By Sharon Penny
November 1, 2014 (San Diego’s East County)--San Diego’s County Trauma System received recognition last June for its role in saving lives. As noted in a previous East County Magazine story, the rate of preventable trauma deaths today stands at less than one percent, whereas 30 years ago it was 21 percent (http://eastcountymagazine.org/county-trauma-system-driving-deaths-down-east-county-lacks-trauma-center).
Also noted in that story was that there are six trauma centers in the county, none of which are located in East County, the most geographically expansive region. In fact, there is only one hospital in all of East County – Sharp Grossmont, which does not have a designated trauma center.
San Diego County consists of more than 4,500 square miles. Many sources, including East County Magazine, consider East County to be the eastern two-thirds of the county, though there is no official geographic designation. Using those calculations, there is more than 3,000 square miles that does not have access to a convenient trauma center.
When asked about the lack of a trauma center, County Supervisor Diane Jacob spoke with high praise of the Emergency Medical Technicians who save lives in the back country.
“The County Department of Emergency Medical Services (EMS) (http://www.sandiegocounty.gov/hhsa/programs/phs/emergency_medical_services/) oversees the trauma system for the County of San Diego and works to provide high quality, effective care for patients throughout the region,” said Jacob.
EMS certifies and regulates prehospital emergency medical service technicians. These include air flight rescue agencies, base hospital coordinators, ambulance dispatching agencies, advanced life support (ALS) providers, fire protection agencies, and private transporting agencies.
The paramedics and emergency medical technicians who serve as the first line of defense in East County have saved thousands of lives over the years and decreased the severity of many injuries. Rural residents speak in glowing terms about these men and women who serve them. However, the lack of a local trauma center with a qualified surgeon and amenities can impact the success rates of survivable outcomes.
One EMT who previously served in the back country said that the distances of trauma centers could ultimately be detrimental.
“We’ve had accident victims as far away as Brawley who have had to seek help at our trauma centers – about two hours by ground transportation. That amount of time can be critical to if someone lives or dies under certain circumstances.”
The EMT, who wished to speak anonymously, said the numbers are thankfully very low of cases like that, but individuals have been impacted.
San Diego County’s Health and Human Services Public Health Officer Wilma J. Wooten disagreed, saying there is no evidence that anyone has been affected by a lack of a trauma center in east county.
“There have been no reports of untoward patient outcomes,” said Wooten. “EMS conducted a time study and assessment that examined transport times to the trauma centers by population density. It was determined that the existing configuration met the current and near future needs. EMS continually monitors the trauma system, and at this time there is no need for an additional trauma center in East County.”
Even though air ambulance services are frequently used to transport severe patients more quickly, the Santa Ana winds that East County experiences can interfere with the ability to use life flight transports.
“In reviewing the Air Ambulance Dispatch Reports, there were a total of 15 weather related cancellations of air ambulance service in East County between October 2013 and August 2014,” said Wooten.
Although that number sounds relatively low, that translates to 1.5 per month. We do not have statistics on the outcomes of those 15 patients.
(subhead): Numbers Game
The reality that East County will most likely never see a trauma center breaks down to a numbers game. There is simply not a large enough population in the back country to make it economically feasible.
Some local citizens, including Campo resident and planning group member Billie Jo Jannen, pointed to Wallowa County in Oregon as an example of large geographic area with a smaller population that has a successful trauma center. They built a 32-bed full service facility www.wchcd.org/services.html.
“It is ridiculous that a wealthy region like ours can't pull together the political will to provide a basic partial service like this when a tiny rural population (7,000 souls as of 2010) like Wallowa County Oregon can do fundraisers and grant applications well enough to build a cutting edge full-service hospital,” said Jannen. (http://www.wvhcf.org/history.html)
According the Wooten, the trauma center in Wallowa County has a Level IV verification. What this means is that the trauma center there is not able to offer full service, but instead must transfer severely injured patients. She explained that San Diego County does not qualify for a Level IV trauma center due to the proximity of our population to Level 1 and Level II trauma centers.
“Trauma Centers must be located within acute care hospitals,” explained Wooten. “The only acute care hospital in East County is Sharp Grossmont in La Mesa.”
Wooten went on to explain that there is a federal Committee on Trauma of the American College of Surgeons that establishes standards for trauma center verification.
“An important part of verification criteria is the number of patients seen by the Center and by key trauma personnel the highest level for trauma centers level IV. Adult Level 1 trauma centers must admit at least 1,200 trauma patients per year to maintain skills. This requirement is extended to Level II trauma centers in San Diego County to ensure a consistently high standard of care throughout the system.”
(subhead): Trauma Injuries in East County
Ninety percent of all trauma injuries are blunt force injuries. These consist mainly of motor vehicle injuries or falls. The other 10 percent are penetrating injuries, from firearms, stabbing, or piercing.
According to a 2012 report by the County of San Diego, in 2010, 949 lives were lost in San Diego County due to traumatic injury (http://www.sdcounty.ca.gov/hhsa/programs/phs/documents/EMS-Trauma_Report_2012.pdf). .
The report also notes “On the average, for every person who died as the result of a traumatic injury, ten more were seriously injured. The three leading causes of traumatic injury were falls, motor vehicle occupant crashes, and assaults. The leading causes of traumatic death were falls, suicide, and motor vehicle occupant crashes.”
Almost 42 percent of the 949 lives lost were due to falls. East County scores low rates in falls and homicides. However, the back country has the highest rates of traumatic injuries and death due to motor vehicle accidents, motorcycle accidents, and sports/recreation activities. The east county community of Lakeside had an abnormally high rate of suicides in comparison to the rest of the eastern region.
Wooten noted that injury rates are both a function of the number of injuries and the size of the resident population in an area. So even though the data shows a very high rate of injuries in a specific area, because the population is so sparse, the actual number of injuries is relatively low.
“For example, in 2013, there were 14 trauma patients in Laguna-Pine Valley, which generated a rate of 247.9 per 100,000 people,” said Wooten.
(subhead): Sign of the Times
Will East County ever get a trauma center or acute care medical facility? It is highly unlikely in today’s climate, and is something would require changes in designations and political will at both the state and federal levels.
Another factor facing California health care systems is the dwindling list of small hospitals.
The U-T San Diego reported on October 11 that small hospitals in California are increasingly facing financial pressures that make it almost impossible for them to stay afloat. The story was specifically on the closure of Fallbrook Hospital in North County (http://www.utsandiego.com/news/communities/fallbrook/).
According to the article, today’s facilities must have large doctor-group connections and referrals in order to remain viable. It quoted an economist from the University of Southern California (USC), Glenn Melnick, who had dire predictions for smaller facilities.
“Smaller and independent hospitals are going to continue to fall by the wayside,” he said. “This trend will accelerate because you’ve got to be part of a big network that has deep enough pockets to bear that risk.”
However, Melnick said in that article that the lack of smaller facilities might be a detriment to consumers.
“There is a lot of evidence that, as they (health care systems) get bigger and take on more and more, their costs don’t necessarily go down,” said Melnick. “From the quality side, even that is not well-supported by research.”
According to the UT-San Diego article, “the most financially vulnerable hospitals tend to be independent operators or those located in rural areas.”