Get in a car crash, take a gunshot, or survive a farm machinery accident in rural Illinois or parts of the Metro East, and you’ll likely be taken to St. Louis University Hospital, across the river.
“The quicker you get somebody here, the better they’re going to do,” said Helen Sandkuhl, who directs the Emergency Department. More than half of the hospital’s trauma patients come from Illinois, and the trip can be a long one. Broad swaths of the state do not have certified trauma centers within 50 miles, creating "trauma deserts" in southern and central Illinois.
“There are a lot of factors, not only the weather conditions, but the traffic conditions, and your resources at the time. In small communities, if they leave with their ambulance, then their community is left uncovered,” Sandkuhl said.
It does not have to be that way. A new study by the Illinois Department of Public Health evaluated eleven hospitals in central and southern Illinois for their trauma capabilities. More than half were deemed able to become a certified trauma center with "relatively little additional investment."
Cost of a Trauma Center
Some estimates put the cost of running the highest level of trauma center above $20 million, a sum that can be unreachable for hospitals, despite modest financial incentives.
Because the trauma desert label is based on travel time, they are not necessarily in rural areas: the Illinois study also focused on the Southside of Chicago, where long ambulance transit times have been blamed for contributing to the deaths of some gunshot victims.
“It’s a small percentage of the total patient population that we treat. However, when there is a trauma, it’s minutes. You’re constantly in the hospital world, balancing priorities to everything else you do, and where you allocate resources,” said Mike McManus, Chief Operating Officer for Memorial Hospital in Belleville. Becoming a certified trauma center bears additional responsibilities for physicians and nurses, for example.
“Not only is it difficult in terms of lifestyle, it’s a risk management issue. That would be a very difficult conversation to have,” McManus said.
Of the central and southern Illinois hospitals in the study, Memorial’s emergency department was given the highest feasibility rating for becoming a certified trauma center. McManus said the hospital would consider certification if the community needed it.
“I think that the fact that we’re so close to St. Louis, with the trauma centers there, it may not be as beneficial than if I was in, say, Centralia or Carbondale,” McManus said.
To qualify as a Level I Trauma Center, a hospital must have high surgical care abilities; a comprehensive range of specialists promptly available; and a heliport, among other things. Level II Trauma Centers have the same services, but on a slightly smaller or more limited scale. (Specialists, for example, have to be available within 60 minutes.)
"I don’t think there’s a trauma desert, I think there are limited resources. Southern Illinois has defaulted to send everything to St. Louis," said Dr. Douglas Char, an emergency physician at Barnes-Jewish Hospital who leads the Missouri chapter of the American College of Emergency Physicians.
"In days when we had money, that wasn't so bad,"
Whose Responsibility?
There may be a middle ground opening up for Illinois hospitals that have some trauma capabilities. The IDPH report suggests creating a scaled-down ‘Level III’ trauma designation for hospitals that do not have the resources to maintain a top-level trauma center. A bill introduced to the Illinois legislature last year did not make it out of the Senate.
Illinois Hospital Association spokesperson Danny Chun says the organization is still studying the issue to determine its position. It may come down to the financial incentives the state can offer rural hospitals.
“In a time of limited resources and limited funding, how do you fund that kind of an enhanced trauma system?” Chun said, noting that the state’s contribution to trauma centers totaled $4.9 million last year—a far cry from the annual cost of maintaining just one center.
Beefing up Illinois’ trauma center network shouldn’t just be the responsibility of hospitals, Chun said. Better transportation systems, hospital-to-hospital partnerships, and improving public health could also make a difference.