When Tragedy Strikes Baystate Medical Center’s Focus On Trauma Response Is Unique In The Region

It might be a weekend automobile crash, a midday industrial accident, or a gunshot ringing out in the night — if the trauma is severe enough, chances are that another patient is being rushed to Baystate Medical Center.
Baystate, as the only Level 1 trauma center outside of Boston in all of Massachusetts, has taken on a significant responsibility in the community — not only to deal with victims of trauma injuries in the heart of Springfield, but also to take transfers from other hospitals not as equipped to handle the most severe traumas.

But what does the designation mean? “The unique quality of a Level 1 trauma center is that it will be able to provide very specialized trauma care in a rapid, efficient way,” said Dr. John Santoro, the chief of Baystate’s Emergency Department operations. “For the hospital, that means devoting a great deal of resources to one patient at a time.”

At a time when hospitals are struggling with funding and staffing, Baystate, in effect, takes on an additional challenge by maintaining the extra resources needed to receive the Level 1 designation from the American College of Surgeons (ACS) — and the additional patient load it entails. But it’s a responsibility the hospital feels must be taken, Santoro told The Healthcare News.

“We’re the only Level 1 presence in the whole western part of the state,” Santoro said. “It’s Springfield to the New York border, to Vermont, to Connecticut. That’s a big area being covered.”

A Regional Resource

As a specialized field of emergency medicine that accounts for just 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all admissions to Baystate Medical Center’s emergency room, trauma care wouldn’t, at first glance, seem to be the most statistically important service provided at the hospital.

However, these are admissions that often involve life-and-death decisions. Even community hospitals throughout the region, from Cooley Dickinson to Noble, Holyoke to Wing Memorial, recognize that Baystate is best equipped to deal with these victims of serious accidents, violence, and falls, sending about 300 patients each year to Baystate once they are stabilized. In fact, these transfers from other facilities account for about 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the 1,500 to 1,600 trauma patients Baystate sees each year.

The ACS Committee on Trauma visits the hospital every three years to ensure that the institution has indeed remained capable of bearing this load. The Level 1 designation requires several standards to be met, the most important of which is adequate staffing — not just in the many fields of surgery needed to deal with immediate situations, but in support areas ranging from nutrition and injury prevention to a follow-up clinic. In fact, the ACS actually requires that a Level 1 center not have too few or too many surgeons — “enough surgeons to provide optimal care, but not so many that they don’t get enough experience to maintain their skills,” said Dr. Patrick Lee, director of trauma and emergency surgical services at Baystate.

A Level 1 hospital is also required to maintain an educational component for other doctors, other area hospitals, and community members — for example, through an injury-prevention program offered to the public. And the hospital’s general surgeons must complete the ACS’ Advanced Trauma Life Support education program.

After all, Lee noted, trauma response in a hospital is a different story than basic emergency medicine, particularly when the patient is elderly. A young victim of trauma might lose some blood and break some bones and come out fine, he explained, but that blood loss in a senior citizen could overwork the heart and cause a heart attack. In fact, any number of weak body systems from the heart to the lungs pose the risk of turning a simple trauma case into a multi-layered threat.

And because the state no longer offers additional funding to hospitals with the trauma designation, all these outreaches and education programs come out of the facility’s own coffers, which, in these days of inadequate reimbursement from public and private insurers, poses an additional financial challenge. “Right now,” Lee said of the focus on trauma, “it’s a money-losing proposition.”

Lives Turned Upside Down

Trauma, as a general medical term, can be a life-losing proposition if treatment is not accurate and immediate. And Springfield, as an urban center, and its surrounding communities produce no shortage of trauma victims. About 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all traumas fit one of three categories, Lee said: automotive accidents, by far the most common cause of trauma injuries; penetrative incidents, such as stabbings and gunfire; and falls. Other, less-common causes include industrial accidents and burns.

Seatbelt laws have lessened the incidence of head injuries in roadway accidents, while OSHA regulations have cut down on industrial accidents, he added, but there are plenty of incidences of all traumas, and the surgeons who work in this field must be prepared at all times. Unfortunately, that usually means nights and weekends, peak times for drunk driving and violent attacks.

“You might need these services at 10 at night and not need that emergency response until tomorrow at 10,” Santoro said. “But you need to provide it on the spot. If you’re going to have the most favorable outcome, the system has to be set up to function at a moment’s notice, providing intensive care for a short time in this unit while still taking care of the other patients.”

In addition to the harsh schedule, trauma surgeons must also contend with a higher-than-normal percentage of uninsured and underinsured patients and are burdened with making quick judgments, often without having any time or opportunity to establish a doctor-patient bond, Lee said. And that leads to a greater possibility of malpractice suits than for doctors who have time to explain the benefits and risks of procedures to patients.

“They’re here, you’re here, and you’re not likely to have time to explain things to them, so you’re more likely to get sued,” he said. “They’ve already been victimized, and if they don’t like the outcome and want to take it out on someone, who else are they going to sue?”

Thankfully, trauma response has become more exact as advances in imaging technology have allowed doctors to make more accurate diagnoses on the spot. “I think that, overall, we continue to evolve, and we’re learning more about the care of patients,” Lee said. “We do try to get patients back to work sooner than ever before, back to being productive members of society.”

And, in the process, doctors are saving more lives, and that’s one reason surgeons put up with the odd hours and tough cases of trauma care, Santoro said.
“When you consider that injury is the leading cause of death in young people, this is where can you get the biggest bang for your buck in salvaging lives and making a difference,” he said.

“I think the region absolutely has to have a Level 1 trauma center,” he continued. “It takes a great deal of resources to be able to do that, and it’s a rigid process, but if not Baystate, then whom? There really is no other answer, so it must be part of our mission.” For victims of violence and accidents brought back to health by these trauma specialists, consider it mission accomplished.