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COMMENTARY: Put Las Vegas patients first on trauma center issue

Updated February 17, 2019 - 2:23 pm

When it comes to trauma, second chances are extremely rare. But the Southern Nevada Board of Health is faced with a unique opportunity for a second chance to put patients first and expand local access to trauma care.

As first responders, the dedicated women and men of the Nevada Highway Patrol Association see firsthand the need for increased trauma care in Southern Nevada. The board owes it to our community to consider expanding the trauma system to provide our growing population with access to trauma care.

In 2016, the last time the health board was presented with the opportunity to update our trauma system, the decision-makers ultimately rejected the applications, claiming the trauma system was working well and there were no incidents where patients or emergency personnel couldn’t get access to trauma center care. But now that the board is considering the same decision once again, it should be that this claim is no longer the case.

There are many signs that indicate the need for expanded trauma care in our region. There are the automobile crashes that occur outside of the Las Vegas Valley or at Mount Charleston that require ground transportation into the valley. There are disasters such as Oct. 1 that caught our trauma system by surprise and led our only Level I trauma center to make an “internal disaster” declaration.

Many of our members were working that night when a shooter opened fire across festival grounds from a suite at Mandalay Bay, killing 58 and injuring more than 700. Not knowing whether the shooter had been neutralized, emergency workers wore ballistic helmets and body protection. Before dispatchers could coordinate resources to transport patients to hospitals, medics had to extract them from the scene of the violence.

But the chaos didn’t end there. As dispatchers began coordinating transport for victims, word quickly spread that, to signal emergency room overcrowding, the University Medical Center — the only Clark County hospital with a Level 1 trauma center — had called an “internal disaster” alert designed to be used in various scenarios where patient care could be compromised. This caused a dispatcher to tell emergency responders that the trauma center was completely out of beds, even though the hospital technically remained open during the mass casualty disaster.

Those who oversee the valley’s emergency management system attributed the mix-up to human error and said they didn’t plan to investigate the problem further. But a closer look at the details tell a different story. The dispatcher’s readiness to reroute stemmed in part from the increasing use in recent years of “internal disaster” alerts. The internal disaster alert on the night of Oct. 1 wasn’t a mix-up. It was a symptom of a growing emergency care capacity problem.

In 2017, UMC issued “internal disaster” alerts on average 4.3 times per week, for a total of nearly 630 hours.

It took at least 15 minutes to correct the message, but confusion lasted more than an hour, and a presentation posted online by UMC about lessons learned from the tragedy indicate that once patients actually were transported to the trauma center, the hospital still lacked the capacity to actually treat victims. In this presentation, the hospital reports that “many patients with less severe wounds were treated and released quickly, some with bullets still in their bodies.”

This clearly indicates a trauma care capacity problem. The health board should need no further evidence to demonstrate that the current trauma system is actually at or over capacity and unable to ensure our citizens and visitors our trauma system is adequate.

As first responders, we take the responsibility to our public health system seriously. When the system is broken, we must all work together to ensure a reliable trauma system for our citizens and visitors. Second chances are rare when it comes to trauma, but we have one here, a second chance to get it right and put patients first.

The unmet need is undeniable. The board should consider the applications with an eye to putting patients and the emergency response teams they rely on first.

Matt Kaplan is president of the Nevada Highway Patrol Association.

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