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Losing the 'Golden Hour' : Medical care: The closing of Huntington Memorial's trauma center may mean the difference between life and death for Glendale accident victims.

March 08, 1990|PHIL SNEIDERMAN and ELIZABETH LU | TIMES STAFF WRITERS

Glendale residents, at one time encircled by trauma centers, are about to fall farther outside the reach of hospitals that provide special treatment for life-threatening injuries.

When the trauma center at Huntington Memorial Hospital in Pasadena closes in May, local accident victims may not get the lifesaving care they need, county health officials said.

The hospital announced Feb. 23 that, after a $3.7-million loss last year, it will pull out of Los Angeles County's shrinking trauma-care network May 1. Huntington's trauma center has been treating severe injury victims from the east side of Glendale and nearby communities.

"It's a major setback for health care," said Virginia Price-Hastings, chief of the county's troubled trauma center network.

It will mean that many accident victims lose the chance for critical care during the "golden hour," the first 60 minutes after an injury, when the chances of survival are the greatest, she said.

Paramedics say five to 15 trauma cases usually originate in Glendale each month.

Emergency rooms also treat life-threatening injuries, but, unlike trauma centers, they do not have surgeons and anesthesiologists on duty at all times. Trauma care "saves 50% more lives than in a comparable emergency room," said David Langness, a spokesman for the Hospital Council of Southern California.

The end of trauma care at Huntington Memorial comes less than a year after the network lost St. Joseph Medical Center in Burbank, which also treated patients from Glendale. Hollywood Presbyterian Medical Center, just southwest of Glendale, left the trauma network in 1988.

"With Huntington gone, the whole San Gabriel Valley is without a trauma center," said Truman Chaffin, director of Los Angeles County's Emergency Medical Services Agency. "There's also a gap in the Glendale-Burbank area since St. Joseph withdrew last year."

Chaffin said he considers those two areas, along with the Inglewood community, as the three most critical holes in the trauma network. To plug these gaps, the county is offering part of its $42-million share of Proposition 99 tobacco tax funds to hospitals that remain in or rejoin the trauma network.

The county is trying to persuade St. Joseph to reopen its trauma center so the Burbank-Glendale area is not left uncovered, Chaffin said.

St. Joseph might rejoin the network, but only under certain conditions, said Daniel Fahey, the hospital's chief operating officer.

"Until we see there's a guaranteed continuation of funds from Proposition 99, and there's an ease of access to these funds by the physicians who treat trauma patients, we as a hospital are not in a position to have further discussions with the county," he said.

After May 1, Glendale's trauma patients will go to County-USC Medical Center whenever an ambulance can reach that hospital within 20 minutes. The decision is based on the distance from the trauma center and traffic conditions. If the trip will take more than 20 minutes, local trauma victims will go to the nearest of the city's three hospitals.

"Glendale does have access to three good emergency departments," Chaffin said. "But that does not mean a surgeon is there to handle a trauma case."

But emergency rooms also face an increased demand. Frequently, they become so burdened that they must close temporarily, and patients and paramedics often end up "shopping" for an open one.

"We are going to be impacted," said Rick Hayne, emergency room director at Glendale Memorial Hospital. "We are going to see more patients who would have gone to a trauma center. And we'll have to deal with them.

"We have the ability to take care of them. But can we do it within the 'golden hour'? That's the question."

The county's trauma network, launched in 1983 with 23 participating hospitals, will have just 12 left when Huntington leaves. The network was designed to guarantee that patients with multiple life-threatening injuries to vital organs such as the heart, brain and lungs could be rushed to a trauma center and waiting surgical staff within 20 minutes.

Statistics from the hospital council show that 44% of trauma victims are injured in car accidents, and 17% are shooting or stabbing victims.

Once a model trauma network, the county's system has rapidly deteriorated, mainly because, hospitals say, they are losing millions of dollars each year on trauma care. Health experts cited as major problems reduced Medi-Cal and Medicare reimbursements and uninsured patients who cannot pay.

The potential collapse of the county's trauma network shows that what is needed is "nothing less than a program of universal, comprehensive health care coverage," said Stan Dorn, staff attorney for the National Health Law Program in Los Angeles.

Los Angeles County's soaring population of about 8.8 million exacerbates the problem, the hospital council's Langness said. During the first year the county operated its network, 4,500 trauma patients were treated; by last year, the number had skyrocketed to 14,000, he said.

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