West explosion shows need for healthy trauma system

Posted Wednesday, Apr. 24, 2013  comments  Print Reprints
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It was clear at both the Boston Marathon bombings and the fertilizer plant explosion in West that a rapid emergency response was essential. Bystanders and neighbors risked their own safety to help the wounded. Emergency medical teams were there in minutes.

People hurt in the explosions were assessed by medical teams trained to make split-second life-and-death decisions in the midst of chaos. The most gravely wounded were rapidly transported to hospitals staffed, equipped and prepared to treat traumatic blast injuries. People who could have died on the scene were saved.

When the West Fertilizer Co. exploded the night of April 17, the medical emergency response network in North Texas was prepared. We were, in fact, in the middle of a two-day training exercise designed to challenge the processes in place to respond to just such mass disasters. Code-named Black Rain, the drill was scaled back to make sure adequate resources were available for West.

Tarrant County is a member of the North Central Texas Trauma Regional Advisory Council, authorized by the state to coordinate emergency medical response in 19 counties. Among 149 hospitals in the network, four have Level I Trauma Centers, including Scott and White Memorial Hospital in Temple, where many of West's injured residents were taken. Three patients were brought to JPS Health Network in Fort Worth, which has Tarrant County's only Level I Trauma Center.

What happened in West was a disaster, but it was mitigated because we have a prepared system and were able to get patients to the right place at the right time for the right care.

The primary source of funding for trauma services in Texas is the Driver Responsibility Program. Drivers convicted of offenses such as speeding, reckless driving and driving while intoxicated pay surcharges that have provided about $720 million in revenue to the state since the program began in 2003. The funds are held in the Designated Trauma Facility and EMS Account, which has a balance of about $425 million that lawmakers are eyeing to fund a variety of unrelated initiatives.

About $133 million a year is generated by the Driver Responsibility Program. The Legislature is currently considering allocating only $59 million for the Texas Trauma System.

Texas lawmakers also are considering legislation to do away with the Driver Responsibility Program altogether. Critics of the program argue that 1.3 million Texans have lost their driver's licenses because they couldn't or wouldn't pay their fines, creating a pool of uninsured motorists who drive up insurance premiums.

But critics of the Driver Responsibility Program have so far not identified an alternative source of permanent funding for trauma care in the state.

Trauma is the leading cause of death for Texans under the age of 44. For every death, many more Texans sustain injuries that affect their quality of life. Motor vehicle crashes are the leading cause of traumatic brain injury among people ages 15-64.

The Coalition to Protect Trauma Care, a partnership of trauma organizations and hospitals throughout the state, is urging the Legislature to ensure a permanent source of funding for trauma services and increase annual funding to reflect the amount currently collected by the Driver Responsibility Program.

Texas needs a vital trauma system in order to be prepared for mass casualty events such as the fire and explosion in West, as well as the violent crimes and accidents that constitute the largest threat to the health and well-being of everyone in the state.

Raj J. Gandhi, M.D., is trauma medical director for JPS Health Network and chairman of the North Central Texas Trauma Regional Advisory Council.

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