By Aaron Collins

Someday, when you’re on your way to work or chauffeuring the kids someplace, an average day could turn to disaster with a serious car accident. At that defining moment, you probably won’t be pondering what Kaweah Delta Medical Center’s new Level III Trauma Center designation means for you.

You’ll have other things on your mind—if you have anything on your mind at all. And at that moment, every second will matter.

Let’s hope that day never comes. But if it does, you’ll be glad to know in advance that Kaweah Delta’s Trauma and Acute Care Surgical Services (TACSS) program means you’ll receive greatly improved care, as well as much shorter travel time to a treatment facility.

The March 2009 opening of the expanded Emergency Department enabled the designation, but a big leap forward is the 24/7 emergency surgical coverage required to maintain Level III status. Cases that once would have been stabilized at Kaweah Delta then sent on to Fresno or Los Angeles for treatment can now be effectively handled in Visalia. Burn and head trauma cases will still likely go to Fresno because of its burn unit and twenty four-hour neurosurgeons on staff.

The Tulare County Board of Supervisors gave Kaweah Delta its Level III trauma designation based on the hospital’s certification by the Emergency Medical Services Agency, according to the medical center’s Trauma Program Coordinator Amber Myers, RN, BSN. Myers adds that the designation and certification are in accord with the standards of trauma care that are set by the American College of Surgeons. In the state of California a hospital can be certified directly by the American College of Surgeons or it can be certified by the Emergency Medical Services Agency, Myers says.

“The local Emergency Medical Services Agency sets standards of trauma care according the American College of Surgeons guidelines. These guidelines are recognized nationally,” Myers says. “Once a hospital feels it is in compliance with these terms, a lengthy application—approximately the size of a text book—is submitted, then certified surveyors from other trauma centers come to analyze our ability to function at the trauma center standard.”

Kaweah Delta’s advanced facilities, resources, and successful training were key to gaining the certification.

“This is a high bar to reach,” says Rebecca Zulim, M.D., a surgeon in the Kaweah Delta trauma unit, explaining that the certification required years of planning, as well as the recruitment of additional surgeons, critical care specialists, and orthopedic surgeons with expertise in trauma care.

Long Road to Certification

“In addition, we underwent a major expansion of our facilities especially in our emergency room, intensive care units, and operating rooms; to prepare for trauma designation,” says Zulim, whose early efforts paid off in accreditation.

Gaining trauma center designation took seven years. A trauma committee was established with the goal of improving trauma care at Kaweah Delta. “As part of that project a number of studies were done to determine if there was need for a trauma center in this area and whether it was feasible for us to do that,” Zulim says. “We determined that this would be very important to our community and, over a period of the last few years we have been working on obtaining the support of our medical staff, the hospital board, and the community.”

Last January, Kaweah Delta underwent its consultative review by an ACS reviewer and his team to see if the facility was, in fact, ready to become a trauma center. It then continued further preparations and on September 11, 2009, underwent official certification review and met the criteria.

As part of the expansion of Kaweah Delta’s Emergency Department, four specially designed trauma bays can now each accommodate up to two patients at a time. “These enable us to perform rapid assessment of critically injured patients, and also to perform a number of emergency procedures that might be needed to save lives,” Zulim points out.

Saving Lives 24/7

According to Myers, Level III Trauma Designation ensures that the community receives specialized trauma care. “We are required and currently have 24/7 general surgical coverage, 24/7 orthopedic coverage, Emergency Department physicians with additional trauma certification, Emergency Department staff with additional trauma certifications, as well as operating room and ICU staff with trauma education,” she says of the rigorous requirements.

Those efforts seem to be paying off in terms of lives saved. Just consider Kaweah Delta’s statistics, says Myers. “Since the inception of Kaweah Delta Medical Center’s trauma committee seven years ago, our in-hospital mortality has improved dramatically. Currently, our in-hospital trauma mortality rate is at 0.4%, which is well below the national standard.”

Myers estimates the overall budget to achieve the designation at around $6.3 million. That amount was required to expand the emergency room, add the trauma bays, fund staff training, and hire additional personnel, including physicians. The trauma bay equipment alone represented $1.5 million of the overall budget.

The hospital will soon have a sixty-four slice CT scanner, according to Myers, which reflects quite and upgrade from the four-slice scanner in current use. Myers says the new equipment will allow patients to be scanned for internal injury much faster, possibly saving lives. The sixty-four slice equipment also provides much better imaging, reducing the time from discovery of injuries to appropriate intervention. Further shortening that critical timeframe is the new trauma operating room adjacent to the existing Emergency Department, set to open by this spring.

Specialized new equipment includes a rapid transfusor for blood and fluid administration, a bedside ultrasound machine for immediate diagnosis of internal injuries, an additional OR suite, and additional radiological screenings. Those close-at-hand instruments also mean less time transporting trauma patients for care elsewhere within the labyrinthine hospital facility.

However, merely purchasing equipment, training and staffing up do not ensure continued Level III designation.

Continuing Effort

“While designation recognizes the work that has been done already, I believe that the most important aspect is that it requires that we maintain the highest standards in the treatment of injured patients in order to keep it,” Zulim says, pointing out that every trauma center is rigorously reviewed by outside staff from the American College of Surgeons every two years. “By setting and keeping the bar high, Trauma Designation assures that the citizens of Tulare County will have access to top-of-the-line trauma care both now and in the future.”

According to Zulim, Kaweah Delta intended to pursue the next higher level of trauma designation, Level II, but the shortage of neurosurgeons meant that it did not meet the standard, although Kaweah Delta sees more than the required number of cases to be considered for Level II.

“One of the advantages of being a trauma center is that is also integrates us into the regional and statewide trauma systems,” Zulim says. “This helps us obtain more seamless access to any highly specialized care that our trauma patients might need that can only be provided by a Level I trauma center.”

Myers says the new trauma care facility represents “a tremendous advance for health care in the Central Valley.” And that’s a leg up that might just come in handy someday.

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