Studies prompt efforts to expand trauma care
Several reports point to a potential state crisis in emergency response
A special fund would be established to help support and expand Hawaii's trauma system, under a bill moving through the Legislature in response to reports of a crisis in the system.
Serious trauma care problems were described in recent studies by the American College of Surgeons, Legislative Reference Bureau and American College of Emergency Physicians.
The Department of Health is forming a committee to develop a statewide trauma system plan by the next session to address recommendations in the reports.
Meanwhile, Senate Health Chairman Rosalyn Baker (D, Honokohau-Makena) said the funding bill is designed to make resources available to ensure trauma services are continued and expanded, as recommended in the studies.
It proposes a dedicated revenue source for a comprehensive state trauma system and services and to subsidize on-call doctors for trauma care.
Various appropriation bills also passed the House to support emergency medical services, especially in rural areas.
"I'm hoping something comes out," said House Health Chairman Dennis Arakaki (D, Alewa Heights-Kalihi).
"From what we hear, it is reaching the critical stage where the whole thing, the system, could implode," he said.
It is especially important to maintain the trauma center designation at the Queen's Medical Center because it is the only one in the Pacific, he said.
A Senate bill pending in the House initially appropriated $3 million for the trauma system special fund and provided that $5 from every annual vehicle registration fee would go into the fund. But the figures were left blank for further discussion when the bill passed to the House.
Baker said the goal is to advance Queen's to a Level I trauma center and create lower-level trauma centers on Maui and the Big Island. Queen's functions as a Level I trauma center, but it is Level II because it has no research component.
She said it takes two to five years to get a trauma center approved and accredited, but because of Hawaii's unique geographic situation, it might be possible to "tweak the definitions of what's a trauma center."
The 108-page College of Surgeons Committee on Trauma report points out that 50.7 percent of deaths in Hawaii for ages 1 to 44 are from injuries, primarily from motor vehicle crashes.
The rates of unintentional injury on the neighbor islands were more than double those for Honolulu, suggesting "an association between delayed access to organized, definitive trauma care and risk of death in areas outside Oahu," the College of Surgeons' report said.
"A concerted public health effort is needed to develop a trauma system serving needs of all residents and visitors in the state."
The Senate Ways and Means Committee report stressed the importance of a strong trauma system not only to deal with traumatic injury "as a public health problem," but to respond to disasters and emergencies.
Risk of lawsuits and high malpractice premiums are among reasons cited in the studies for a shortage of on-call specialists.
The Hawaii Medical Association, hospitals, state insurance commissioner and others strongly advocated medical malpractice reform this session, but the measures did not clear key committees.