Rescue Mission

How to save Texas’ trauma care system.

GLAMOROUS AND EXPENSIVE HELICOPTER programs make it appear that Texas offers state-of-the-art emergency medical treatment. In fact, the helicopter programs, which could be used far more effectively, are only a small part of an inadequate and overburdened trauma system. The crisis is twofold. In small-town and rural Texas, 126 hospitals have closed in the last eleven years. Meanwhile, big-city emergency rooms are overloaded with patients, many of whom can’t pay.

In 1989 the Texas Legislature passed a law requiring the creation of a statewide system to make certain that critically injured patients get to a full-service 24-hour trauma hospital as soon as possible. But all the Department of Health has done is carve the state into 22 regions, each of which is supposed to come up with its own plan. The Legislature has authorized no funding; so nothing much is likely to happen.

What ought to be done? Trauma experts say there are a few things we can do:

• Treat helicopters as public utilities. Think of helicopters as flying ambulances. Most ambulances in Texas aren’t run for profit anymore, and helicopters shouldn’t be either. They should be part of the Emergency Medical Service system, as is the case in Austin. In Maryland, for example, most of the pilots and flight paramedics on helicopters are state troopers. When not on medical missions, helicopters are available for police work.

• Create a statewide 911 network. In trauma, time is everything. A single universal number will save minutes and lives. Currently only 40 percent of Texas’ population is covered by 911 systems.

• Improve the training of emergency workers. In Texas, entry-level EMS attendants average only 40 hours of training. The national average is 120 hours. The problem with minimally trained EMS workers is more severe outside of big cities. A few sparsely populated counties, such as King, Kenedy, and Loving, are what trauma experts call dead zones—they have no EMS system at all, neither ambulances nor volunteers.

• Provide funding for the treatment of trauma. Trauma is a money-losing proposition for hospitals because so many victims don’t have insurance. Ron Anderson, the president and chief executive officer of Dallas’ Parkland Memorial Hospital, has suggested taxing the main causes of trauma injuries—guns and cars—to help pay for emergency medical care. He has proposed both a “bullet tax”—a penny per bullet—and a $16 fee on cars, boats, and motorcycles to raise $225 million. This money would go to two types of hospitals: rural hospitals that can stabilize victims and big-city designated trauma centers.

• Limit emergency room liability. “You can’t treat trauma by a recipe,” Anderson says. Emergency room doctors treat patients with multiple injuries and unknown medical histories; they have to take risks in order to save lives. Liability limits would reassure doctors who are hesitant to treat trauma because they are afraid of getting sued.

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