Thursday, May 22, 2008

Twenty years of trauma

This month marks the twentieth anniversary of the designation of OHSU as one of Oregon's two Level I trauma centers. (But what to get them? I don't think china would last long in a trauma shop.)

Since 1988, the Department of Surgery's Section of Trauma & Critical Care has treated nearly 2500 patients per year; research by the Rural Trauma Study Group–led by Dr. Richard Mullins and funded by the Centers for Disease Control and Prevention–have found that the odds of death for injured Oregonians have declined significantly, especially among brain-injured patients, over that time.

The announcement from the OHSU newsletter Outlook ran as follows:

Oregon trauma system turns 20

More than 25 years ago, a landmark study showed trauma patients in the Portland area who had been taken to the nearest hospital had inappropriate outcomes based on the severity of their injuries. This proved a rallying cry to the Oregon legislature, which called for the institution of a statewide trauma system.

It was a simple enough idea: hospitals that treat the most trauma patients will have better outcomes. And those hospitals should have specialists, life saving equipment, and ancillary services immediately available to patients in need.

May marks the 20th anniversary of the Oregon trauma system. Oregon was one of the first states to develop a statewide trauma system, and is unique in its inclusion of smaller, rural hospitals as Level III and IV trauma centers. Today, Oregon’s system stands as a model for other states, and OHSU remains dedicated to serving as one of the state’s two Level I trauma centers.

OHSU cared for more than 17,000 trauma patients between 1995 and 2004; more than 4,000 of those patients were transferred from hospitals around the state. OHSU is the state’s medical resource hospital, answering about 3,000 calls annually from paramedics and EMT’s. Data from these calls are used for research to determine when changes in emergency medical response protocols are needed. The emergency communications center based at OHSU ensures Portland area patients are taken to a hospital that has space to care for them, and ensures no hospital is overwhelmed during incidents with more than 10 patients.
The day after the new trauma care system went into effect, The Oregonian touched on the controversy surrounding the designation of OHSU and Emanuel as the two centers:
The Portland area's long-heralded trauma system went into full swing Monday with little fanfare to mark the occasion.
Monday was the official date for Oregon Health Sciences University and Emanuel Hospital & Health Center to begin taking care of the most seriously injured accident victims in the Portland area.
Other hospitals that had treated badly injured patients during the past several years have gradually dropped out of the trauma field during the past few months.
In October, after intense competition among five Portland-area hospitals, the Oregon Health Division designated Emanuel and OHSU as trauma centers.

One question surrounding the selection has been whether the two hospitals could accommodate the area's flow of serious injuries.
The choice of OHSU and Emanuel was the result of a lengthy assessment conducted by nationally respected trauma experts. An article from the Sept. 20, 1987 Oregonian noted that:
Medical experts from across the country will begin arriving in Portland Sunday to help decide which Oregon hospitals will be designated at trauma centers -- places where the most seriously injured people in the state are treated.

On Monday a four-member team will begin examining five hospitals outside the Portland area. A week later, a five-member team is scheduled to survey five Portland-area hospitals competing for the lucrative trauma center designations.

Both teams will review hospital records, examine equipment, interview hospital workers and investigate medical records of patients who have been treated for trauma to help decide which of the institutions should receive what amounts to a state franchise to treat seriously injured people.

Nancy Clarke, manager of emergency medical services for the Oregon Health Division, said the Lester Wright, Oregon public health officer, is scheduled to decide by Oct. 12 which of the hospitals will be designated.

Three of the five Portland-area hospitals -- Emanuel Hospital & Health Center , Oregon Health Sciences University , and St. Vincent Hospital and Medical Center -- have asked to be named level one trauma centers. Such a designation requires that the hospitals do trauma research and operate educational programs in the treatment of serious injury.

Two other hospitals -- Providence Medical Center and Portland Adventist Hospital -- are contenders for a second-tier designation.

State health officials have not said how many of the Portland institutions would be named as trauma centers.

Other proposed trauma hospitals in the state are Tillamook County General Hospital, Seaside General Hospital, St. Helens Hospital, Newberg Community Hospital and Columbia District Hospital in Astoria.
OHSU has proven itself to be a valuable and effective statewide resource for trauma patients. Happy Birthday to them!

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