May 22, 2014: The Latest Facts about Trauma Care on the South Side

The Latest Facts about Trauma Care on the South Side

May 23, 2014

Q: Why can't the University of Chicago Medical Center have a Level 1 adult trauma center, like the other top medical centers in the city?
A: In 1986, the city launched a system designating seven hospitals in Chicago, including the University of Chicago Medical Center, and three in nearby suburbs as trauma centers. In 1988, hospital officials decided to not renew the University of Chicago Medical Center's application to be part of the city's adult trauma network because it was delaying other life-saving surgical procedures. Also at that time, there were other adult trauma centers that were serving the South Side. No one could have predicted that the other hospitals would also pull out of the city's trauma network or shut down completely.

This decision has allowed the University of Chicago Medical Center to concentrate resources in the clinical specialties where it can play the greatest role and where it has the most to offer, which includes a comprehensive Emergency Department for adults and children, a Level 1 trauma center for children, a neonatal intensive care unit, a burn unit and a hospital-based emergency helicopter service.

While the financial and staff resources required to build and operate a Level 1 trauma center are substantial, the Illinois Department of Public Health will designate new trauma centers only when there is demonstrated need, including when time of arrival to existing trauma centers is greater than 25 minutes.

Q: If a trauma victim is taken to your emergency room, would that person be turned away?
A: No. Any adult who comes to the Emergency Department on his or her own with a traumatic injury would be treated. If a higher level of care is needed, that patient would be stabilized before being transported to a designated trauma center. This falls under the federal Emergency Medical Treatment and Labor Act, or EMTALA. Under the city's trauma network, paramedics are required to take a victim of a traumatic injury directly to a certified trauma center.

Q: Would having a trauma center benefit the University of Chicago's medical students, who currently have to go elsewhere to get this kind of work experience?
A: Because hospitals are different and find efficient ways to share access to various specialties, all medical students in Chicago must travel to gain experience as part of their training. Students from other medical schools come to the University of Chicago medical campus or go to Stroger Hospital or Loyola University Medical Center in Maywood to observe operations in a burn unit. Many students come to our Medical Center to learn about pediatric and neonatal intensive care. Further, our intensive care unit has been cited as a national model for improving recovery after critical illness (see New England Journal of Medicine, April 24, 2014).

Q: What is the University of Chicago Medical Center doing to serve the community?
A: The Medical Center recently conducted a community health needs assessment in pursuit of data and as part of requirements of the Affordable Care Act. The analysis, which involved surveys of South Side residents, identified these priorities as the most important health issues in the community: diabetes, cancer prevention and access to primary healthcare, as well as childhood obesity and asthma. The Medical Center is actively engaged in offering services to address these concerns.

Violence prevention also was identified, confirming much of the work under way by the University of Chicago Medicine. We have partnered with Cure Violence to work in neighborhoods to defuse disputes and with the state to train nurses to become certified Sexual Assault Nurse Examiners. Also, in an effort to address the links between gun violence and teen depression, UChicago Medicine's Urban Health Initiative formed a unique collaboration with eta Creative Arts Foundation to feature a physician-written play, "It Shoudda Been Me," which uses actors to communicate the effects of neighborhood violence on youth.

As for direct patient care, our adult and pediatric emergency rooms are among the busiest in Chicago, with almost 47,000 adult visits and nearly 30,000 pediatric visits in the fiscal year ending June 30, 2013. The Medical Center also delivers 1,500 newborns a year, about 1,000 of whom are from the South Side. About 50 percent of our pediatric intensive care patients come from neighboring communities. South Side community hospitals transfer more than 900 critically injured patients a year to our Medical Center. Comer Children's Hospital's trauma center cared for 260 seriously injured children last year. Our burn center treated about 300 patients in the last fiscal year, a third of which come from the South Side. We also have outreach programs that provide free basic care and screenings on the South Side, and our pediatric mobile unit visited 25 schools -- mostly on the South Side -- to offer free immunizations in fiscal year 2013.

Q: Wasn't there a 2013 study that looked at the impact of transport times on survival rates?
A: Yes, there was a study published in 2013 that suggested an association between total pre-hospital time (from the time of the emergency call to delivery of patient to the hospital) and survival for a specific group of trauma patients. The authors note some shortcomings of their data. They:

  • Point out that their study is limited to 0.4 percent of all trauma patients and that the majority of the patients with penetrating thoracic injuries did not benefit from shorter transport times. In fact, survival rates for certain far larger patient groups improved with longer transport times.
  • Note that "comprehensive changes in a system that is working well for most patients may not be indicated or cost-effective."

An accompanying editorial in the same journal notes additional limitations, including the retrospective nature of the study, the lack of important pre-hospital data, and the "trend towards decreased mortality with increasing total pre-hospital time intervals."

Q: The University of Chicago already has a Level 1 pediatric trauma center. Why can't the age limit be raised to take in older patients?
A: The age range for trauma care at Comer Children's Hospital is from birth to age 15 years and 364 days, which is in accordance with the Emergency Medical Services and Trauma Center Code adopted by the Illinois Department of Public Health.

Q: Have you met with the community about the issue of trauma care and urban violence?
A: Yes. There have been several campus meetings on the topic, including a University of Chicago Student Government-hosted forum in November 2011 that involved hospital officials and community activists. Most recently, the University of Chicago Medicine leaders met with students, local residents and members of the University community at an open forum on May 28, 2013. The event, held on the University campus, was part of a four-month series of dialogue with the community.