Life and death in the emergency room - includes article on Dr. John West - part 1

Washington Monthly, Nov, 1985 by Paul Glastris

Another problem is that not all trauma centers are as proficient as the one at Cook County. The state of Illinois designated certain hospitals as trauma centers 15 years ago; since then there has been no serious review to see if these hospitals are doing the job. An emergency room nurse with 20 years experience told me of a young woman suffering multiple injuries from an auto accident who was brought to a "level II' trauma center in a suburb near Chicago. The surgeon on duty arrived in the emergency room within 30 minutes of the woman's arrival. Three hours later, still in the emergency room, she died. When the nurse asked the department director why the woman was never operated on, he replied that "the surgeon was afraid about what he was going to find when he opened the gal's chest, because he knew he didn't have the equipment to handle it.' Why, then, asked the nurse, wasn't she immediately transferred to the "level I' trauma center five minutes down the road, where they would have the proper equipment? The director replied that the surgeon wouldn't allow it, claiming the woman was "too unstable to transfer.'

The ultimate catch-22: a patient too badly injured for the surgeon to handle but too unstable to transfer to a hospital where she might have been saved. "I reviewed the records on this case,' the nurse said. "I know this was a preventable death.'

Fortunately, there are now trauma physicians and city officials calling for changes in Chicago's emergency medical system--changes that have saved lives in other cities. First, they want to redesignate trauma centers and begin inspecting and auditing their performance. Then, they want to institute triage protocols to get seriously injured patients to those centers. John Barrett, chief trauma surgeon at Cook County Hospital, estimates that these simple changes could save as many as 200 lives a year.

Chicago's trauma system is typical of systems throughout America. There are much better ones--for instance, in Maryland, parts of California, and Seattle--though advances in monitoring are showing that even these systems aren't saving a large number of patients with treatable injuries. Other areas of the country, such as southern Florida and many rural areas, have almost no trauma centers at all. Most urban and suburban America has trauma care like that in Chicago: half-organized, unassessed, slipshod.

"Safe in the arms of Jesus'

200 lives--just in Chicago. The figure gives some idea of the magnitude of the problems regarding the treatment of trauma. At least 140,000 Americans die each year of traumatic injuries; three times that figure sustain permanent disabilities. According to a National Academy of Science (NAS) report issued last spring, injury is "the principle public health problem in America today.' Trauma is the leading cause of death among Americans under the age of 44 and causes the loss of more working years than cancer and heart disease combined--at a cost to society estimated by the NAS to be in the tens of billions of dollars each year. Advances in the treatment of heart disease and cancer come slowly and at a tremendous cost. Great improvements in the treatment of trauma victims are available now; indeed, they've been around for years.