Before accepting my current position as Congressional Lobbyist for the American College of Surgeons (ACS) Division of Advocacy and Health Policy, I worked as an emergency medical technician (EMT) in Connecticut for six-and-one-half years—so it was a natural fit to focus on trauma policy when I joined the College in October of 2013.
To gain a better understanding of trauma care from the hospital side, I scheduled an observation shift in June at the R. Adams Crowley Shock Trauma Center in Baltimore, MD. Given my EMT background, I had some idea of what to expect from a 24-hour stint at an inner-city trauma center, and yet I was astonished by the volume of patients and the severity of the injuries that kept coming in on a near-constant basis. The evening was filled with patients suffering from gunshot wounds, motorcycle and motor vehicle collisions (MVC), assaults, and, unfortunately, a case of traumatic cardiac arrest. Despite all the tragedy that came through the bay while I was at the Shock Trauma Center, which is affiliated with the University of Maryland Medical Center, I came out of the experience incredibly proud to be an ACS staff member and to work alongside a team of physician and staff advocates who fight daily to create a better health care system.
Although Baltimore has a reputation for being a violent city where traumatic injury is common, the truth is, these events can and do happen throughout the U.S. However, in Baltimore, thanks to a great trauma system, the patients who receive care at Shock Trauma Center have an inherently better chance of survival simply because they live in the state of Maryland. As a health care advocate, the ACS recognizes the need to increase access to quality trauma care for all Americans.
What makes the Shock Trauma Center unique?
As the accompanying article on the ACS Committee on Trauma Needs Based Assessment of Trauma Systems (ACS NBATS) indicates (see “Committee on Trauma introduces needs assessment tool aimed at resolving trauma center debate“), every community is different, and no cookie-cutter solution is likely to improve trauma systems. The Shock Trauma Center model of trauma care, however, is one from which we can all learn.
The Shock Trauma Center is designated through the Maryland Institute of Emergency Medical Services as the only Primary Adult Resource Center in the state of Maryland and averages nearly 8,000 patients annually.* This freestanding trauma center encompasses a 13-bay trauma resuscitation unit to manage trauma-activated patients from the entire state of Maryland. This volume of care is supported by a trauma system that uses Maryland State Police helicopters to transport trauma patients throughout the state, and ground units for transport within the vicinity of a trauma center.
Funding for the Maryland trauma system comes from a $17 fee assessed on motor vehicle registrations. This revenue is used to cover the costs of the trauma system, including the Maryland State Police medical helicopter program. In addition, trauma hospitals in the state are divided in an effort to preserve quality and volume at all trauma facilities to ensure all patients are treated at the facility with the most appropriate resources.
A catalyst for change
In June, the American Medical Association House of Delegates approved the ACS-led resolution to support the concepts set forth in the Hartford Consensus™, encouraging the education of official first responders (police, fire, emergency medical services) and potential immediate responders (civilian bystanders) about bleeding control and tourniquet use. This type of public education is a revolutionary step in saving lives and turning bystanders of traumatic events into lifesaving heroes. This initiative is just another example of why the ACS is at the forefront of trauma care and why surgeons need to be leaders in advocating for legislation on trauma care funding and systems development.
I finished my observation shift 17 hours before the deadliest mass shooting in U.S. history at the Pulse nightclub in Orlando, FL, on June 12. Thankfully, the Orlando Regional Medical Center, an ACS-verified Level I trauma center, having prepared through drills, was ready. As the hospital was within the immediate vicinity of the scene, several lives were saved. We can’t allow tragic events such as this one to act as the catalyst for lawmakers to begin thinking about trauma care—the funding, education, systems planning, and preparation must happen well in advance.
In the last several years, the College has sent a trauma-focused message to Capitol Hill. Now, it’s time for us to bring legislative leaders to our trauma facilities. The only way to truly understand the vital role trauma surgeons and trauma centers play in keeping Americans healthy is to show our leaders this reality firsthand. Outside of health care, it’s difficult for people to think about or plan for a health care emergency, but when the unthinkable happens, it’s imperative to have a well-funded and well-equipped trauma system in place.
*Cohn M. New University of Maryland Shock Trauma tower opens. Baltimore Sun. November 8, 2013. Available at: www.baltimoresun.com/health/maryland-health/bs-hs-shock-trauma-20131108-story.html. Accessed July 11, 2016.