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Why Does Santa Cruz County Not Have its Own Trauma Center?

Kent Benedict, head of EMS services in Santa Cruz, explains why major trauma cases are flown over the hill to three medical centers in Santa Clara County.

When Alfonzo Ruben Lopez Espinoza was , medics immediately decided to fly the 23-year-old parolee to a San Jose-area trauma center.

Santa Cruz County has about 3,000 trauma cases per year, and of those, about 10 to 11 percent are flown on helicopters to three emergency medical centers in Santa Clara County, according to Emergency Medical Services (EMS) director Dr. Kent Benedict.

“All of these have a tremendous amount of experience in dealing with big time trauma,” he said, referring to Santa Clara Valley Medical Center, Stanford University Trauma Center, and Regional Medical Center of San Jose.

But why are these trauma cases flown out on costly helicopters? And why does Santa Cruz County not have its own trauma center?

Time it takes to go over the hill

The winding Highway 17 is notorious for traffic jams, construction work and general delays. That’s why Santa Cruz paramedics don’t want to risk taking someone with a life-threatening emergency by ambulance to one of the Santa Clara County medical centers, said Dr. Benedict.

Santa Cruz emergency medical staffers rely on a “trauma triage system,” in which “they evaluate patients and develop a trauma score,” said Dr. Benedict.

A score of three is given to injuries at high risk; a two is for major traumas that are not as bad; and one for minor injuries. See the chart in the photos above for a visual of the triage system.

Straying on the side of caution, scores of two and three are airlifted out on helicopters, mostly through CALSTAR. These lifts often racking up bills for the patients of upwards of $10,000, depending on their insurance situation, said Benedict.

There are times when a patient is flown to a trauma center, and be found to be suffering from injuries that can be treated at a local hospital, said Dr. Benedict. For example, Lopez-Espinoza, the car crash victim flown out early Monday, actually was uninjured.

Yet 65 to 75 percent of the time, the injury sustained really was life threatening.

“The medics only have 15 minutes to evaluate the patient,” said Dr. Benedict, pointing out that they have to use their best judgment, and cannot afford to take risks.

Lack of medical personnel

In order to have a medical trauma center that’s running 24/7, a lot of staffers are needed. And there simply is not enough medical staff in Santa Cruz County who are also comfortable performing emergency surgical operations.

“We don’t have the capacity to have a 24-hour, full-staffed trauma center,” said Dr. Benedict.

Instead, Dr. Benedict is in talks with Santa Cruz County about upgrading one or two of Santa Cruz’ existing hospitals to a “super community hospital.” 

“These are community hospitals that have been able to upgrade their care,” said Dr. Benedict. That means it would have more staffers, a larger blood bank, and a radiology department.

Yet Dr. Benedict projects that most major traumas would still need to be flown over the hill.

“Maybe there would be a reduction from 10 to 11 percent, to nine percent,” he said. But before Santa Cruz county hospitals can make the upgrade, they must first get the staffing commitment of the doctors and a financial commitment.

What are your thoughts on the lack of a trauma center? Does it scare you that victims have to be flown over the hill? Tell us in the comments!

Jacob Bourne (Editor) October 24, 2011 at 07:07 PM
What about the patients who die en route over the hill that could have been saved close by, at a local trauma center?
Brad Kava (Editor) October 24, 2011 at 07:27 PM
Really, I can't believe that with 300 cases a year and a $10K cost per flight, that we can't staff a trauma center here and that Santa Clara can. It's plain backwards.
Cathy P. October 24, 2011 at 07:36 PM
"These lifts often racking up bills for the patients of upwards of $10,000, depending on their insurance situation, said Benedict." ------------------------------------------------------------------ If I knew for certain that Mr. Lopez-Espinoza would actually be footing this bill, instead of us the taxpayers, I could feel a little better about it, but I agree with Brad above: not having a trauma center in Santa Cruz County is "plain backwards!"
Rachel Stern October 24, 2011 at 07:49 PM
Thanks for your comments. Brad, the $10k cost for flight is a worst-case scenario, rather than a blanket figure (he didn't have average costs of what insurance usually covers). Having a trauma center in SC would mean having operations 24/7 with staff who are comfortable and capable of dealing with trauma. The Santa Clara County centers deal with thousands of patients from across the Bay Area on a daily basis, so one has to do a cost-benefit analysis if it's worth it to have a trauma center in SC. And Jacob, that is a good question. I'm not sure how much longer it takes to fly someone over the hill via helicopter than to carry them by ambulance to a local hospital. I will look into this and get back to you.
Lori October 24, 2011 at 09:36 PM
My dad was flown from Santa Cruz to the San Jose hospital after a car accident. Bill: $30,000
Butch Cole October 24, 2011 at 10:04 PM
I suspect that the 'real' reason is the insurance status of the Patient. A good number of the so called tauma Patients have no insurance..goal is...get them out of here! I have no actual statistics but, based on stories from friends/acquaintances...there are a LOT of people flown out without signifigant injury most to the tune of $30,000. Suspect that the "trauma triage" protocal's need to be reviewed.
Jennifer October 24, 2011 at 10:26 PM
Butch - that's a pretty big assumption. Hundreds of patients are treated daily and locally without insurance. Often these patients are triaged in the field and the choice is made to fly them out then and there. If we err on the side of caution - great! Better safe that sorry. Checking for an insurance card is not part of the A through I of trauma assessment.
Jennifer October 24, 2011 at 10:31 PM
But yes I do think it would be great to have a trauma center on this side of the hill. Staffing, training and remodeling/upgrading facilities would cost a lot of money that we just don't have right now. Anyone feel like writing a grant??
Dave Martone October 25, 2011 at 01:25 AM
Santa Cruz County EMS has a good trauma plan. We just don't have enough trauma for a local team to keep up proficiency like they do in Santa Clara. As Dr. Benedict referred to we don't have the resources. How many neurosurgeons do we have vs. how many would we need. BTW, you can join CalStar for a nominal amount so in the event you need an air ambulance it is free.
Brad Kava (Editor) October 25, 2011 at 01:32 AM
Dave, I never knew about joining Calstar...we should do an article about that. Could be a bargain.
Butch Cole October 25, 2011 at 05:03 AM
I agree that this county is not in a position to treat major trauma Patients for all of the reasons sited but.....the "hundreds of patients treated daily..without insurance walk in and by law may not be turned away. I have a question about the trauma triage....are the Patient's accessed or the 'mechanism or injury' the deciding factor?
Jennifer October 25, 2011 at 06:44 AM
Patients are definitely assessed, regardless of the chief complaint all patients are assessed in the field and again in the ER. Trauma patients are assigned a trauma score and that largely influences the decision to fly them out or not. And my family does buy into the Calstar program, it's about $50 a year. Great deal.
Jennifer October 25, 2011 at 06:46 AM
http://www.calstar.org/membership/ Here's the link. $45 for a family annually.
Xanthippe October 29, 2011 at 06:13 AM
I wonder, how many lives were lost in ambulances on Highway 17 prior to flying people over the hill? Anyone have numbers on that? Who pays for this very expensive service when it comes to indigents? Somebody does; who?

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