Could Fracture During Disaster

An exponential increase in UAB trauma cases, which doubled from 1999 to 2005 and totaled more than 3625 cases in 2006, has created a crisis for UAB Hospital and for Alabama as a whole. UAB is the only American College of Surgeons (ACS) Level 1 trauma center in the state. “The expanding number of trauma cases overtaxes bed availability and overstrains every hospital department,” says Loring W. Rue III, MD, chief of the Section of Trauma, Burns, and Surgical Critical Care and director of the UAB Center for Injury Sciences.

In addition to the tens of thousands of patients who receive nontrauma-related care in the UAB Hospital Emergency Department every year, UAB averages 80 hospitalized trauma patients a day — a 23% increase since 2005.

UAB’s skyrocketing trauma patient census partially results from collapsing trauma care at community hospitals. University of South Alabama Medical Center and Huntsville Hospital, which provide a standard of care equivalent to that of the ACS Level 1 ranking, do their share, Rue says, but many small hospitals have limited trauma capabilities and send their patients to UAB.

UAB also accepts an increasing number of trauma patients from beyond its borders. Mississippi closed its burn center and sends its most severe injury cases to UAB. “Even the Atlanta area has airlifted patients here,” Rue says. “Out-of-state patients drain hospital resources because they tend to be critically ill and remain in intensive care for extended periods,” he says.

Instate, Montgomery is in particular need of better trauma care, and UAB Health System (UABHS) will reinforce trauma care at its affiliate Baptist Health Montgomery.

UABHS, the Medical Association of the State of Alabama, and the Alabama Hospital Association are seeking legislative funding to help community hospitals institute trauma programs capable of treating less severe injury cases and easing the financial pressures resulting from uncompensated trauma care. Money from proposed legislation would establish a statewide regionalized system to coordinate routing of emergency patients to the closest appropriate hospital. A statewide council would work with regional councils to operate the routing system, which the state health department would oversee. At present, the seven-county Birmingham Regional Emergency Medical Services System (BREMSS) is the only fully operational part of this system.

Rue, BREMSS Executive Director Joe E. Acker, and Huntsville trauma surgeon Rony J. Najjar, MD, are working with the Alabama Department of Public Health to institute a BREMSS-like system for northern Alabama and eventually for the rest of the state. “Only a statewide comprehensive trauma system will relieve pressures from this major health crisis,” Rue says.

Last year BREMSS received national recognition for its trauma system and contributions to homeland security from Mitretek Systems, a nonprofit science, technology, and strategy organization, and from Harvard’s Kennedy School of Government. This award sparked an initiative for a summer 2007 symposium with the governors, homeland security directors, and major trauma center directors from Alabama and surrounding states. It will focus on measures to enhance regional trauma care systems and promote collaborative interactions that enhance responsiveness to natural disasters and terrorist actions.

For more information:
Dr. Loring Rue
1.800.UAB.MIST
mist@uabmc.edu