Most Mainers, thankfully, live their lives without ever having to put to the test the capabilities of seat belts and traffic guardrails, or the state’s trauma system, for that matter. I never have, either. But as a practicing emergency physician, I have the privilege of delivering care within the trauma care system and witnessing its extraordinary capabilities on a daily basis.
Built with inclusivity and our state’s rural character as top-of-mind priorities, Maine’s comprehensive trauma system aims to get patients the right care at the right time in a geographical area more than triple the size of Massachusetts. Of crucial importance to patient outcomes are the pillars of a three-hospital system with coordinated air and ground ambulance coverage.
I am deeply concerned that Maine citizens may lose one-third of this system based on discussions at recent meetings of the Trauma Advisory Committee to Maine Emergency Medical Services. Some proposals discussed would prevent Central Maine Medical Center from offering the highest level of trauma care within its capabilities, resulting in unnecessary additional travel to other facilities for patients.
Fortunately, a different recommendation emerged from the most recent advisory committee meeting and goes before the Maine EMS Board this week. CMMC and other hospitals in Maine support this proposal because it would preserve patient access to CMMC’s advanced and highly specialized trauma services and update the state trauma system plan to reflect changes in the health care landscape that have taken place since 1996.
This debate was prompted by the recent board-level decision to eliminate neurosurgical services at CMMC. It became clear over multiple years that there simply is not enough neurosurgical volume in this region to support such a costly program. In terms of trauma care, only 13 percent of CMMC’s yearly cases brought to us from accident scenes require a neurosurgical consultation – typically a review of imaging such as an MRI – and very few patients require neurosurgical operations.
What will CMMC look like without neurosurgery? Actually, a lot like it did with that specialty. It will continue to have capabilities far beyond most hospitals in Maine: in-house, 24/7 board-certified emergency physicians, trauma surgeons, anesthesiologists, intensivists, pediatric and adult hospitalists. We have immediate access to orthopedists, oncologists, neurologists, infectious-disease specialists, specialty surgeons and interventional cardiologists.
The Maine EMS Board, utilizing definitions from a 25-year-old state plan, could reach a decision this week that would have drastic implications for access to specialty trauma care for a large swath of Maine. Trauma patients – including those who clearly are not in need of neurosurgical consultation, much less surgery – would be prevented from transferring to CMMC, even if it is closer than the other two trauma centers, both of which are also experiencing staffing and bed shortages.
It’s not just patients in the communities immediately surrounding CMMC, or even those who live or are injured in our system’s primary areas of central, western and midcoast Maine, who would be affected. CMMC has one of only three trauma programs in Maine verified by the American College of Surgeons, which sets the gold standard for trauma care.
The ripple effects would be felt across the state when hospitals are already struggling with capacity constraints stemming from the current COVID-19 surge and health care workforce shortages. We need to let the doctors and EMS providers who respond to and care for victims of traumatic injury use their best clinical judgment about where a patient should go.
Maine’s trauma system was created with a spirit of collaboration to avoid the missteps its builders saw elsewhere around the country. By recognizing the significant trauma capabilities of one of its key stakeholder hospitals, it can continue this tradition and best serve the people of Maine.
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