Officials with the county's trauma care system on Thursday discounted any increased risk to North County residents from the removal of a Life Flight medical helicopter to San Diego from a base in Oceanside.
The relocation from Oceanside's Tri-City Hospital to the UCSD Medical Center, effective Wednesday, was made for economic reasons alone after Tri-City decided to no longer pay for support services that the jet helicopter requires, said Caroline Bear, community health chief of the emergency medical services division at the medical center.
"We were able to make a temporary decision to move the helicopter and reevaluate its use because we felt there would not be an increased risk to potential patients," Bear said.
And while Bear said that officials hope to find another, less expensive North Coast location within two weeks for the helicopter--one of two Life Flight aircraft--she added that ultimately the best location to serve the majority of county residents could be elsewhere than along the coast.
"There's a lot of trauma activity in East County, so we're not certain just where the optimal place to put the helicopter would be," Bear said.
The relocation has raised concern in North County about how area residents will now fare under the county's trauma system. That system transports patients severely injured in accidents or violence to county-designated hospitals that have specially equipped and staffed trauma centers, where chances of survival are said to be better. As a result, emergency rooms not similarly equipped are bypassed, even if closer to the accident scene.
None of the county's six approved trauma centers are in North County, and there was concern before the system began last year over how to bridge distances in getting severely injured residents to the
nearest centers at Scripps Memorial in La Jolla or Palomar Memorial in Escondido.
The basing of a Life Flight craft at Tri-City has been viewed as a political compromise to soothe concerns, even though medical personnel said during public hearings that care would not suffer if transport came from San Diego. Tri-City has unsuccessfully attempted to become a trauma center and is now suing the county to gain that designation.
Tri-City's notice to UCSD on May 1 that the hospital wanted between $3,500 and $5,500 a month to cover helicopter costs resulted from county supervisors spurning a Tri-City request for designation. "We have to cut our costs because of huge expenses--$25,000 a month--we had in running a trauma program," Mark Havel, Tri-City spokesman, said. "We could absorb those costs if we became a (designated) center."
The Life Flight helicopters are operated by UCSD Medical Center, the lead trauma center, with financial support from the other designated hospitals. While technically not under the county's trauma administrators, Life Flight nevertheless serves as a key cog in making the system run--it transports two-thirds of all victims--and is coordinated closely with other parts of the system.
"I think that not having the helicopter here, even temporarily, will mean more difficult decisions by everyone involved whether to wait for Life Flight in an emergency or use a non-trauma center," said James Page, Carlsbad battalion fire chief in charge of the city's emergency services.
As of Wednesday, the helicopter is based at Scripps Memorial during daylight hours and at UCSD from sundown to sunrise. Bear said that flying times to North County locations will increase by a maximum 15 minutes with the Life Flight craft at UCSD, compared to having the helicopter at Tri-City.
But while the additional time for getting a helicopter to a scene may appear to compromise care, the perception is inaccurate, Dr. William Baxt, medical coordinator for the system, said Thursday.
"There is no data to show that there is an adverse effect," Baxt said. An earlier study Baxt did in 1983 showed that patients taken to hospitals by Life Flight arrived 23 minutes later than they would have if taken by ground ambulance but had 52% less mortality. Baxt said the higher level of care involved with Life Flight--where a physician or medical nurse handles the care as compared with a paramedic or medical technician --more than compensates for any time delay.
"A little extra time may not be that critical if the patient is getting emergency room treatment in the field," Baxt said.
Both Bear and Baxt said that a north coastal location for a helicopter may not be the optimum placement despite pressures for a North County presence.
"Remember, the reason it was placed in North County to begin with was because of the pressures the county had upon it (from North County officials)," Bear said. "I'm not saying that there isn't a need to access patients in North County, but I'm not saying that care would be different if the helicopter were not there."
Baxt said that the helicopter, when based at Tri-City, was utilized less than half as much as the helicopter based at UCSD Medical Center. The North County craft was moved to Scripps from Tri-City during daylight hours about a month ago so that it could respond more quickly to emergencies in East and South County when the other helicopter was on a flight.
"I think that for the time being, when Life Flight is again placed in North County, we will now be able to schedule it more for other areas," Baxt said.
Added Bear: "Our intent is certainly not to drop North County. But there is no data to support a difference of five to ten minutes as making a difference as long as we bring definitive care."