Overseers of Arkansas’ emerging trauma system are reviewing the events surrounding the death of a prominent lawyer in Clinton to help address gaps in the operation developed to speed critical treatment for those who suffer catastrophic injuries, particularly in rural areas of the state.
The system funded by a 2009 tobacco tax increase currently includes 55 hospitals statewide, and its Little Rock call center has handled more than 15,000 calls since it opened last year. Another 21 hospitals are expected to be part of the system by April 1, 2013.
Both Level 1 trauma centers in the state are at Little Rock — three others, two in Memphis, Tenn., and one in Springfield, Mo., serve border areas of the state.
Five hospitals are designated Level 2 centers and provide comprehensive clinical care. Seventeen are Level 3 facilities and provide care for mild and moderate injuries.
Among the 28 hospitals designated Level 4 centers that focus on stabilization and transfer is the Ozark Health Medical Center at Clinton. Attorney Brett Blakney, 43, died there of head injuries about 4 a.m. May 4, about six hours after police said he was punched in the face during a scuffle outside a nightclub he owned and hit his head on the sidewalk.
Authorities said Blakney died at the hospital before he could be transported to a Level 1 trauma center in Little Rock. The circumstances surrounding his death are being reviewed by the Governor’s Trauma Advisory Council.
"This process gives the opportunity for improvement for any piece of the system that may not have worked as it should," said Bill Temple, branch chief of injury prevention and control at the state Department of Health.
Since Blakney’s death, concerns have been raised about the lack of transportation to take him to the University of Arkansas for Medical Sciences in Little Rock. Gary Padget, CEO of Southern Paramedic Service, which serves the hospital at Clinton, has said an ambulance was available by 1:30 a.m. to take the injured man to Little Rock, but the patient was never cleared for transport.
Rebecca Bradley, the hospital’s quality control manager, did not return a telephone call for comment last week.
Temple said a review by the Trauma Advisory Council’s State Performance Improvement Subcommittee is expected to be completed by the end of the summer.
Dr. Todd Maxson, trauma director at Arkansas Children’s Hospital and a trauma consultant for the Health Department, said officials with the trauma system are "working with ambulance providers to understand that there are situations in which transfers are urgent and in those situations we are giving them tools to be able to respond in a more timely fashion than they have been able to before."
One of the concerns about the death at Clinton, Temple said, is that the ambulance company had just one ambulance in the county during part of the time Blakney was in the hospital’s emergency room. According to a police report, nurses at the hospital that night said the ambulance company could not leave the county unattended.
To address the issue, Temple said, a new procedure is being implemented requiring county ambulance services to have agreements with two neighboring counties so if they run short of ambulances backup service will be available.
"This process is being completed as we speak," Temple said, adding that counties that don’t complete the agreements could lose future trauma system funding. "We expect we’re going to see a pretty good compliance with that."
Arkansas is the last state in the nation to develop a statewide trauma system. The framework of the system was enacted in Act 393 of 2009 and was the centerpiece of Gov. Mike Beebe’s multi-million dollar health program funded mostly by a 56-cents-per-pack increase in state tobacco taxes.
The tax generated about $62.4 million in the 2011-2012 fiscal year, of which about $33 million, which included some carryover funds, went to the trauma system. The remainder of the tax revenues are funding more than 20 other health-related programs.
On the day the governor signed Act 393 into law, state health officials said creation of the trauma system would take several years to fully implement and would ultimately help lower state health care costs, especially in long-term rehabilitation, because patients would get to the correct hospital sooner and receive the necessary trauma care quicker.
The Level 1 centers — UAMS and Arkansas Children’s Hospital in Little Rock, as well as Regional Medical Center and Le Bonheuer Children’s Medical Center in Memphis, and St. John’s Hospital in Springfield, Mo. — handle the most extreme cases.
Level 1 hospitals receive between $1 million and $1.5 million each year of designation. Level 2 centers receive between $500,000 and $750,000 annually; Level 3 hospitals between $125,000 and $187,500 and Level 4 centers between $25,000 and $37,500 a year.
Another key component of the system, the communications center, opened in January 2011 and has handled more than 15,000 calls.
About 550 radios capable of statewide communications also have been distributed to ambulances across the state and are monitored by the communications center.
At the center, dispatchers use digital maps to see the location of the trauma call and a "dashboard" to see which hospitals are nearby and what capabilities they have to treat the trauma emergency.
"They can determine if their intended destination has the capability and capacity a patient needs, and if it doesn’t then the call center can find them the next nearest place that does," Maxson said. "We save tremendous amounts of time and wasted effort getting the right patient to the right place in the shortest amount of time."
Trauma system funds are also available annually for the 118 ambulance providers participating in the system, emergency services training and for emergency services associations.
Funds also are available for burn treatment readiness programs, the Injury Prevention Center at children’s Hospital and trauma education courses for doctors, nurses and emergency medical service personnel.
"There is no doubt, I think, one of the biggest improvements that we have seen and will continue to see in the system is in rural Arkansas," Maxson said. "The hospitals that you go to initially are, and will, continue to be better prepared in caring of urgent trauma cases. There is an education process that goes to every corner of the state and is teaching physicians, nurses and medics how to stabilize and rapidly transport people."
The new trauma system also includes a performance improvement component which allows trauma professionals to review individual cases to see what improvements, if any, can be made to the entire system.