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Trauma system being developed

By Mary Nelson, Daily News

Trauma injuries kill an average 2,500 people every year in Minnesota. It is the leading cause of death for Minnesotans ages 1-44 and the third leading cause of death for all age groups.

Minnesota has taken a big step toward creating a statewide trauma system to provide prompt and appropriate care following a serious injury for all Minnesotans. The Minnesota Department of Health, together with the State Trauma Advisory Council, established criteria and a process that hospitals can be designated as trauma centers. Officials anticipate this process will soon result in a trauma care system to serve all parts of the state. St. Francis Healthcare Campus, Breckenridge, will be part of this process.

A state trauma system will be a major milestone in helping state officials address a leading cause of death in the state, Dianne Mandernack, Minnesota commissioner of Health said.

Minnesota is one of only nine states that hasn't implemented a formal system to coordinate the care hospitals provide to trauma victims. The impact of trauma is not limited to the more violent and congested urban areas of the state. The leading cause of injury deaths in Minnesota is motor vehicle crashes, with 70 percent of all fatal crashes occurring in rural areas. Comprehensive statewide trauma systems have decreased motor vehicle crash deaths by nine percent and increased survival rates by 15 to 20 percent among those seriously injured in states where the systems has been implemented.

North Dakota created a comprehensive trauma system a few years ago. St. Francis Healthcare Campus has been a level IV trauma center for North Dakota for a few years and went through its second certification process just prior to moving to the new campus last year, Director of Nursing Nancy Nordick said. Nordick said St. Francis will join the Minnesota state trauma system as well.

To receive a trauma level, a hospital is visited by a state review team that reports to the state trauma committee.

There are different criteria put out to determine what level of urgency is needed, Nordick said. In some cases St. Francis will see a patient come by ambulance that needs a higher level of care. "In that case we stabilize and transport," Nordick said.

Communication is key. Nordick said hospital personnel are in communication with ambulance personnel during a transport and also contact a level I or II trauma center for further assistance. Whether a car, farm or industrial accident or something like a gunshot wound or stabbing, all incidents are considered trauma.

Ambulance personnel look for symptoms and make the call whether to activate the system, Nordick said.

Minnesota looked at other states including North Dakota when setting up its program. A small number of Minnesota hospitals provide superb trauma care. Many Minnesotans live in parts of the state that have traditionally been isolated from optimal trauma care resources. With this in mind, officials of the Minnesota Department of Health worked since 2003 to develop a comprehensive statewide trauma care plan.

Nordick said North Dakota has five levels of trauma. The state determines the criteria and grants designation, Nordick said.

Level IV standards include a trauma team activation plan with a current advanced trauma life support certified physician as designated leader. Equipment is available for resuscitation and life support for all ages, several levels of airway control and ventilation equipment, pulse oximetry, electrocardiograph, gastric decompression, spinal stabilization equipment, triage decision scheme, trauma transport plan and more. Trauma systems provide extra assurance that seriously injured residents in all areas of the state will be promptly transported to and treated at facilities with resources to care for their injuries, Mandernack said.

Trauma centers provide life-saving care for seriously injured people. The time between serious injury and receiving surgical care is the most important predictor of survival. This is called the golden hour, and as the golden hour winds down, so do the chances for survival.

Gov. Tim Pawlenty proposed and signed into law a trauma system legislation establishing the State Trauma Advisory Council, which recently approved the final criteria hospitals must meet to become designated as a trauma facility and to become part of the new state-wide system.

The closest Level II trauma centers are Innovis and Meritcare in Fargo, Nordick said.

The highest levels of trauma care are found at Level I and II, which include immediate surgical services along with various specialists. These levels are currently available in Minnesota. The closest to Breckenridge is in the Twin Cities at Hennepin County, Nordick said.

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