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Coordination Key to Solving Emergency Care Crisis
Neurosurgeon proposes adopting permanent command center approach for ambulances
The 40-year-old woman in Lake Jackson had a hemorrhage in her brain. When her physician called Memorial Hermann Hospital to arrange a transfer, he learned that every bed in the Neurosurgery Intensive Care Unit was full.
At the President’s Executive Luncheon, from left, Ralph
O’Connor and Clive Runnells, talk with Guy Clifton, M.D., who
holds the Nancy, Clive and Pierce Runnells Distinguished Chair
in Neurosurgery at the UT Medical School at Houston. O’Connor
and Runnells are life members of the UT Health Science Center
at Houston Development Board.
Photo by Kim Coffman
About eight hours elapsed from the time of her injury until she finally received surgery at The University of Texas Medical Branch at Galveston. Although she survived, she ended up vegetative and in a nursing home.
The woman had medical insurance – and small children.
This incident in 1999 was the first time that Guy Clifton, M.D., had to turn away a patient in the 30 years he had been practicing medicine.
Clifton, who holds the Nancy, Clive and Pierce Runnells Distinguished Chair in Neurosurgery at The University of Texas Medical School at Houston, discussed “Access to Emergency Medicine: Your Health May be at Risk” at the Oct. 12 President’s Executive Luncheon at the Hyatt Regency Downtown.
Better coordination of ambulance services could go a long way toward improving emergency access, he proposed.
In 2001, trauma centers in Houston were full – and diverting patients elsewhere – 50 percent of the time, said Clifton, who founded Save Our ERs that year to expand services and capacity for emergency rooms and trauma centers across Texas.
According to a 2001 study by Charles Begley, Ph.D., professor of management, policy and community health at the UT School of Public Health, the mortality rate had doubled for those injured in the outlying areas around Houston.
Preliminary data from a 2005 study of the Houston-Galveston area show that trauma centers were still on diversion 30 percent of the time, Clifton said. For seriously injured or ill patients being transferred from community hospitals in outlying areas, 70 percent of patients took more than two hours for transfer, exceeding the Texas Department of Health’s standard of care for transfer.
Thirty percent of hospital administrators responding to the survey said that patients were frequently endangered by transfer delays. And delays of six to eight hours were up from 9 percent in 2001 to 15 percent in 2005.
“What we’ve got is a massive maldistribution problem, lack of coordination and lack of accountability,” Clifton said.
“We have 59 ambulance services in the 13-county region that respond to 9-1-1 calls,” he said. “About 50 percent of these are small services with three or four ambulances. We have medical directors who live in Florida. We have an operation of emergency services that works like a tow truck operation.”
A patient in an emergency situation has no way of knowing which hospital is most appropriate for that patient’s condition. Yet the ambulance companies are afraid they’ll be sued if they don’t take the patient to the hospital that the patient requests. As a result, Clifton explained, some of the lower level trauma centers in the region were treating 150 trauma patients a year, while the major trauma centers at Ben Taub and Memorial Hermann hospitals were overloaded with 3,700 patients.
Trauma Centers |
| The trauma system in the Houston-Galveston area is made up of three level 1 trauma centers: The University of Texas Medical Branch at Galveston, Ben Taub Hospital and Memorial Hermann Hospital. Patients should be deployed to these hospitals when they have major injuries, such as a severe head injury or a crushed chest. A level 1 trauma center must have CAT scans, neurosurgeons and operating rooms ready and staff in the hospital 24 hours a day. Another six hospitals in the region are level 3 and can take care of people, for instance, with a broken arm or broken leg. |
“I couldn’t understand how things worked so well during Rita and Katrina,” he said. “I’ve been going around telling everybody we didn’t have enough hospitals beds – in 2001 that looked like what the problem was. But we have sufficient emergency room capacity and bed capacity in this 13-county region to handle everybody we need to.
“David Persse, who’s director of Houston’s Emergency Medical Services, told me what happened,” he said. “When they had the influx of several thousand patients from New Orleans and many hundreds from the Beaumont area, they had ambulances from as far away as Alaska coming into this region – hundreds of ambulances. The drivers didn’t know the region; they didn’t know where the hospitals were; they were just here to help.”
Persse and Mayor Bill White set up a command center using cell phones to direct the distribution of emergency patients.
For example, Persse would get a call from an ambulance driver from Alaska who was in Matagorda County. The driver would describe the patient, and Persse would direct the driver to the most appropriate hospital. Then he would call and tell the hospital to take the patient.
“That’s how 2,000 people from New Orleans got into hospitals, and I don’t think anybody ever changed their elective surgery schedule,” Clifton said.
Now, a similar system needs to be established on a permanent basis.
“If you think this doesn’t affect you, think again,” he said. “In an emergency situation, you can’t tell who’s got insurance and who doesn’t. You’ve got blood on your shirt, and you’re ‘cooked’ just like anybody else. It’s a community problem.”
By Ina Fried, Public Affairs