TRAUMA CENTER
Doctor Carsten Zieger, Director of the Arroyo Grande Community Hospital Emergency Room, left, waits for RN Frances Wheeler and Doctor Kristopher Lyon on Friday at the ER in Arroyo Grande. //Phil Klein Phil Klein

When it comes to developing a trauma plan for San Luis Obispo County, it isn’t a matter of one side versus another, as far as the San Luis Obispo County Emergency Services Management Agency is concerned.

“We’re not taking sides in this,” explained Charlotte Alexander, executive director of the EMSA, a nonprofit agency under contract to the San Luis Obispo County Health Agency. “This isn’t an ‘us versus them’ issue.”

But when it comes to the hospitals’ viewpoints, that could be the case.

Ron Yukelson, assistant administrator and director of business development for Sierra Vista Regional Medical Center, said objections being raised by Arroyo Grande Community Hospital officials are just an attempt to keep the San Luis Obispo hospital from becoming the county’s Level 2 regional trauma center.

“French (Hospital Medical Center) and Arroyo Grande (Community) completely obfuscate the issues not because they want to be trauma centers but because they don’t want Sierra Vista to be a trauma center,” Yukelson said.

In a separate e-mail, he said “it’s time we put the best interests of the health of our community ahead of business interests.”

Rick Castro, Arroyo Grande Community president and chief executive officer, and Dr. Carsten Zieger, director of the emergency room, recently asked the Arroyo Grande City Council to back their opposition to creating a regional trauma center in San Luis Obispo (see “Traumatic Shift in Care,” Dec. 7 Santa Maria Times).

They said that’s the direction being taken by a state-mandated trauma plan being developed by a committee of the San Luis Obispo County Emergency Services Management Agency.

Castro and Zieger believe creating a regional trauma center in San Luis Obispo will harm surgical care at Arroyo Grande Community because it will require a full range of specialty surgeons to be on duty 24 hours a day, with a backup team also on call.

They claim the plan is based on two consultants’ “boilerplate” report that used outdated statistics and methodology.

Yukelson also indirectly questioned some of the data in that report, which indicated Arroyo Grande Community and Twin Cities Community Hospital in Templeton each receive more than twice as many trauma patients as French and Sierra Vista combined.

Yukelson provided data from the Office of Statewide Health Planning and Development that show Sierra Vista had 56.7 percent of the “market share” of trauma patients among 26 major hospitals.

However, the data supplied by Yukelson shows the total number of inpatients, not the number of patients initially transported to any particular hospital as indicated by the consultants’ report.

“There are lots of (emergency rooms) that treat trauma patients,” Yukelson said. “But we’re not talking about stabilization and resuscitation. We’re talking about trauma ‘care.’”

He also disputed Arroyo Grande Community’s contention that having a full range of surgical specialists on duty at a trauma center, with a backup team available, would reduce other hospitals’ access to surgeons.

“That’s patently untrue,” he said. “If you talk to the surgeons, you’ll find that’s a specious argument. All the physicians are on call to all the ERs. At no time can they point to when they didn’t have a doctor available because there was one (at Sierra Vista).”

Alexander said the EMSA has not verified Arroyo Grande’s contention because it doesn’t have the necessary data.

Yukelson emphasized that Sierra Vista’s main concern is for the EMSA to get a trauma plan approved so it can be implemented as soon as possible.

But he also said Sierra Vista wants to become the county’s designated Level 2 trauma center, claiming it has been serving as the county’s unofficial trauma center for 35 years.

“We’ve invested in the infrastructure to function as a trauma center,” he said.

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Alexander said the goal of the EMSA and its Trauma System Committee is to develop a plan that will provide the best care for trauma patients.

And while not all committee members agree with various aspects of the working plan, Alexander said everyone, from hospitals to first responders, has been part of the process since “day one.”

“The report was delivered to all the stakeholders in May 2008, and we’ve been working on this publicly since then,” she added. “This isn’t new. The fact that all the hospitals are talking about it is because we appear to be nearing some kind of completion on it.”

And while the committee is leaning toward a regional Level 2 trauma center, she said it could be months before the committee recommends a plan to the EMSA board.

“This will fundamentally change the way the county (trauma) system operates,” she said. “We don’t want to take that lightly. We don’t want to rush this along.”

Once the EMSA board accepts the plan, it must go to the County Health Agency, the County Board of Supervisors and, finally, the state Emergency Medical Services Authority. Only after state approval can the plan be implemented.

Alexander said consultant Diane Akers, a registered nurse with a master’s degree in business administration, spent two and a half days going through data on the county’s trauma patients.

“She was looking at, ‘Are there enough trauma patients to support a trauma center?’” Alexander explained, as well as where trauma patients originate.

“What she found was they’re pretty evenly distributed — one-third in the North County, one-third in the center and one-third in the South County.

“Given that they’re evenly spaced, it makes sense to have a centrally located trauma center,” she said.

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