OGDEN -- If Rep. Gabrielle Giffords, of Arizona, had been shot through the head in an area without a hospital designated as a trauma center, she most likely would not have survived.
That's what an Indiana official said shortly after the shootings in Tucson earlier this month as he lamented that his state lacks a sufficient number of trauma centers.
A significant portion of the U.S. population does not have adequate access to a trauma center within an hour's drive, according to a report published this month in the Journal of the American Medical Association.
Trauma centers are a key component of the infrastructure of the U.S. health care system because they have been shown to decrease morbidity and mortality for injured patients of all ages, from children to the elderly, state the authors of the report.
However, trauma centers are often underfunded, and because of this, several across the nation have been forced to close.
In the Top of Utah, McKay-Dee Hospital in Ogden and Ogden Regional Medical Center are designated trauma level II centers. This means the hospitals have resources available to treat the most severely injured patients 24 hours a day.
Hospitals must meet extensive criteria outlined by the American College of Surgeons to be designated as a trauma center.
A trauma center sees everything from single-system injuries, such as a broken ankle, to severely injured people with multiple life-threatening injuries, said Kayleen Paul, trauma nurse coordinator and critical care director at McKay-Dee Hospital.
Trauma center ratings go from a level I, the highest level of care, to a level V.
A level I center is a regional center, usually in a large, populated area, and is usually connected to a teaching and research hospital such as the University of Utah.
Level II centers are generally community hospitals that can provide comprehensive trauma care. They are expected to meet most of the requirements of a level I center, Paul said.
"In a trauma level II center, the surgeon does not have to stay in the hospital. He or she must be in the emergency department upon arrival of the patient or no longer than 15 minutes after the patient arrives," she said.
Both hospitals in Ogden have trauma bays within the emergency room. These bays are larger than typical emergency department rooms and hold many life-saving supplies and equipment, and can even hold up to two patients at a time.
Each hospital also has a trauma team required to be immediately available at all times. The team consists of one or two emergency room physicians, a trauma surgeon, specially trained nurses and technicians, a respiratory therapist, X-ray technicians, radiologist, anesthesiologist, lab phlebotomists, social worker and pastoral care, said Deanna Wolfe, trauma nurse coordinator at Ogden Regional Medical Center.
"An organized way of taking care of trauma patients saves lives and provides better outcomes," Wolfe said. "When everyone has a job to do and knows what the job is, it works like an orchestra."
Wolfe remembers a 16-year-old who was knocked out while playing football. When he got up and walked to the bench, he passed out again. When he arrived at the emergency room, he was unresponsive. A CT scan showed blood building up in his brain.
"He was in the operating room within 18 minutes of arriving at our ER door," Wolfe said. "His brain was beginning to push into his throat because the bleeding was taking up the space the brain usually does.
"If he had waited even 15 more minutes, he would have either died or had severe disability. He left the hospital without any deficits and comes back to visit us periodically."
Dr. Joan Balcombe, an emergency room physician at Ogden Regional Medical Center, said the national rate of death in trauma patients is proved to significantly decline when patients are treated in a trauma center.
Ogden Regional consistently has been below the national average for trauma patient death year after year, she said.
McKay-Dee Hospital is also below the national average for trauma patient death.
"We've had some great cases and truly snatched many people from the jaws of death -- some spectacular car chases, the people who were in bed when a truck crashed through their house, people shot and stabbed in the heart, a few really severe head-injury patients who made miraculous recoveries," Paul said.
Paul, Wolfe and Balcombe all say that, although the Top of Utah is fortunate to have two trauma centers, prevention is still easier than repairing.
"Please wear your seat belt. Please wear a helmet for biking or skiing. Wear all the protective gear you can," Paul said.
"Don't do dumb things like riding on the hoods of moving cars. Be careful on the ice. Drive slower in bad weather."
The Associated Press contributed to this article.
Trauma center levels
There are five trauma-center classifications, with I being the highest.
• Level I: Provides comprehensive trauma care, serves as a regional resource and provides leadership in education, research and system planning.
A level I center is required to have immediate availability of trauma surgeons, anesthesiologists, physician specialists, nurses and resuscitation equipment. Level I centers must treat 1,200 admissions a year or 240 major trauma patients per year or an average of 35 major trauma patients per surgeon.
• Level II: Provides comprehensive trauma care either as a supplement to a level I trauma center in a large urban area or as the lead hospital in a less population-dense area.
Level II centers must meet essentially the same criteria as level I, but volume performance standards are not required and may depend on the geographic area served. Centers are not expected to provide leadership in teaching and research.
• Level III: Provides prompt assessment, resuscitation, emergency surgery and stabilization with transfer to a level I or II trauma center.
• Level IV & V: Provides advanced trauma life support prior to patient transfer in remote areas in which no higher level of care is available.
The key role of the level IV center is to resuscitate and stabilize patients and arrange for their transfer to the closest, most appropriate trauma center-level facility.
Level V trauma centers are not formally recognized by the American College of Surgeons, but they are used by some states to further categorize hospitals providing life support prior to transfer.
Source: American Trauma Society
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