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New state trauma rule has little effect in Putnam County

Friday, June 1, 2012

A new rule passed by the state's Emergency Medical Services (EMS) Commission puts stricter guidelines on responders to traumatic injuries, but it will have largely no effect on Putnam County.

The Triage and Transport Rule advises that once EMS personnel have assessed the condition of each patient at the scene of an incident, they should then determine if the patient falls into the most severe categories of trauma injury as defined by the Centers for Disease Control and Prevention. If so, the patient must be taken to the nearest trauma center.

The main exception to the rule, however, is if transporting the patient to a trauma center would take more than 45 minutes.

Like much of the state, Putnam County does not lie within 45 minutes via ambulance of one of Indiana's eight certified trauma centers.

"Based on the version that passed, most of the county is outside of the range," Putnam County Operation Life Executive Director Kraig Kinney told the Banner Graphic.

The nearest certified trauma centers are IU Health Methodist Hospital, Wishard Memorial Hospital or IU Health Riley Hospital for Children, all three of which lie in or near downtown Indianapolis.

Kinney pointed to the extreme eastern portion of Interstate 70 in Putnam County as possibly falling within the range, but this depends on traffic.

According to information from the American Trauma Society (see inset) no part of Putnam County lies within 45 minutes of a trauma center.

Even if the rule is extended to transport by helicopter -- which is only an option sometimes -- there is still just a small portion in the northeast part of the county within 45 minutes.

Kinney said he had been following the development of the rule closely, having voiced objections over carrying the rule too far.

"It seemed like an absolute -- 'You will do this,' but we were cautious," Kinney said.

He said the biggest worry expressed by some rural EMS services was the decision being taken out of the hands of the medics on the scene. Black-and-white absolutes cannot always be applied in the field.

"No two trauma runs are exactly alike and you can't apply every rule exactly the same," he said.

Other exceptions include a patient's right to decide and if the patient's life would be endangered if critical care is delayed.

The rule is well-intentioned, even if it does not apply to a wide swath of the state. It aims to better provide critical quality care during the first 60 minutes following a traumatic injury, known as the "golden hour" of care in emergency medicine.

"In our efforts to create a statewide trauma system, this rule is foundational," said State Health Commissioner Gregory Larkin, MD. "It should mean more severely injured patients will be taken directly to trauma centers, and it should also mean more hospitals will become trauma centers."

Kinney said Operation Life was already following its own form of the rule voluntarily, whenever possible.

"It increases the chance that the person not only survives but that they avoid longer term injury and speed recovery time," Kinney said.

The lack of trauma centers in the state means they are simply not readily accessible for many Hoosiers. Besides the three in Indianapolis, there are two in Fort Wayne, two in Evansville and one in South Bend.

Some suburban areas near Chicago and Louisville may also have access across state lines.

Trauma centers differ from hospital emergency rooms in some significant ways.

Emergency departments are not trauma centers, as the typical emergency department treats broken legs, concussions, back sprains, lacerations, injuries resulting from motor vehicle rear-end crashes and trips on the sidewalk.

Trauma center "typical patients" include those with multiple fractures, brain injuries, paralysis, punctured lungs, handgun and stab wounds, car rollovers and ejections or falls of more than 20 feet. They are verified by the American College of Surgeons.

Indiana has emergency medical services providers, trauma centers and a trauma registry to track these most severe of injuries, but is one of only nine states that do not have an integrated statewide trauma system.

In 2008, Sen. Tom Wyss (R-Fort Wayne) authored Senate Enrolled Act 249 which tasked the EMS Commission with creating a rule to establish protocols for the transporting of trauma patients.

"I applaud the work of the EMS Commission and the state agencies involved in passing this rule," Wyss said. "I wanted to make sure that Hoosiers were being taken to the proper destination after suffering a traumatic injury. This rule is one more step in the right direction toward patient safety and quality care."

The Indiana State Department of Health's Division of Trauma and Injury Prevention will conduct a Trauma Listening Tour this summer. The goal is for Hoosiers to learn more about trauma, learn how state and local agencies currently respond to trauma, learn how an integrated trauma system could help the state and, most importantly, gather personal stories of how trauma has affected those in our state.

To learn more about the Trauma Listening Tour, visit www.StateHealth.in.gov.

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