Courtney Terwilliger can still picture the life draining out of the 19-year-old girl as the ambulance sped toward the nearest trauma center 76 miles away — too far to save her.
Her stomach got bigger as she bled internally. Her skin began to feel cold.
“Time ran out,” said Terwilliger, director of emergency medical services at Emanuel Medical Center in Swainsboro.
It’s cases such as these, where patients may have lived if a trauma center had been closer, that wear on Terwilliger and others.
More than two years after legislators gave the state’s languishing trauma care system a $58.9 million infusion, Georgia’s death rate for traumas remains significantly higher than the national average. State funding has been cut to $10.5 million this year for the state’s 18 trauma centers. The dwindling funding comes at a time when Georgia needs up to 12 new trauma centers to make sure all its residents are within an hour’s drive.
Still, there are signs of hope.
Hospitals are increasing trauma care despite the financial burden. A statewide trauma communications system is in the works to coordinate services. And there is a renewed push in the General Assembly to create a permanent source of funding.
Traumatic injury — typically caused by car crashes, falls and work accidents — is a leading cause of death in Georgia, with the state’s trauma death rate roughly 20 percent above the national average, experts say.
While the death rate in rural Georgia, says Terwilliger, is “heartbreaking,” the issue is far more than a rural problem. After all, plenty of Atlanta drivers speed through the South Georgia segment of I-75 on the way to Florida’s beaches.
Rural fatalities
Ideally, Georgia should have about 30 trauma facilities to ensure all residents live within 50 miles of one, said Dr. Dennis Ashley, chairman of the Georgia Trauma Care Network Commission. Trauma patients have a greater chance of survival if they receive care within one hour.
The dearth of trauma centers is particularly acute in South Georgia, where there are huge gaps in coverage along I-75 south of Macon, said Kevin Bloye, a spokesman for the Georgia Hospital Association.
Roughly 700 Georgians die needlessly each year because they are too far from a trauma center, Bloye said. In 2009, 48 percent of fatal auto accidents happened in rural areas, a University of Georgia study shows, while just 18 percent of Georgians live in rural counties according to recent census estimates.
Funding is so minuscule, “we feel like we’re almost not helping anybody,” said Ashley with the trauma commission, established by the Legislature in 2007 to address Georgia’s trauma care crisis.
Revenues from the state’s “superspeeder” program — the commission’s sole source of money — have fallen far short of the $23 million a year the program was expected to bring in. The program levies additional $200 fines against drivers traveling 85 mph or faster on highways and interstates or 75 mph or higher on two-lane roads.
After an initial, one-time $58.9 million boost in 2008-09 from the state, funding fell to $17.5 million in 2010 and the initial budget for 2011 was cut by 53 percent to $10.5 million as the superspeeder program failed to deliver expected revenues.
Some facilities upgrade
A Level I trauma center, which treats the most severe cases, spends $5 million each year in staffing, equipment and other costs just to be able to receive patients, Ashley said. Grady Memorial Hospital, metro Atlanta’s only Level I facility, received $12.7 million in 2009 from the commission but has since seen funding shrink to $1 million this year.
In 2006, Georgia trauma care providers lost $70.7 million on trauma operations, according to a commission report. Hospitals often lose money on trauma care because staffing and equipment are expensive while many patients are uninsured.
Though the financial stress of running a trauma center has prompted some hospitals to leave the network in past years, the state hasn’t lost any recently and has added some, Ashley said. In 2009, Athens Regional Medical Center became a Level II center and Walton Regional Medical Center in Monroe upgraded from Level IV to Level III status.
It’s not about receiving funding, said Atlanta Medical Center CEO William Moore, who hopes to receive approval from the state by this spring or early summer for a Level I trauma center.
“Trauma is a commitment that hospitals have to make. Up to recently, there has been no additional funding available at all.”
Grants can help
WellStar Health System is also investing $4 million to make Kennestone Hospital in Cobb County a Level II center, hiring more trauma surgeons and creating a trauma database.
WellStar received a $300,000 start-up grant from the trauma commission, said Patricia Mayne, Kennestone’s vice president of emergency and surgical services.
Increasing the number of trauma centers is one piece of the puzzle, said Ashley with the trauma commission. In the Birmingham region, having an integrated network has decreased the trauma death rate by 12 percent, he said.
Despite severe funding cuts, Georgia’s trauma commission is forging ahead with plans to create a statewide trauma communications system, hoping to launch a pilot program in the Macon and Augusta areas within six months.
The system will tie into every hospital and allow emergency care providers to quickly identify which facility has the ability to care for critical patients, Ashley said. If, for example, a neurosurgeon is busy with two head traumas, the hospital can let everyone know by entering it into the computer, he said. The group is spending $1 million to get the communications center, which will be in Forsyth, up and running.
Some 33 states have found ways to permanently fund trauma care and Georgia must too, said state Sen. Greg Goggans, R-Douglas. Goggans said he was disappointed by the November defeat of a constitutional amendment that would have added $10 to vehicle registration fees — providing between $80 million and $90 million annually to fund trauma care.
Now, he is leading another effort with Senate Resolution 140 that would dedicate funds from existing tag fees already paid to the state. With Georgia facing a $1.5 billion shortfall in 2012, however, Goggans said he doesn’t plan to make a big push until January in hopes that the state’s financial crunch will have eased.
Ashley said he feels good about the progress made but still worries daily some hospitals may get out of trauma care.
“I don’t know how long we can keep that pace with the limited funding we have,” he said. “I think we could very quickly slide back at any time.”
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