Trauma Centers

The Alameda County Board of Supervisors has proposed to increase a countywide tax by up to $8 to help bail out the county's trauma care system. The system is "financially punishing the three participating hospitals," said Don Perata, chairman of the Board of Supervisors. "With this kind of support, no hospital gets rich providing trauma care, but we will finally have a solid program." The tax plan would provide $4 million a year for the trauma centers, set up to treat victims within the first critical hour of injury.

BOSTON - As 3 o'clock neared Monday afternoon, officials at Brigham and Women's Hospital, one of Boston's premier medical centers, expected this year's marathon would be a nonevent. "We were winding down," said Barry Wante, the hospital's emergency management director. The slow pace was welcome after last year, when unseasonably warm weather led to a rash of heat injuries among runners, inundating the city's hospitals. Full coverage: Explosions at the Boston Marathon But on Monday, the hospital's radios suddenly crackled with reports from the finish line.

With the closure of St. Joseph's Hospital trauma center, public officials should now admit that the ill-conceived, expensive and overblown trauma system in Los Angeles is finished, kaput, no more. Trauma systems in Los Angeles, San Diego and Orange counties have never been proven to improve patient survival. In the five years since the L.A. system began, mortality from motor vehicle accidents has not improved at all! How long will the taxpayers have to subsidize this white elephant which does us no good?

Marine Lance Cpl. Jorge Ortiz is in pain. A combat photographer, Ortiz was taking pictures of a captured weapons cache in Sangin, Afghanistan, on Jan. 15 when he stepped on a buried explosive device. Photos: Rehabilitating injured vets The blast ripped off his legs above the knees and snapped off four fingers on his left hand and the thumb on his right hand. Classified as a triple amputee, Ortiz is now an inpatient at the Polytrauma Rehabilitation Center at the Department of Veterans Affairs hospital in Palo Alto — one of four VA centers nationwide staffed and equipped specifically to treat the most grievously wounded U.S. military personnel in Afghanistan and Iraq.

The Board of Supervisors has delayed until Feb. 12 its decision on whether to designate Santa Monica Hospital or Brotman Memorial Medical Center in Culver City as county trauma centers. Officials of both hospitals have argued that they should be selected for the prestigious designation to fill a void in trauma services on the Westside. The existing trauma centers on the Westside are UCLA Medical Center in Westwood and Daniel Freeman Hospital Medical Center in Inglewood.

Trauma centers save lives. Unfortunately, because of factors beyond their control, many lose money they cannot afford to lose if they are to survive. The California Assembly Office of Research reports that 55 trauma centers in 13 counties lost more than $130 million in 1986. Until recently Orange County's four trauma centers had managed to avoid that problem.

A map in the Trauma Hospital Program office of the Los Angeles County Department of Health Services charts the deterioration of the trauma network, with areas of crosshatching marking the regions no longer within 20 minutes by ambulance from a trauma center. The deprived areas in Eastern San Gabriel Valley and around the Los Angeles International Airport soon will spread to Eastern San Fernando Valley. With the closing June 19 of the trauma center at St. Joseph Medical Center in Burbank, the county will have lost nine of the 23 trauma centers established in 1983.

According to the Hospital Council of Southern California, a trauma center is a hospital that has dedicated medical staff and special equipment to care for major trauma patients. Trauma patients are defined as persons who have sustained acute injuries which put them at significant risk of mortality or of a severe disability, such as brain damage or reduced usage of a limb.

LONDON -- Battlefield surgery is moving to Birmingham, England, where a center for the treatment of trauma and microbiology opened this week in the new Queen Elizabeth Hospital Birmingham. Pioneering military surgeons and researchers will adapt techniques and knowledge learned in the war zones of Afghanistan and Iraq to treat injuries resulting from civilian disasters like traffic accidents or terror attacks. Funded by the Department of Health, the Ministry of Defense and Birmingham University Hospitals, the National Institute for Health Research Centre for Surgical Reconstruction and Microbiology is "the first and only research centre of its kind in the U.K. to focus both on military and civilian care and treatment," the  Department of Health says in a statement.

The blood-thinning drug warfarin is used by millions of people to prevent blood clots. However, people who suffer traumatic injuries while taking the medication are more likely to die. Researchers at Vanderbilt University studied the outcomes of adults who were admitted to trauma centers. They found warfarin users were more likely to die from their injuries compared with non-warfarin users: 9.3% compared with 4.8%. These patients were also more likely to have more severe injuries and to have sustained injuries in their homes.

War has often spurred medical advances: immunization against tetanus during World War I, the perfection of penicillin during World War II, and more. Now a leading San Diego physician wants the medical and political establishments in the United States to improve trauma care for civilians by adopting a system akin to that developed by the U.S. military to treat battlefield casualties from Iraq and Afghanistan. Trauma continues to be "a disease for which we have a cure," said Dr. A. Brent Eastman.

Since county officials shuttered Martin Luther King Jr./Drew Medical Center's trauma unit three years ago, rising numbers of severely injured patients have been transported to Harbor-UCLA Medical Center, a 10-mile drive away. The closure of the busy trauma center in Willowbrook, just south of Watts, raised concern that it would take longer to move patients and put them at greater risk of death.

In the 10 days since one of the worst commuter rail accidents in California history, the region's trauma surgeons have reknit shattered limbs, repaired battered organs and returned dozens of patients to homes and families, where many will now face weeks or months of painful recuperation. Twenty patients remain in the region's hospitals as a result of the Sept. 12 head-on collision between a Metrolink commuter train and a Union Pacific freight train in Chatsworth.

The Board of Supervisors on Tuesday unanimously approved raising certain criminal fines to help pay for trauma centers and emergency care across the county. The move, authorized by state legislation last fall, will levy an additional $2 for every $10 in some criminal penalties collected. Set to expire in 2009, it is expected to raise about $33.3 million for indigents' emergency care, help fund new and existing trauma centers, and pay for 26 new health department positions.

As Lance Cpl. Ryan Buchter lay bleeding in the Iraqi desert, his fate hinged on the efficiency of a medical lifeline that stretches halfway around the world. From that moment forward, hundreds of strangers would work to save him. Buchter's platoon was in a village called Husaybah on Nov. 8, searching for the enemy. He was standing in the doorway of a farmhouse when an insurgent inside rolled a grenade at his feet.

IN the rooms at Thousand Oaks Surgical Hospital, wood-crafted cabinetry hides ugly wires and oxygen lines. Wall-to-wall windows offer a serene panorama of the Santa Monica Mountains. There is a couch that pulls out into a bed for family members, a carpeted floor, a flat-screen television set and a roomy bathroom stocked with plenty of plush towels and a cozy waffle-quilt bathrobe. "The rooms are bigger, the food is like eating in a fancy restaurant....