When a man fell 20 feet from a lift machine near the base of the Sagamore Bridge last weekend, paramedics had to make split-second decisions to save the man’s life.
With no trauma hospitals on Cape Cod, a medical helicopter was called to meet paramedics at Beth Israel Deaconess Hospital in Plymouth to fly the injured man to the hospital’s Boston campus, a Level I (highest level) trauma center.
The state has designated 17 hospitals to care for patients with traumatic injuries. Neither Cape Cod Hospital nor Falmouth Hospital is on the list.
This means that anyone suffering traumatic injuries, such as serious injuries from a car crash, has to be taken elsewhere, the nearest center being South Shore Hospital in Weymouth, which is a Level II center.
Sandwich Fire Chief John J. Burke said that if a helicopter cannot fly for whatever reason—be it weather-related or lack of availability—it can be a 45-minute ambulance ride from some parts of town to Weymouth. On the other hand, it is about 15 minutes to Cape Cod Hospital in Hyannis.
He said it is difficult to quantify the impact of that extra 30 minutes in specialized care, but patient outcomes would be improved if the option to go to Hyannis with trauma patients existed.
‘We’re Working On It’
This week, Patrick Kane, senior vice president of communications and business development at Cape Cod Healthcare, said the organization is looking to get Cape Cod Hospital designated as a Level III trauma center.
“We are working on it, but there are many details and decisions to be made,” he said.
Chief Burke cheered this news. He noted that in addition to saving time on travel to a trauma center, having a trauma center on-Cape would save time when the paramedics are deciding where and how to transport the patient, he said.
For example, paramedics responding to a crash on the Mid-Cape Highway at Exit 65 (former Exit 5) can be actively planning to take the patients to Hyannis rather than waiting until they get to the scene.
Having a trauma center on-Cape would also help with fire departments’ staffing, since a trip to the nearest trauma center can result in several paramedics being tied up for up to four hours. Being able to go to Hyannis would cut that time in half and mitigate the need to bring in additional staff who would need to be paid overtime.
Chief Burke noted that trips from Upper Cape towns to South Shore Hospital are much shorter than trips from farther down-Cape. The farther away a town is from the bridges, the harder it is for patients to get care in a life-threatening situation, he said.
“The farther you go out on the Cape, the more isolated we become,” said Orleans Fire Chief Geof Deering, saying that it can take half an hour just to get to Cape Cod Hospital from Orleans.
He added that it is a 60-mile ride from Provincetown to Cape Cod Hospital, let alone to South Shore.
“That’s a long time in an ambulance with a critically injured person,” he said.
If his paramedics are picking up a patient with traumatic injuries, right now they start heading toward Hyannis anyway. That way, if a medical helicopter is available, they are able to meet at the Barnstable Municipal Airport.
In the meantime, paramedics are busy giving patients the best care possible on the ambulance ride.
“Those early minutes in those emergencies are critical,” he said.
Chief Deering said the men and women working as paramedics have a wide range of skills and are well-equipped to do as much as they can while getting a patient to a trauma center or landing zone.
“To get any of those resources that much closer to the people who need them makes a lot of sense,” Chief Deering said.
Level I, II and III
Trauma centers are certified by the American College of Surgeons, and in Massachusetts those centers are categorized as Levels I, II or III.
To be considered as an accredited Level III trauma center, a hospital has to have access to emergency physicians, surgeons and anesthesiologists 24 hours a day, seven days a week, 365 days a year. This accessibility enables hospitals to assess and resuscitate patients promptly and to provide surgical and critical care services to patients.
These hospitals also need to have plans in place for transporting patients to Level I or II centers in the event that a patient requires a higher level of care.
Level II centers add to those requirements by having specialists available at all times such as orthopedic surgeons and neurosurgeons. Level I takes those requirements a step further by requiring more specialists in areas such as cardiac surgery, pediatrics and plastic surgery.
Level I trauma centers are defined as being able to provide care for every aspect of any injury. They are also generally teaching hospitals with staff actively training future trauma teams.
Chief Burke said that even if Cape Cod Hospital attains the trauma designation, some incidents may still require transport to an off-Cape trauma center. Specifically, he said eye injuries would still be better served at Massachusetts Eye and Ear or Massachusetts General in Boston. Amputations would likely be taken off-Cape as well.
Cape Cod Hospital opened in 1920, becoming the first hospital in the region. While plans had been in the works for a hospital for some time, the influenza pandemic of 1918 provided a big push toward its completion, since many sick people had to be taken to Boston at that time. Falmouth Hospital was founded in 1963.
Since that time, the population of Cape Cod has grown, and the medical needs of residents have shifted.
With more serious car crashes, water incidents such as near drownings, boating accidents and serious falls, Chief Burke said it is high time that a trauma center be available closer to home.
The emergency room at Cape Cod Hospital is one of the busiest in the state, he said, and the staff is competent and capable of handling traumatic injuries.
“It gives us a bunch of options,” he said in terms of where to bring patients. “I wholeheartedly endorse those plans.”