A LifeStar helicopter lifts off from Centennial Park after picking up Mary Ann Munsch, 65, Lawrence, on July 23. She was crossing Sixth Street at Schwarz Road when she was struck by a car, but was home recovering 11 days later.

Douglas County Fire & Medical personnel help put a child from Baldwin City into a LifeStar Helicopter for transport to Kansas City. Experts say treating a victim within the first hour after a traumatic injury is crucial.

While dinner was simmering in the crockpot, Mary Ann Munsch walked to the nearby Dillons on Sixth Street to pick up some couscous and salad greens to go with dinner.

After purchasing the items, she headed back home. As she was crossing Sixth Street at Schwarz Road, she was struck by a PT Cruiser. Her head hit the windshield and broke it.

The accident left her unconscious with obvious injuries to her left eye, which was bleeding.

She was transported to nearby Centennial Park, where a LifeStar of Kansas helicopter picked her up and took her to Kansas University Hospital, a trauma center.

Munsch was there within “the golden hour,” or one hour after the accident. In fact, she was there about 35 minutes after the crash.

“Getting an acutely injured patient to a trauma center quickly increases their chance of survival and decreases their potential complications down the road,” said Dr. Scott Robinson, medical adviser for Lawrence-Douglas County Fire & Medical.

Studies show that patients who suffer traumatic injury are 25 percent more likely to survive if they are treated at a trauma center.

After spending 11 days in the hospital after the July 23 incident, Munsch was home recovering. She is grateful to have KU Hospital nearby.

“Not every hospital can have every expert, but I think that is what the med center has,” she said.

According to the American College of Surgeons, which verifies trauma centers, KU Hospital has a full range of experts who are available 24 hours a day. It also provides trauma research and education programs, and that’s why it has a Level I rating, the highest a hospital can receive.

Leading cause of death

Many patients in the United States and Kansas aren’t as lucky as Munsch. Traumatic injuries are one of the leading causes of death and disability among Kansas residents. In 2005, 1,174 Kansans died from unintentional injuries, and 494 of them were in vehicle crashes.

Nationwide, traumatic injuries are the leading cause of death for Americans younger than 44, claiming more than 140,000 lives and permanently disabling 80,000 people annually.

Efforts are under way to develop a national trauma system, but in the meantime it is up to states and local officials to provide a system.

“While patients can pick and choose where to go for elective procedures, if you are in a car accident or fall off a ladder, you are at the mercy of the system – or lack of a system,” A. Brent Eastman, an American College of Surgeons trauma expert, said in a recent Wall Street Journal article. “Americans think if they call 911 that everything is going to be taken care of, but there has to be a trauma system in place to ensure that you are taken to a center that can provide the level of care commensurate to the degree of your injury.”

Fifteen states – including Missouri, Oklahoma and Illinois – have only one verified trauma center. Kansas has five. Via Christi Regional Medical Center and Wesley Medical Center, both in Wichita, also are Level I trauma centers. Overland Park Regional Medical Center and Stormont-Vail Regional Health Center in Topeka are Level II trauma centers, meaning they provide the same patient care but don’t provide trauma research and education programs.

Improving care statewide

While the state has a trauma program, it wants to do better, especially for the rural areas in western Kansas, where residents are at a much higher risk of dying from a traumatic injury. About 60 percent of trauma deaths nationwide occur in rural areas even though they account for only 20 percent of the population.

Kansas expects to have new regulations for designating trauma centers in November. Rod Bremby, secretary of the Kansas Department of Health and Environment, is expected to sign the new regulations this week. They are similar to the American College of Surgeons’ standards. Level I and II centers will need to be verified by the American College of Surgeons, while a Level III can be verified by the American College of Surgeons or request a team from KDHE.

“This is a big step,” said Rosanne Rutkowski, director of the Kansas Trauma Program. “This puts us on par with a lot of the other states.”

The state hopes to have at least one trauma center in the Kansas Trauma Program’s six regions.

“Hopefully by the end of the year, there will be 10 facilities in Kansas that are verified as trauma centers,” she said.

LMH mulls Level III

Lawrence Memorial Hospital is in the beginning stages of determining whether it wants to pursue becoming a Level III trauma center and is awaiting the state to finalize its regulations. Such a center might not have all of the specialists but can perform emergency resuscitation, surgery and intensive care. They also have transfer agreements with higher-level trauma centers.

“We are really waiting for the state of Kansas to decide what they are going to do and when with regards to trauma care,” said Robinson, who also is the medical director of LMH’s emergency department.

Robinson said the hospital already provides the kind of care that a Level III center does. The designation, he said, mostly would require some new positions to handle lots of paperwork.

“They want somebody, honestly, to collect data,” he said. “What it boils down to is you have to have a designated person, usually a nurse, who collects data on all of the cases that you take care of.”

The designation also would require a chunk of change. The American College of Surgeon’s initial consultation can cost between $9,000 and $15,000. KDHE said its costs would be comparable. Rutkowski said the Kansas Hospital Association is providing grants that cover most, if not all, of the consultation costs. But the grants don’t include the expenses related to meeting trauma center criteria, such as staffing.

“To become a trauma center is a huge commitment,” said Robinson, who before coming to LMH in 1994 helped develop trauma centers in California. “Not necessarily a financially rewarding commitment – in fact usually, it is quite the opposite.”

So why should Lawrence consider applying?

“It proves the quality of care because they are verified that they are providing the services that they say they are,” Rutkowski said. “They also have the potential for receiving higher (insurance) reimbursement for becoming a verified trauma center.”

Rutkowski also said that data show the quality of care improves at hospitals who go through the process.

And while LMH considers whether it wants to go through that process, Robinson reassures Douglas County residents that they are in good hands.

“In Douglas County : we have a system in place for emergency medical services that functions as if we are in a trauma system. And by that I mean, if a multisystem trauma patient shows up on the highway, paramedics have triage guidelines to directly triage them to a Level I Center.”