Hagerstown trauma center can't stay open

Not enough surgeons for 24-hour staffing

May 31, 2002|By M. William Salganik | M. William Salganik,SUN STAFF

Unable to find surgeons to cover round-the-clock shifts, Washington County Health System in Hagerstown announced yesterday that it is suspending its trauma center, effective tomorrow, while it attempts to figure out how to handle the staffing demands.

"I believe we'll be in the trauma business," said James P. Hamill, the hospital's president. "but we need to find the right model."

Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems (MIEMSS), which oversees the state's shock-trauma system, said the suspension of services in Hagerstown was "unexpected and very precipitous," and had not, to his knowledge, ever happened before in the state.

Washington County handled 659 of the state's 15,000 trauma center cases last year, Bass said. He said the eight other trauma centers have enough capacity to handle the cases but that longer travel - patients who would have been treated in Hagerstown will have to be transported to Baltimore or Bethesda - could mean delays in treatment for some critically injured patients.

He said patients could be transported by helicopter in favorable weather. If the helicopters are unable to fly, he said, patients will be transported to another trauma center if they are stable enough. Otherwise, they will be treated at the nearest emergency room.

He said about 85 percent of trauma patients are treated at trauma centers and that most of the rest are people injured in remote areas of the state on days the helicopters are grounded.

Trauma centers provide specialized emergency care for seriously injured or wounded patients. Pioneered by the R Adams Cowley Shock Trauma Center at University of Maryland Medical Center, they were developed to provide care within "the golden hour" after injury, when lives that would otherwise be lost can be saved.

In addition to the UM center, the state system includes centers at Johns Hopkins, Bayview, Sinai, Prince George's, Suburban, Peninsula Regional and Cumberland Memorial hospitals.

Washington County has been part of the trauma system since 1980, Bass said, and the other hospitals have been participating longer.

Washington County was the only "nonmetropolitan" hospital in the state and one of the few in the country, Hamill said, to offer Level 2 trauma care, meaning that a trauma surgeon must be on the premises at all times. The other Level 2 centers in the state, he said, have residents (doctors finishing their training) on hand to help cover shifts, but Washington County doesn't have a residency program.

He said six or seven general surgeons in the Hagerstown area, all with training and experience in trauma care, took turns working 12-hour shifts at the trauma center but found it a "real burden."

Although the problem had been discussed for a few months, he said, it culminated in the past few days when it became clear that the surgeons hadn't agreed to work enough shifts to provide full coverage for next month.

Doctors at two surgical practices in Hagerstown, Surgical Associates LLC and Hagerstown Surgical Clinic, declined to comment yesterday.

The trauma centers at Peninsula Regional Medical Center in Salisbury and Cumberland Memorial Hospital are Level 3 centers, which means a trauma surgeon is on call - reachable and able to get to the hospital quickly - but not necessarily on the premises. Hamill said that becoming a Level 3 center is one option Washington County will consider.

He said a team from the American College of Surgeons will visit the hospital late next month to study ways the center could operate. He said he did not know how long it would take to get the report, reach decisions and do whatever was needed to reopen the trauma center.

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