Health

Sunday, Jul 01 2012 12:00 PM

KMC's trauma closure rates remain high

BY KELLIE SCHMITT Californian staff writer kschmitt@bakersfield.com

From January to May, severely injured patients couldn't go by ambulance to Kern Medical Center -- the county's only trauma facility -- on 16 separate occasions for a total of 3,707 minutes.

That means someone in a life-or-death situation had to go somewhere else for care, somewhere without the critical resources KMC has to offer.

And that's not good, said Jenny Wilson, director of emergency services for Bakersfield Memorial Hospital.

"When KMC is closed, those trauma patients are going to non-trauma centers," she said. "It's not optimal care for those patients."

That's because the county's other hospitals don't have the same equipment and staffing as KMC, a Level 2 trauma center that can handle everything from shootings to nasty car crashes.

In November, The Californian reported that KMC's closure to all ambulance traffic including traumas -- something known as full closure -- had soared by seven times over the previous year to more than 12,000 minutes.

So far, this year's numbers have dropped, though they're still much higher than 2010's, when the county hospital went on full closure for 1,625 minutes. (The numbers don't include times KMC is closed to everything except trauma).

The high numbers are troublesome since closure of the county's only trauma center could lead to delays in care, or even patient transfers to facilities outside Kern County. Academic studies and government agencies have demonstrated that a severely injured patient's risk of death is significantly lower when care is provided at a trauma center versus a non-trauma center.

KMC chief executive Paul Hensler said the hospital closes when its capacity is taxed, usually after a major auto crash or multiple shootings. Sometimes, there isn't enough capacity in the emergency or operating rooms. Essential equipment malfunctioning could also be a cause.

"I've been satisfied every time we've gone to diversion it's for a good reason," he said. "We're all very sensitive to staying open."

In fact, Hensler was on call several weeks ago and turned down a surgeon's request to go on full closure. They had used up their blood supply, and needed a half hour to get more. Hensler weighed the odds and figured they could get more blood in time.

When KMC closes to trauma, the other area hospitals will take those patients. While they can handle some of the less serious cases, they'll simply stabilize severe trauma until they can move those patients to a trauma center.

But Kern County Emergency Medical Services chief Ross Elliott said KMC often takes the worst cases anyway, even if it's supposedly closed to ambulances.

"If our backs are against the wall and there's a major trauma, we call them and say, 'Can you take this?'" he said. "And usually they fit it in."

That's partially why he thinks the entire closure policy at local hospitals is used as a crutch by staff who are feeling overwhelmed. He pointed to December 2011, when KMC wasn't closed at all to ambulances -- proof the hospital could manage to stay open.

The county has been working on a no-closure policy that wouldn't allow any of the area's hospitals to close to ambulance traffic, something that could be sent to the Board of Supervisors by this fall.

Hospital leaders say everyone's on board with that policy, something that has already been instituted in other counties throughout California.

Amy Olson, director of emergency services at Mercy Hospitals of Bakersfield, said her previous hospital, a trauma center in Nevada, never went on closure. When things got busy, staff worked internally to adapt, even calling in extra staff if needed.

Along with ensuring severe trauma patients end up in the best place, keeping hospitals open lets patients in ambulances pick the hospital they prefer, instead of occasionally being forced to go across town if the nearest one is on closure, she added.

Now, when one hospital closes, it creates more pressure on everyone else in the system, sometimes forcing them to close in a domino effect, said Jarrod McNaughton, a vice president at San Joaquin Community Hospital.

"It doesn't make sense to have closure in our community," he said. "We're following many, many counties in California that have instituted a similar policy."

John Surface, a division manager at Hall Ambulance, said he doesn't anecdotally recall if any local residents have suffered when KMC is fully closed to ambulances. But common sense tells him it can't be good for Bakersfield.

"If the only trauma center for 400,000 people is full, chances are that sometime someone suffers because of that," he said.

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