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

Washington Monthly, Nov, 1985 by Paul Glastris

If you're dubious about these numbers and you've never heard of the "trauma crisis' before, you're in good company. Many doctors don't believe it either. Most of us don't see injury as a preventable, treatable "disease' but rather as a matter of fate, an act of God. It's easy to believe the emergency room doctor who tells you that "nothing could be done' for the friend who dies from injuries suffered in a car crash. Yet study after study demonstrates that most emergency rooms simply aren't set up to save the most seriously threatened trauma patients. "Most people who wind up in ERs think they're safe in the arms of Jesus,' observes John Otten, a trauma surgeon in Peoria, Illinois, "and that's often true in about 10 minutes.'

The best way to save trauma victims is still through prevention--seat belt use and air bags in cars, gun control and so on. But the secret to saving lives once injuries occur is quick and effective surgery. The major cause of death in cases of trauma is simply the loss of blood. Surgery won't save most trauma victims, since more than half die so suddenly that even if the injury occurred in the operating room, the surgeons probably couldn't do a thing. But of the roughly 40 percent of trauma deaths that occur in hospitals, a large percentage could be saved using existing surgical techniques. How big a percentage is open to debate. But studies from all over the country have found that in places where there is no complete system of trauma care, which is most of the U.S., 20 to 50 percent of those who die in hospitals from trauma could have been saved. In other words, 10,000 to 30,000 people die each year because an effective system of care hasn't been established.

In Chicago, trauma physicians and others have argued strongly for the changes, but so far without success. The roadblock isn't an immovable bureaucracy or corrupt politicians. Instead, the opposition comes from within the medical community--specifically from doctors and administrators at some Chicago hospitals that do not have trauma centers. Stan Zidlow, head of emergency medicine at Northwest Community Hospital, says that the doctors who sit on key advisory committees of Chicago's Emergency Medical Services Commission and oppose these changes, seldom say so; they just gum up the works. "After each new proposal came before the commission,' he explains, "the medical community would put it back to the committee, have terms redefined, wouldn't designate people to watch for abuses in the system and so on. Every one of these proposals never came to fruition, and no agreement was reached.'

Why oppose such sensible improvements? Two reasons, say trauma care reformers, are ego and ignorance. Physicians and hospital administrators refuse to believe that a lack of understanding and commitment on their part is killing people. The other big reason is money. The seriously injured often represent sizable revenues for doctors and hospitals. They require numerous procedures, close attention and, for those who live, long convalescences in expensive wards. By giving each Chicago hospital a share in the lucrative victims market, the current system pleases the largest number of local hospitals--at the annual expense of those 200.