their license plate.

"The reality is -- this has to happen, and people have to be held accountable for their failure to support it. You've got to play hardball. That's what has got to happen."

Dan Miears knows first-hand how important quick, quality medical care is to the traumatically injured.

He was paralyzed in a motorcycle accident in 1989. His father performed CPR until the ambulance arrived. The EMTs who responded saved his life. They had tried to get a helicopter ambulance but weren't successful. So road blocks were set up from the accident site near Cleveland, Ga., to the hospital in Gainesville.

When it comes to the health care system, Miears said, there is a huge emphasis on the first few hours. But things seem to get bogged down with recovery.

After a year of rehabilitation, Miears decided he wanted to be remembered for how he responded to his accident. He has spent years educating people about spinal cord injuries, and has worked on several manuals and information cards for medical professionals and others.

In rehab, "every roommate I had was a deer hunter," Miears said. They had all fallen out of their deer stands. So he worked on an information card that is given out with hunting licenses.

When it comes to setting up a trauma network in Georgia, "the rhetoric has bounced around for years and years," Miears said. "The rhetoric has got to stop.

"There has been too much money wasted in the wrong area to set up trauma services," he said.

Miears urged those in attendance at Wednesday's forum to think about the lives cut short by traffic crashes.

"I want you to challenge yourself, to see what you can do to keep another roadside memorial from going up in your community and in this state," Miears said.

The gold standard for trauma networks is the one in Maryland.

Mary Beachley is the state coordinator and manager for the trauma system.

Maryland's system breaks the state into regions, and each has its own trauma center. Air ambulance transportation is provided by the state police.

Maryland got into trauma networks early on because of a visionary, Dr. R. Adams Cowley. Cowley operated the "shock trauma" center at the University of Maryland and was one of the authors of the landmark white paper, "Accidental Death and Disability: The Neglected Disease of Modern Society," published in 1966.

Through a grant from the U.S. Army, Cowley was studying the effects of traumatic shock. He worked in what was called the "death lab." During that time, a very good friend of the governor was in a serious traffic crash. The governor called Cowley and asked if he could help his friend.

"He said, 'Yes, I can if you can get him to my lab,'" Beachley said. The governor used his state helicopter to transport the friend to the lab. The man is still living today.

And that experience created huge public support for the idea of trauma networks.

"One of the things that Dr. Cowley recognized was, if you're going to have a trauma system, you have to have hospitals located throughout your state that are qualified," Beachley said. Patients must get to a qualified hospital in the "golden hour," which is the hour after an injury. Once that time passes, the chances of survival plummet.

Beachley said it is important to involve all the stakeholders -- doctors, hospitals, EMS providers, legislators, and the general public -- in forming a good trauma network.

But what's even more important, "you need to have visionaries. You need to have champions," Beachley said.

"Our system has been in place for a number of years. The fight continues to keep it operational."