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Douglas County ER could become trauma center soon

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Lori Rosch knows how to keep cool under pressure.

She has to.

"My job is to remain calm," said Rosch, clinical director of Douglas County Hospital's emergency room. "Because everybody is going to stay calm if I'm calm."

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As the hospital's ER manager, she is charged with coordinating a team of nurses and doctors responsible for the lives of the hospital's most vulnerable patients.

An 11-year veteran who's seen her fair share of major trauma cases - car crashes, farm accidents, construction mishaps - Rosch said planning is critical in emergency medicine.

"You need to have the ability to change your direction quickly," she said. "You can go from sitting around with an empty ER to having three or four ambulances out [on calls] at one time.

"You never want to be unprepared."

In times of crisis, such as medical emergencies, preparation pays off in precious seconds that can prove the difference between life and death, Rosch said, which is why she supports the hospital's recent application to join a burgeoning statewide trauma system.

She said the network would help hospitals across Minnesota, including Douglas County's, significantly improve their ER care.

The fourth leading cause of death among Minnesotans, trauma kills an average of 2,400 people in the state each year, according to the Minnesota Department of Health (MDH).

"These are typically young patients [in their] teens, 20s, 30s and 40s," said Chris Ballard, MDH's statewide trauma system coordinator. "And they are patients whose outcomes we can affect."

Ballard said a comprehensive trauma network would improve efficiency in Minnesota ERs - saving more lives - by creating uniform guidelines to classify incoming trauma victims based on the severity of their injuries, and requiring individual hospitals to draft protocols ahead of time to follow for each class of patients.

Under the system, participating hospitals will be designated as trauma centers and separated into four different tiers based on their size and care resources.

Ballard said once the network is set up, any time a trauma patient is admitted at a Minnesota hospital, regardless of its designation, his or her condition will be diagnosed and, using the statewide guidelines, sent directly to the appropriate level trauma center.

"So you've identified ahead of time what the definitive care is for these different [injuries]," he said. "If it's a head injury, [then] definitive care might be hospital A, or if it's a femur fracture, definitive care might be hospital B."

By streamlining the process of getting trauma victims the care they need more quickly, the department estimates the system could boost survival rates 15 percent to 20 percent among seriously injured patients.

"Trauma's a time-sensitive disease," Ballard said. "There's this critical time period [following a life-threatening injury] that you need to get evaluated and there needs to be intervention."

This concept is known as the "golden hour," he said, which states that the longer the time between when a person suffers a traumatic injury and when he or she gets proper treatment, the less likely that person is to survive.

It reiterates how important it is to immediately send patients to the correct care facilities, Ballard said, and how a statewide system could make that possible.

Hospitals designated as level-one trauma centers, which are expected to be able to handle any trauma patient, have the most resources and are subject to the strictest state requirements (there are currently four, and all are located in the metro area).

Level-two centers need fewer resources and don't have to meet as many state regulations as level ones do, followed by level-three and level-four trauma hospitals.

"We anticipate the vast, vast majority of hospitals will come in at level-four [centers]," Ballard said. "Which is great, we just want to get everybody participating."

Douglas County Hospital has applied for a level-three designation. As a larger regional hospital, it has more resources than most rural Minnesota hospitals, including a 24-hour ER staff physician and on-call surgical services.

"We take very good care of our trauma patients, but what this will do is it will give us a formalized system," said Barb Friederichs, Douglas County Hospital's senior clinical director. "This will help us to improve some of our standards of care. We definitely have developed new protocols with this plan - trauma protocols that we didn't have in place [before]."

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