CONTACT: TOM MOORE
8798 John Pappajohn Pavilion
Iowa City IA 52242
Release: Dec. 28, 2000
UI part of new, coordinated statewide trauma care system
IOWA CITY, Iowa -- On Jan. 1, all hospitals, physicians
and emergency medical service personnel will implement a new statewide system
that coordinates the services required to provide optimum care for the seriously
injured trauma patient. From the emergency medical technicians providing life-saving
interventions at the scene of an injury to staff members at rehabilitation
centers helping to restore normal function, the new system will affect all
health professionals who provide trauma care in Iowa.
"Trauma is a very serious public health issue in Iowa,"
said Andrew Nugent, M.D., interim director of the Emergency Treatment Center
at University of Iowa Hospitals and Clinics. "It's the leading cause of death
among Iowans between the ages 1 and 44. About 300,000 of our citizens need
emergency medical care annually."
The goal of Iowa's trauma system is to match injured
patients' needs to existing resources for optimal trauma care. The system
is designed to organize personnel, facilities and equipment in order to provide
efficient and effective coordinated trauma care.
"A well-coordinated statewide trauma system saves
lives," said Patrick Kealey, M.D., UI professor of surgery and director of
Trauma, Burns and Critical Care Services at the UI Hospitals and Clinics.
"In addition, coordinated trauma care reduces medical costs, as well as the
indirect costs to society from disability and deaths that are associated with
The roots of Iowa's statewide trauma system began
to grow in 1995 when state legislators passed the Iowa Trauma Care System
Development Act. That legislation designated the Iowa Department of Public
Health, through its Bureau of Emergency Medical Services, as the lead agency
for trauma care system development and implementation.
The all-inclusive system was designed to take into
account the rural nature of the state.
"Epidemiologists studying mortality in injured patients
have known for quite a while that the risk of death from trauma is about twice
as high in rural environments than it is in urban or suburban settings. At
least part of that excess risk can be attributed to the kinds of injuries
we deal with, but part is also related to the difficulty
in providing the proper care quickly to those most in need," said Alfred Hansen,
M.D., an emergency medicine specialist at the UI. "Iowans should be proud
of the fact that the leaders in trauma care in this state devoted a great
deal of time and effort to establish a comprehensive system that involves
all the required components. I think it took real vision to adopt this approach
and not focus exclusively on the biggest hospitals in the more urban settings.
There is still a lot of hard work to do to bring about full implementation
and to work out the bugs, but the blueprint is sound and seems to place the
needs of the patients first."
Out-of-hospital emergency medical services are vital
links in any trauma system. The new Iowa trauma care system goes into operation
at the scene of the accident, when trained first-responders and EMTs arrive
on the scene. They evaluate the patient's injuries and begin treatment. That
treatment is continued while they transport the patient. The emergency care
team will remain in contact with the hospital as they transport the patient.
"Communication between the ambulance crew and the
hospital provides valuable information about the patient's condition and enables
the activation of the appropriate response from special trauma teams at the
hospital," said Jeffry Gauthier, administrative associate in Emergency Medical
Services at the UI Hospitals and Clinics.
University of Iowa Health Care specialists will support
the Iowa Statewide Trauma System by providing around-the-clock physician coverage,
two AirCare helicopters for rapid transport of severely injured patients and
resident physician training. UI Health Care also has established a partnership
for resident training with the R. Adam Crowley Maryland Shock Trauma Unit
at the University of Maryland, a center that specializes in treating penetrating
trauma, such as gunshot wounds. The Emergency Medical Services Learning Resource
Center at the UI Hospitals and Clinics also played a role through its training
programs for emergency medical technicians, paramedics, nurses and physicians
throughout Iowa. That training included instruction in Advanced Trauma Life
Support (ATLS), the "gold standard" of trauma care.
All hospitals in the state participate in the trauma
system through a process of categorization and verification as trauma care
facilities. There are four levels of trauma care facilities in Iowa: community,
area, regional and resource. The system is based upon having the local ambulance
service assess the patient's injuries, and to then rapidly stabilize and transport
the patient to the hospital that can best serve the needs of the patient.
"We firmly believe that as partners in this system
for trauma care that we can enhance the outcomes of trauma cases," said Carol
Scott-Conner, M.D., Ph.D., UI professor and head of surgery.
"Not only will the patients benefit, but all Iowans
will reap the benefits of having more of those patients recover and return
as contributing members of society."
The role of a community trauma care facility
is to provide initial evaluation and stabilization of the severely injured
patient. They have the necessary equipment and diagnostic resources to initially
resuscitate severely injured patients. Stabilization may include immediate
surgical intervention. Most patients who require surgery and specialized care
will be transferred to resource or regional trauma care facilities.
An area trauma care facility also provides comprehensive
inpatient services to patients who can be maintained in a stable or improving
condition without specialized care. Critically ill patients who require specialized
trauma care are transferred to a resource or regional trauma care facility.
The role of a regional trauma care facility
is to provide comprehensive care for the severely injured patient with complex
multi-system trauma. An organized trauma team is available to meet the patients
arriving at the emergency department, with a broad range of physician specialists
who are "on-call" to promptly provide care or consultation. Regional trauma
care facilities also serve as resources for continuous quality improvement
activities in the region.
The resource trauma care facility provides
the most comprehensive trauma care for patients with complex multi-system
trauma. An organized trauma team is available to patients immediately upon
arrival in the emergency department, with a broad range of physician specialists
also "on-call" for prompt care or consultation. In addition, resource trauma
care facilities serve as a resource to all other trauma care centers for continuous
quality improvement activities.
The Emergency Treatment Center at the UI Hospitals
and Clinics is one of two resource trauma care facilities in the state. "This
is an exciting development for Iowans," Nugent said. "Without a doubt, this
new trauma care system enhances the treatment of injured patients across the
University of Iowa Health Care describes the partnership
between the UI College of Medicine and the UI Hospitals and Clinics and the
patient care, medical education and research programs and services they provide.