UCMC Trauma Center

Activists and UCMC discuss solutions to trauma desert

By Brandon Lee | Produced by Forrest Sill | May 1, 2015

Marta Bakula/Chicago Maroon

In a previous edition, The Maroon investigated the devastating health care issues that afflict the South Side, and why community and student group demands have been framed in opposition to the University of Chicago Medical Center (UCMC) administration. This article will focus on a different question on which consensus has not been reached: whether a trauma center will actually improve trauma mortality outcomes. The establishment of a trauma center at UCMC is one of several solutions to trauma mortality that are currently under consideration. What the administration, community and student groups will agree on to resolve the trauma desert, however, is unclear.

Would A Trauma Center in the South Side Improve Mortality Outcomes?

On August 15th, 2010, youth advocate and aspiring musician Damian Turner was gunned down in a drive-by shooting, only four blocks from UCMC. Chicago Fire Department paramedics were required to drive him to the nearest Level 1 trauma center, Northwestern Memorial Hospital, on the northern edge of downtown. Some claim that if the South Side, through UCMC, had been equipped with a T1, Turner would still be alive today.

The first hour after the onset of out-of-hospital traumatic injury is typically referred to as the “golden hour,” and is considered a crucial, life-or-death window of time when trauma can be safely addressed. Yet the relationship between transit-to-hospital time and mortality outcomes remains largely unclear. In March of 2010, a nationwide study conducted by Dr. Newgard, who is the Director of the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University, analyzed 3,656 trauma patients, ages 15 and up, and found that there was no association between transport time and in-hospital mortality. Furthermore, total emergency medical services (EMS) time, which includes activation of EMS, time-to-scene, and transport time still did not predict in-hospital death.

Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort.
The Annals of Emergency Medicine, Volume 55, Newgard CD, schmicker R, Hedges JR, et al., Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort. 234-246, Copyright Elsevier 2010.

“The best, largest study available to us now suggests that pre-hospital time isn’t as related to injury death as we’ve always sort of assumed, and as our instincts would tell us it is” said Brendon Carr (M.D, M.A, M.S), the Director of the Emergency Care Coordination Center at the U.S Department of Health and Human Services, to WBEZ radio station in an October 2011 article on whether trauma centers will reduce mortality.

Scatterplot diagram of percentage of patients dying as a function of Injury Severity Score for blunt and penetrating trauma.
Source: These images were published in The Annals of Emergency Medicine, Volume 55, Newgard CD, schmicker R, Hedges JR, et al., Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort. 234-246, Copyright Elsevier 2010.

Since then, two studies in 2013 have reached conflicting conclusions. The first was published in The Annals of Emergency Medicine and divided trauma into two general categories: blunt and penetrating. Gunshot wound (GSW) and stab victims fall under penetrating trauma. Utilizing a database of 19,167 trauma patients, they found that trauma severity and the time a patient is at the scene of injury strongly predicted penetrating trauma mortality: patients who were at the scene longer and sustained harsher injuries were more likely to die. However, transport times did not show this trend.

A study done at Northwestern University’s Feinberg School of Medicine by Marie Crandall disputes these findings. Utilizing the Illinois State Trauma Registry (1999-2009), and restricting their study to 11,744 GSW patients, her team found that when victims were shot more than 5 miles from Level I or II trauma centers, this corresponded with a higher likelihood of mortality.

The Illinois Department of Public Health reviewed Crandall’s work in their “Trauma Center Feasibility Study” this January, and stated that although proximity to trauma centers was found to have some positive effect on survival outcomes for gunshot wound (GSW) victims, injury severity, lack of insurance and suicide intent were overwhelmingly more predictive of mortality. IDPH concluded that reducing mortality due to GSWs will require a strategy that, not only improves trauma care access, but also fosters mental health service access and addresses the disparity of health insurance. In their own discussion of the study’s results, Crandall et al noted that “modifications of trauma systems cannot address any of these issues.”

What do both sides want?

The Illinois Department of Public Health released the “Trauma Center Feasibility Study” this past January, which assessed the level of services currently available at various hospitals within the City of Chicago, and surveyed each responding facility about its interest in pursuing a trauma level designation. Trauma levels are traditionally designated on a level of 1 to 5, from offering most comprehensive to least comprehensive care, though only levels 1 through 3 were considered for this survey in light of the need to address penetrating injuries.

