Alabama tornadoes: Trauma communication system underused

ALABAMA — In the hours after the tor­nadoes, the injured poured into hospitals across the state. More than 2,700 in all, they arrived with bro­ken bones, fractured skulls, bodies pierced by glass, wood and stones.

They came on April 27 in ambulances, pickup trucks, family cars, or simply walked, wounded, through hospital doors. Some had only minor injuries; others were clinging to life. And there were all levels of inju­ries in between.

By most accounts, the health care system, from the front lines of rescue workers to the nurses and doctors in the hospitals, did great work that day un­der extreme conditions. Many lives were saved through heroic medical in­terventions.

But records and inter­views show that as the dis­aster unfolded, many areas of the state — outside of the Birmingham region — failed to fully implement a statewide communications plan with a proven track re­cord for reducing the deaths of trauma patients by matching them with the closest appropriate hos­pital.

The result of this failure to embrace the Alabama Trauma System is hard to quantify. But the main hos­pital for Tuscaloosa — DCH Regional Medical Center — faced an influx of 800 pa­tients, causing it to tell first responders and other hos­pitals that it was unavail­able to take more patients. And the hospital main­tained that status for more than 14 hours.

The Alabama Trauma System is designed to keep hospitals from this kind of overload by routing patients elsewhere, said Joe Acker, who oversees the Alabama Trauma Communications Center, the hub of the system, and is executive director of the system’s central region.

“They (DCH) did a heroic job, but the system should have never let them be placed in that situation,” Acker said. “It’s foolish to say that one hospital can treat all of those (victims) — that massive number — and turn your back on a resource.”

Officials with DCH and emergency management personnel in Tuscaloosa say the disaster was so extraordinary that using the system was nearly impossible and perhaps would have compromised patient care by absorbing too much paramedic time. “We had so many patients and very few caregivers so we didn’t have time,” said Glenn Davis, executive director in the trauma system’s west region which includes Tuscaloosa. “We were scooping and running with them.”

Edgar Calloway, director of operations for NorthStar EMS, which transported 300 patients in 200 ambulance rides to DCH that night, also cited patient volume and the urgency for care.

“You can’t expect what we do on a daily basis to work on a disaster of this scale,” he said. The Alabama Trauma System “works great, and was well-minded in the way it was set up. But you’re talking about — from a Tuscaloosa standpoint — we transported 200 patients in the first few hours alone.”

Acker, though, believes the system is especially useful in mass casualty incidents.

If it had been better used statewide, would there have been less hospital crowding, better patient care and fewer deaths?

Acker says he can only address what he knows first hand. “In this region, it went very, very well. I think we know we would have had more deaths if not for the system. We saved those who would not have survived.”

How it works

At the heart of the Alabama Trauma System is the Alabama Trauma Communications Center (ATCC), operating out of a hardened, one-story white building in Birmingham where paramedic-trained dispatchers field calls and monitor hospitals.

Paramedics and emergency medical technicians at the scene call in by phone or radio to the center. Dispatchers log the patient into the system and direct that patient to the appropriate hospital based on the patient’s level of injuries and the hospital’s availability and capability to treat those injuries.

The center’s dispatchers use LifeTrac, a secure computer network, keyed into 45 hospitals statewide to monitor each hospital’s status in terms of beds, equipment, doctors and critical care units.

Day to day, only the most seriously injured patients — based on a statewide protocol that paramedics are required to learn — are called in to the system. But under a disaster plan, such as the one used by the central region, all patients are called in, giving dispatchers the wide scope of injuries and the chance to more broadly manage patient volume at any given hospital.

“You don’t want to be dealing with a broken finger when a severe trauma is coming through the door,” said Dr. Loring Rue, chief of trauma at UAB Medical Center, who has documented the system’s success.

The Alabama Trauma System was born out of the Birmingham Regional Emergency Medical Services System (BREMSS), which started in 1996 with a push and some money from UAB to more efficiently manage its trauma care load.

After BREMSS’ implementation, a study found that trauma death rates dropped by 12 percent in the region while the rate for the rest of the state remained the same, Rue said.

BREMSS has been recognized for its disaster response capabilities, with a positive review from the Journal of Trauma for its performance following the 1998 tornado that killed 32 people in Jefferson County, and with the Mitretek Innovations Award in Homeland Security, a prestigious national award sponsored in part by Harvard University.

That success and increasing concern about the rest of the state’s high injury mortality rate propelled Gov. Bob Riley in 2009 to expand BREMMS statewide under the umbrella Alabama Trauma System, which is run by the Alabama Department of Public Health.

Regions of the state have been brought on one at a time, and now only the southeast region, which includes Montgomery and Dothan, has not yet joined the voluntary program.

But while the system was in place for all of the hard-hit areas on April 27, it was greatly underused during the tornado disaster outside of BREMSS, which is the central region in the statewide system, according to records and interviews.

Read the full story here.

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