2013-03-29 / Columnists

Dispatches

Delayed Access to Level I Trauma Care for Rockaway
By Dr. Dennis Graham DNSc, NP and Catherine Graham RN MSN

Your elderly parent is walking down the basement stairs. You hear a crash, and find her at the bottom of the stairs, unconscious. You call 911 and an FDNY ambulance is dispatched immediately with a paramedic team. It’s 6:00 p.m. on a Friday night and the paramedics tell you she needs to be treated at a Level I Trauma Center (LITC). Jamaica Hospital is the closest––but that’s 15 miles away. The ambulance leaves your home at 6:15 p.m., while you wonder, “How long will this take?” and worry whether your parent will be ok traveling this distance

The reason why your parent was taken to Jamaica Hospital is that she has a better chance of surviving this injury. Stanford University Medical Center reported in 2008 that being treated at a Level I Trauma Center increases a seriously injured patient’s chances of survival by an estimated 20 to 25 percent. The Centers for Disease Control and Prevention (CDC) reports that in 2009 it is estimated that more than 20,400 older adults died from unintentional fall injuries and that injuries are the leading cause of death for children and adults ages 1 to 44. Motor vehicle accidents, falls, and assaults are the most common sources of trauma.

An LITC will have trauma surgeons, nurses, and technologists available––including those trained in such specialties as neurosurgery and orthopedic surgery––as well as highly sophisticated diagnostic equipment and medical treatment.

St. John’s Episcopal––the only hospital on the Rockaway Peninsula––is not a Level I Trauma Center. Queens County has three LITCs and one in Brooklyn that are available for residents of the Rockaways. An important principle of trauma care is the concept of the “golden hour,” where having a team of experts immediately available for early intervention can save lives. The time spent treating at the scene and transporting to an LITC uses up some of these crucial moments of trauma care.

There is no public data available reporting the average time to an LITC for Rockaway residents. In our newly formed not-for-profit Center for the Study of Health Care Delivery and Patient Care Technologies, we decided to study how long it would take to transport a Rockaway resident to an LITC. Using the Google Earth Map Directions application to collect the median/mean time in minutes and distance to travel between the six Rockaway zip codes and four proximal LITCs at 10:00 a.m. and 6:00 p.m., we compared median/mean with the other 55 zip codes in Queens.

What did we learn? The median time to Jamaica Hospital––as mentioned above, the closest LITC to the Rockaways–– is 49 minutes at rush hour and 26 minutes during non–rush hour compared with 22 and 12 minutes for rest of Queens. At times Jamaica Hospital can be put on diversion, which means taking the patient to the next closest LITC. That is New York Hospital of Queens, with travel times of 52 minutes during rush hour and 29 minutes otherwise. Next in line is LITC Elmhurst Hospital at 55 and 35 minutes. Brookdale Hospital in Brooklyn, another LITC, may be used at the discretion of EMS. The median time is 45 minutes during rush hour and 23.5 at other times.

FDNY ambulance crews can use emergency lights and sirens to shorten the trip to an LITC from the Rockaways, but it also shortens the trip for every other area in Queens.

The time and distance in miles for a Rockaway resident to any of the Queens LITC’s is at least two times longer in both distance and time when compared with the rest of Queens.

The Commission on Health Care Facilities in the Twenty-First Century addressed the state of hospital care in New York State in 2006. Their report made multiple recommendations impacting on the Rockaways. Proposals included merging Peninsula Hospital and St John’s Episcopal and building a new 400-bed hospital to serve both eastern and western Rockaway populations.

Building a new hospital or establishing an LITC in St John’s Episcopal would take years to complete, but in the long run improve health care for future residents of the Rockaways. The New York State Department of Health has not yet acted on this six-year-old report.

Temporary measures could be imple- mented by the NYFD that may decrease travel time to an LITC. For example, Rockaway ambulances could be outfitted with satellite radio GPS with live traffic reports to obtain the best route to the closest LITC. Another technology that could be studied is a traffic light preemption system which turns red lights to green as the ambulance approaches a traffic light, to see whether this improves transit time.

Because of geography, there are no quick fixes for the delay to LITC care for this community. The Rockaway community needs the cooperation of the NYC government and NYFD to verify that our measures of time to LITC are accurate and, once confirmed, address possible solutions.

Rockaway residents need to bring up these issues with elected officials to recognize this disparity, request temporary measures be taken, and discuss long-term solutions to improve access to LITC care for this vibrant community.

Note:

The Center for Study of Health Care Delivery and Patient Care Technologies is a newly formed not-for-profit center established to study health care delivery systems and patient care technology, thereby improving outcomes and quality of life.

For further information contact Dennis Graham or Catherine Graham at PCTology@gmail.com or cfinngraham@gmail.com

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