American College of Surgeons (ACS) Trauma Center Definitions
Source: Trauma Center Feasibility Study, Released 1/2/2015. Illinois Department of Public Health

Using a feasibility cutoff of 60%, indicating that the facility in question already has 60% of available resources to sustain a particular trauma center level, IDPH found that UCMC was the only respondent that could sustain a Level 1, and one of two facilities that could sustain a Level 2 center. Yet when surveyed for its interest in acquiring a trauma level designation, UCMC indicated no interest despite having the highest readiness. Advocate Trinity, Jackson Park and Roseland, however, expressed high interest in acquiring a trauma level designation despite their poorer feasibility scores.

Hospital Feasibility Scores
Source: Trauma Center Feasibility Study, Released 1/2/2015. Illinois Department of Public Health

When asked whether they would be willing to help finance a T1 at another South Side hospital, UCMC stated via e-mail that, over the past few years, they have met with other area health care providers and medical directors about ways to improve South Side health care. Among them, trauma care and violence prevention were repeatedly discussed. “Trauma services overwhelmed the hospital’s other surgical facilities and delayed life-saving procedures for other patients,” stated the UCMC in an email. UCMC also mentioned that that, even today, operating rooms are often fully occupied for life-saving and advanced surgeries, many of which are not available at other hospitals in the area.

Since IDPH’s report, UCMC released a statement in March, detailing the administration’s current plans to tackle trauma in the South Side, while maintaining other vital services. It stated that they “remain open to working with state, city, county and other healthcare providers to evaluate the needs of the South Side and the long-term financial and operational realities of running an adult trauma center,” encouraging a regional solution. A feasibility study, which began this past January, by UCMC will assess the realities of opening a trauma center on the South Side.

This statement followed a number of expansions by the hospital, including the expansion of the age of non-trauma patients in Comer Children’s Hospital’s pediatric emergency department from 15 to 17 years of age last summer. Most recently, UCMC announced that it is taking formal steps toward raising the age limit of Comer’s Level 1 pediatric trauma center from 15 to 17 years of age. Last year, Comer T1 cared for 260 children. According to UCMC, Comer Children’s Hospital will care for about 120 more patients as a result of the age increase, which would be about a 40% increase in its number of patients.

Veronica Morris Moore, youth organizer for Fearless Leading by the Youth emphasized that while T1 has acquired substantial press coverage, it isn’t the only possibility for addressing trauma care on the South Side. “It doesn’t have to be a level 1 trauma center at the University of Chicago,” Moore said. “They open up a level 2? Somewhere else? I’m not going to be mad at that,” she said. “I’m not going to keep protesting for a level I. We’re not unreasonable people.”

Moore also emphasized at UCMC should not be the only provider of trauma care in the South Side, either. “I believe there needs to be a network. So we can’t just be on the shoulders of the University. It has to be a support team…different levels, different agencies have to be a part of this,” she said. She insisted that there should be a joint meeting in which Aldermen of South Side neighborhoods, Mayor Rahm Emanuel, President O’Keefe, other heads of healthcare providers within the region, community members and youth leaders congregate and discuss details to a regional solution to the South Side trauma desert.

Abdullah Pratt, who is the Medical Students for Health Equity (M-SHE) President and 4th year Pritzker Student, corroborated Moore’s assessment that more frequent, inclusive communication is needed moving forward. He believes that tactics used by community and student groups to approach the administration were not well-received, and cites miscommunication as the cause for slow progress. “It works both ways. Things that the hospital administration was saying weren’t well understood, or taken as seriously, by community and student groups,” Pratt said.

Pritzker Associate Dean of Students, Dr. Jim Woodruff, reinforced that the trauma desert is an overwhelming challenge that will require considerable efforts to surmount, given the South Side’s financial obstacles. “No less than six hospitals in the south side have disappeared…and the University of Chicago is one of a handful of hospitals that has remained in existence” Woodruff said, when asked about the history of health care providers in the South Side.

Existing hospitals had to become either secondary care institutions, which provided basic in-patient care, or academic tertiary care centers, such as UCMC. The latter types rely on their reputation to bring in patients with more robust forms of insurance that allow patients to cover the full costs of their care and subsidize the care of patients in the south side.

However, he hoped that no matter what solution is reached to address the trauma desert, it will not come at the cost of vital services which address chronic illnesses the University already struggles to provide, and hardly garner media attention.

“If we fail to have these conversations, then we can anticipate that those problems are simply not going to receive adequate attention,” said Woodruff.