Traumatized health care

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Medical professionals call it "the golden hour" - that 60 minutes immediately following a serious trauma injury. If a patient with a stab wound or a fractured skull can be treated within that golden hour, their chances of survival and recovery increase dramatically.

Out of Georgia's 152 hospitals, only a scant 15 are trauma centers. And those 15 are grossly underfunded and overworked.  Nate Owens/Staff
Nate Owens/Staff
Out of Georgia's 152 hospitals, only a scant 15 are trauma centers. And those 15 are grossly underfunded and overworked.

Knowing this, you would think Georgia - one of the top 10 populous U.S. states - would have a comprehensive statewide network of trauma centers to quickly treat these vital-care patients.

Think again.

Georgia's trauma system is advancing slowly - and with injuries so serious that the entire system is in jeopardy.

Let's start with the number of trauma centers in the state. A scant 15 of Georgia's 152 hospitals are trauma centers - and seven of them are clustered in metro Atlanta. The other eight are in Augusta, Savannah, Macon, Columbus, Rome, Dalton, Thomasville and, interestingly, the small town of Madison. We'll come back to Madison in a minute.

What an uneven scattering of resources. Looking at a state map, you'll find that all of south Georgia has only two trauma centers. Between those and the three trauma centers on Georgia's fall line, there is a dead zone - and you can take that term literally - where there may be hospitals, but no trauma centers.

That means if you're in a bad car wreck in one of these forgotten south Georgia counties, you have a higher chance of dying. That's not a knock against rural hospitals or EMS; it's just a fact. Only about one in four major trauma patients in Georgia gets treated at a trauma center, according to the Georgia Hospital Association. That makes the state's trauma death rate higher than the national average. Even bringing down our death rate to the national average would save, by the GHA's count, more than 700 lives a year.

So why not just wave a magic stethoscope and make all hospitals trauma centers? Well, there are a couple of problems with that.

Trauma centers typically are ranked on four levels - Level I being the highest, with the most specialists, equipment and resources; and Level IV the lowest, serving as a place basically to keep patients stabilized, safe and treatable until they can be taken to a larger trauma center.

Aha, you say - hospitals basically do Level IV stuff anyway. So all Georgia hospitals could, in theory, be Level IV trauma centers, right?

Well, no. Take the trauma center in Madison. It's the state's smallest, and Georgia's only Level IV. It has dedicated staff who are firmly committed to the stressful, inconvenient duties a trauma center demands of medical professionals. Other hospitals may not be able to secure that kind of commitment from already overworked staff.

That's because the way things operate now, running a trauma center in Georgia is a losing proposition. The patients most likely to come in are uninsured or impoverished, or both, and they know a hospital certainly won't turn them away. So a trauma center offers services that largely get no financial compensation.

Knowing that, try convincing a physician under those circumstances to help staff a trauma center: "Well, doc, you'll be on call 24 hours a day, seven days a week, and there's a good chance you won't get paid for your work." It's those kinds of conditions that drive physicians into private practice.

It's also those kinds of conditions that are causing existing trauma- center hospitals to rethink their futures. Macon's Medical Center of Central Georgia, one of the largest trauma centers in the state, is doing just that - considering dropping its Level I status.

No one is even thinking about making Georgia's trauma system larger at this point because the immediate and most dire problem is that it is hemorrhaging money. Last year, hospitals and doctors lost about $249 million because legions of uninsured or indigent trauma patients are overburdening the system. And if you're running a concern that's losing close to a quarter-billion dollars a year, something has got to be done.

The Georgia General Assembly has the chance to do something, and it better do it fast. The legislature's Trauma Study Committee released recommendations Thursday on how the state can make up part of the trauma system's shortfalls.

One suggestion is to add $5 to the motor vehicle tag tax, an idea that's good because it's so broad-based. Since the trauma system is for all Georgians, all Georgians should chip in to fix it.

Another good suggestion, also broad-based, is to tack a $1.41 fee on monthly cell phone bills. It's small and painless, and it's an instant revenue generator.

Still another suggestion would allow Georgia taxpayers to check a box on their state tax returns to indicate that they want to contribute either 5 percent of their tax returns or $5 toward helping the trauma centers.

So the chief concern now is to secure badly needed funding, then decide how that funding is to be distributed for maximum benefit. Call it bureaucratic triage.

Georgia's trauma system needs to be healed, and lawmakers need to act as if all Georgians' lives depend on it.

Because they do.


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