A study by the Indiana State Department of Health concluded in 2012 that there aren’t enough trauma centers in the state nor are there enough emergency medical service providers in rural areas.

Currently Indiana has nine trauma centers located in Indianapolis, Fort Wayne, South Bend and Evansville, leaving large areas of the state without access to immediate specialized trauma care.

The study noted the state needs to address the problem of trauma injuries through the design, implementation and oversight of a statewide system. The Department of Health is responsible for creating a plan.

St. Vincent Hospital in Indianapolis was designated a trauma center in January.

Jane Whinnery, director of the trauma center, said work toward designation as a trauma center started in November 2010. St. Vincent was required to accumulate a year’s worth of data before an application could be submitted to the American College of Surgeons.

“We received the full designation in December and accepted our first trauma patient on Jan. 26,” she said.

St. Vincent has a dedicated trauma operating room and intensive care unit for trauma patients, she said.

“We are required to have a group of physicians with specialized surgeons, emergency physicians, anesthesiologists, neurosurgeons and nurses on call 24 hours a day and seven days a week,” she said. “We have a group of physicians that work together as a team.”

Ninety-five percent of the trauma patients seen at St. Vincent are suffering from blunt force injuries from vehicle crashes and 5 percent are penetration injuries from gunshots or knives, she said. Downtown Indianapolis hospitals likely see a higher number of penetration wounds, she said.

Whinnery said St. Vincent requires nurses to take part in a Trauma Nurse Core Course that is offered for nurses in the emergency room, trauma center and intensive care unit.

“We provide specific trauma training during a two-day course,” she said. “It is specific to St. Vincent.”

Whinnery said Indiana wants to develop more Level 3 trauma centers. She said Indiana currently has just Level 1 and Level 2 centers.

The Indiana State Trauma Care Committee, appointed by former Gov. Mitch Daniels, is exploring ways to increase the access to trauma care in rural areas of the state.

“We will help any hospital that wants to be a Level 3 trauma center,” Whinnery said. “We can provide the training, which is intensive.”

The study by the Department of Health recognizes the need for a strategic plan in the state.

“Bad things happen where state trauma systems are not in place; where trauma systems exist, they save lives,” the study said. “Trauma systems lower preventable death rates by 25 to 30 percent.”

Just 24 percent of the state is located within 45 minutes of a trauma center by conventional ambulance, the study reported. Outside of large population centers, cities like Lafayette, Kokomo, Muncie, Anderson, Richmond and Terre Haute are not close to a trauma center, except through transportation by air ambulance.

Joe Albanese, director of Trauma Centers for Illinois, said Indiana has not developed a trauma system, but is working on one.

“They recognize the need to develop a trauma center plan,” he said.

The Health Department study found Indiana has elements of a trauma system, but no real system for a pre-planned, comprehensive, inclusive network of trained and equipped trauma care providers.

Those trauma care providers should include ambulance crews, hospitals, trauma centers, physicians, nurses and rehabilitation specialists.

Trauma patients are those who show signs of shock, airway problems, head or spinal injuries, multiple long bone fractures, ejection from a motor vehicle and burns.

“These most seriously injured patients have the best chance to survive if they receive definitive medical care within ‘the Golden Hour,’ which is the hour immediately following the injury,” the study said.

The Indiana Emergency Medical Services Commission recently passed a rule requiring the most seriously injured patients be taken to a trauma center unless the nearest trauma center is more than 45 minutes away by ground transportation. The new rule is expected to result in the creation of more trauma centers and more patients being taken to them.

Local hospitals are a part of a statewide trauma system, but the study found where timely access to a trauma center is not possible in rural areas, the emergency rooms of hospitals provide care to a trauma patient out of necessity.

“For all the trauma centers we have, there are not enough of them to adequately meet the needs of Hoosiers and visitors to the state,” the study said.
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