Indiana Bill Would Require State Trauma System

Feb. 3--This is the scene: A two-vehicle accident on Interstate 69, two miles south of the West Jefferson Boulevard intersection, leaves both drivers with head injuries and multiple broken bones. Lutheran Hospital is just up the road, St. Joe Hospital is 6 1/2 miles farther east, and Parkview Hospital is 13 1/2 miles away. Dupont and Parkview North hospitals are 14 to 15 miles away. Where should the victims be taken?

According to local standards that emergency services personnel follow now, the accident victims would be taken to the closest hospital, Lutheran. In the future, that might not be the case.

A bill passing the Indiana Senate on Thursday and now bound for the House would provide a statewide trauma system, and the Indiana State Department of Health would write standards for where trauma patients should be treated.

Ohio, one of 43 states that already has a statewide system, sends its most serious trauma victims to a hospital with a trauma center verified by the American College of Surgeons, or ACS.

In Fort Wayne, at least for now, that is only Parkview.

"One of the problems with something like this is we get in the middle of competition between hospitals," said Sen. Tom Wyss, R-Fort Wayne, the primary author of the bill. "I don't want to see a turf battle. I don't want to see Lutheran and Parkview fighting over patients."

Dr. Mary Aaland, one of two Fort Wayne surgeons who has completed fellowships in trauma surgery and the director of Parkview's trauma center, said although the legislation is a "win-win for patients, this is where the politics start flying."

Wyss says a statewide trauma system would help identify areas where access to trauma-level care is absent or minimal, and "put together some standards." It also would allow the state to apply for federal grants, which may be needed to pay costs associated with a system, he said.

But medical standards already exist for trauma centers. They must meet specific criteria before earning "verification" from the American College of Surgeons, which is the national benchmark for trauma care. Presently in Indiana, that verification is voluntary.

Indiana has five ACS-verified trauma centers: Methodist and Wishard Memorial hospitals in Indianapolis, St. Mary's Medical Center in Evansville, Memorial Hospital in South Bend and Parkview in Fort Wayne. The state's only ACS-verified pediatric hospitals are Riley Hospital for Children in Indianapolis and St. Mary's in Evansville.

Level I is the highest verification, meaning the hospital is capable of providing "leadership and total care for every aspect of injury, from prevention through rehabilitation. In its central role, the Level I center must have adequate depth of resource and personnel," according to ACS' Web site. Most Level I trauma centers are within teaching hospitals with physician surgical residency programs.

Methodist and Wishard are Level I-verified, the other three, including Parkview, Level II.

The designations may be as much a marketing tool as they are a statement of better care by one hospital over another, Wyss said. "It's a competitive advantage."

Research published in the Jan. 26 New England Journal of Medicine found the overall risk of death was 25 percent lower when care was provided at a Level I trauma center than at a non-trauma center. But the studies focused on Level I, and Tom Miller, CEO of Lutheran Health Network, says that's an important point. Aaland, on the other hand, argues the same correlation in mortality rates can be made for Level II centers because the treatment protocols are the same for both Level I and II.

Ohio's trauma system mandates those who meet major trauma criteria -- penetrating injury to the head, neck or torso, a chest injury affecting breathing, severe coma or limb loss, for example -- be taken to centers of care meeting the state's written standards, which are the same as ACS'.