By Aaron Collins

Kaweah Delta Medical Center just hit the one-year anniversary of achieving its Emergency Department designation as a Level III Trauma Center, a seven-year effort that has changed the way emergency care is administered in Visalia and improved prospects for Tulare County trauma patients via Kaweah Delta’s Trauma and Acute Care Surgical Services (TACSS) program.

“Daily life has changed dramatically since receiving our designation,” says Amber Myers, RN, BSN, Trauma Program Coordinator for Kaweah Delta. “Since that time, the Trauma Acute Care Surgical Services have been available 24/7 for any trauma that rolls through our Emergency Department doors.

“Orthopedic surgeons have likewise committed themselves to excellence,” offering orthopedic care around the clock. “I am proud to say that all of our Emergency Department nurses, Operating Room nurses and ICU nurses have taken additional trauma courses. All ER nurses are currently Trauma Nurse certified and all ICU nurses will have Trauma Nurse certification within six months,” Myers says.

In the past year, KDMC treated over 800 trauma patients. Many of those patients would previously have lost precious minutes of lifesaving intervention during lengthy transport to hospitals outside the city, most often Fresno.

According to Kaweah Delta, the 76% of the patients treated were victims of “blunt trauma,” like motor vehicle crashes, falls and sports injuries. Trauma patients ages 18-29 accounted for 24% of the total. All trauma victims in the area now come to Kaweah Delta Medical Center, except for those with burn injuries or certain isolated head injuries.

Breathing Easier, Faster

Since the designation, Kaweah Delta Medical Center purchased glidescopes for the Emergency, Anesthesia and Critical Care departments. A glidescope is used for difficult airway intubations resulting from severe trauma. “Many times, trauma patients are so badly injured that it is difficult for the physicians to (see) the anatomy to place a tube that allows that patient to breathe,” Myers says. This device helps doctors relieve respiratory distress faster.

A new sixty four-slice CT scanner allows for faster imaging of the trauma patient and quicker diagnosis of internal problems, Myers says. This CT scanner sits within steps of the Trauma Bay in the Emergency Department to ensure the quickest response — one of many such requirements for the certification by the Emergency Medical Services Agency in accord with established standards of trauma care by the American College of Surgeons. Kaweah Delta’s advanced facilities, resources and successful training were key to earning that designation.

The Emergency Department physicians have also established bedside ultrasound courses. “ED physicians with training in reading of bedside ultrasounds ultimately improve the time from injury to diagnosis/treatment. The ED Physicians have also opened this up to all Trauma surgeons to attend,” Myers reports.

Increased interaction with other trauma centers is one major boon for patients following the designation. “KDMC has become very involved in the regional and state trauma system. We attend monthly Regional Trauma meetings that include Fresno, Tulare, Kings and Madera counties,” Myers says.

One of the advantages of being a Trauma Center is that it integrates the hospital into the regional and statewide trauma systems, helping to offer more seamless access to highly specialized care.

“We are very involved in the Central California Regional Trauma Coordinating Committees, which meet quarterly and include the following counties: Alpine, Calaveras, Tuolumne, Stanislaus, Mariposa, Merced, Madera, Fresno, Kings, Tulare and Kern,” says Myers, the Regional Director for Central California’s Rural Trauma Team Development Course. Dr. Tim Spade and Dr. Rebecca Zulim are members of the Executive Committee.

Additionally, every fifteen months KDMC participates in the State Trauma Summit, at which all California Trauma Centers come together. The department has become very well integrated into a system that improves information flow and care approaches.

Aside from these meetings and committees, Myers says, Fresno Regional Medical Center “has extended their hand and been very involved in establishing structure to our program. We have a trauma transfer agreement that allows any trauma patient at KDMC needing a higher level of care to be transferred to RMC in an expedited fashion.”

With a successful year under their belt, what lies ahead? The shortage of neurosurgeons in the region means that the next higher level, Level II designation, is unlikely. But public education about the benefits of local Level III services is on the agenda. “Kaweah Delta remains committed to attaining a high bar of trauma care delivered to Tulare County residents. We have been fortunate to receive great support from hospital administration, physicians and staff,” Myers says. “This support pushes us to become a Level III Trauma Center that offers the best in trauma services. In the upcoming year we would like to engage our local businesses, churches, schools and organizations in trauma services and education that Kaweah Delta Medical Center can offer them.”