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Surgeon Envisions Nationwide Trauma System

Cheryl Clark, for HealthLeaders Media, August 25, 2010

This week, Eastman was back in Wyoming, where he and his wife, fellow Scripps Memorial physician Sarita Eastman, own a vacation home. 

Spending quiet time there beneath the majesty of the Grand Tetons, he spoke with me about the discovery of the Golden Hour by Maryland Shock Trauma's R. Adams Cowley MD, and the fact that most cities in the country now have major certified trauma centers. And he spoke of the challenges that remain in bringing those life-saving, rapid fire systems to the reach of small town America.

It's now closer than ever, with trauma care funding and demonstration projects for rural America embedded in 10 of the 974 pages of the Patient Protection and Affordable Care Act. The landmark legislation included mentions of various grants for rural trauma spending, many in the tens of millions dedicated for trauma system improvement. But unfortunately, that money was not appropriated, Eastman says, something he hopes will change with the rural support of Sen. Max Baucus of Montana and Nevada Sen. Harry Reid.

"It would be a big start," Eastman says hopefully.

Eastman himself helped create one of nation's first trauma systems. In San Diego County in the early 1980s, he and several emergency room doctors from area hospitals persuaded reluctant county health officials that though such a system might hurt some hospitals in some political districts, (those hospitals would no longer receive patients via ambulance,) it would lower the preventable trauma death rate. And that it did, from 22% to between 1% and 2%, figures that have been maintained for the last quarter century.

Patients might be stabilized in smaller, non trauma hospitals initially. But if they can be transported—through a preferably government-regulated, monitored system—to a verified trauma center, ready specialty board-certified providers such as neurosurgeons, anesthesiologists, plastic surgery experts and others could save most of these otherwise doomed patients.

There, patients critically injured by vehicle collisions, violence, falls, or in the case of the Wyoming wilderness, bear maulings and lightning strikes, could survive with plenty of quality years to enjoy.

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