With two dead and four students still critically injured from an early Sunday morning van crash, doctors at Medical College of Georgia can still imagine it being worse.
A team of 80 doctors was quickly pulled together at MCG's Regional Trauma Center soon after the first call came in around 8 a.m., said Dr. Robert Martindale. The doctors then waited for nearly an hour for the first patient to be wheeled through the doors, Dr. Martindale said. That long delay continued throughout the day as patients who were first sent to hospitals in the area were transferred to MCG, the last one arriving around 4 p.m., some eight hours after the first call, Dr. Martindale said.
Those delays could have been fatal, said Thomas Gadacz, chairman of the Department of Surgery, as he leaned against a wall outside the now silent trauma room on Monday. That they were young and fit to begin with may have helped them survive the hypothermia and blood loss in the hours they waited, Dr. Gadacz said.
"If this was a bunch of middle-aged women on their way to Sunday School, I don't think we would have had any survivors," he said.
And at least some of the delay could have been prevented. Officials with Wilkes County Emergency Medical Services said the biggest problem was finding air ambulances to get the critically injured to Augusta - 77 miles away. Blake Thompson, director of the ambulance service, said he ran into problems with both civilian and military services.
At Fort Stewart, "the biggest thing was they were waiting for clearance," Mr. Thompson said. "We don't want a bunch of red tape."
But Fort Stewart spokesman Maj. William Oaks said approval was granted within 10 minutes of the call and the helicopter lifted off 10 minutes later and was en route when a second call came in saying it was no longer needed.
Mr. Thompson said it caused enough of a delay that he had to turn elsewhere and was going to approach state legislators about getting a more streamlined system for military cooperation. There were also problems with getting helicopters out of Atlanta, Mr. Thompson said.
"They were asking me how much the patient weighed and what kind of insurance did they have," Mr. Thompson said. A hospital service based in Madison made two runs and even intercepted a ground ambulance en route to MCG with a critical patient, loading the patient off the interstate and flying them in, said Brad Tucker with Wilkes County EMS.
There was a further delay in Augusta because MCG has no heliport - it was dropped from designs for upgrades to the ambulatory care center to save on building costs, said Dr. Michael Hawkins, chief of trauma surgery. The patients Sunday were flown to a heliport at University Hospital and then driven to MCG, a delay of another 15 minutes, Dr. Martindale said. University Hospital discontinued its air ambulance 10 years ago because of the high cost and lack of an agreement among area hospitals about sharing the costs, said University spokesman Chris Naylor.
What could have prevented a lot of the confusion is something doctors at MCG have been asking for the past six years - a statewide plan for handling trauma patients, with a coordinated system for dispatching patients to specific hospitals equipped to handle them. The idea has been brought before state health agencies and the Legislature but it never seems to go anywhere, Dr. Gadacz said. A plan has already been drawn up and the system could take advantage of existing services and be administered under existing state agencies, Dr. Gadacz said.
That system would probably have helped at the scene, where Mr. Thompson said he was making decisions about who needed to go where when MCG was standing ready for them.
"We're always expecting this sort of thing," Dr. Hawkins said.
Many of the patients first sent to regional hospitals ended up at MCG anyway, Dr. Hawkins said.
The cost of having a coordinated plan "wouldn't be millions" and might end up being the difference if another van rolls off a rural interstate.
"If would be terrible if it takes a really tragic event to bring this about," Dr. Gadacz said.