AUGUSTA — The Maine EMS Trauma Advisory Committee voted to halt transfers of neurological trauma patients from area hospitals to Central Maine Medical Center, but decided little else during the two-hour emergency meeting Tuesday.
On Monday, officials from Central Maine Medical Center announced the hospital is ending its neurosurgical trauma program, one of just three in the state. The hospital will continue to stabilize neurosurgical trauma patients in the emergency department, however patients who require further care will need to be transferred to either Maine Medical Center in Portland or Eastern Maine Medical Center in Bangor.
Committee members largely expressed a desire to obtain pertinent patient data from CMMC before making any further decisions.
“Making a decision today we may undo a week from now doesn’t make any sense to me,” committee member Thomas Judge, the executive director for LifeFlight of Maine, said. “I think we’ve got to make decisions with data. I don’t think there’s an emergency to suddenly change how things work.”
Not all committee members were in agreement. Just under half of the 17 members voted against a motion that called for the committee to reconvene in two weeks to give CMMC and a subcommittee more time to prepare the data. Committee member and Maine EMS Medical Director Dr. Matthew Sholl urged the committee to take immediate action to address the urgent change in trauma services.
“We have a very binary plan right now that rests on both regional trauma centers and on trauma system hospitals,” he said. “What feels imperative right now for us to acknowledge is that we don’t have three regional trauma hospitals, and it feels like we need to make some changes today and then . . . certainly affirm the importance of reviewing data (later).”
The committee will additionally direct the Medical Direction and Practice Board to issue guidance to EMS providers. Currently, an emergency bulletin from Maine EMS tells providers to take patients to Maine Med or EMMC if transport time is 45 minutes or less. If the transport time would exceed 45 minutes, EMS providers should head to the nearest hospital for stabilization.
“We are still certified by the American College of Surgeons as a level two trauma center. We do have a gap,” said Central Maine Medical Group President Dr. Jason Krupp. “We’re going to have to put forward an interim plan, this group will have to, to help our EMS providers to get people to the right place, recognizing that Central Maine Medical Center hasn’t abdicated all of its trauma capabilities.”
Neurosurgical trauma care encompasses traumatic brain injuries, spinal cord injuries, skull and spinal fractures, brain bleeds and other conditions. CMMC has not clarified whether they will be ending all neurosurgical services at the hospital.
During the meeting Tuesday, Krupp said the move to end the hospital’s neurosurgical trauma program was largely due to the hospital’s inability to hire neurosurgeons. One recently retired, and a second position has been vacant for several years. While he declined to definitively say whether CMMC’s neurosurgical trauma patient care will reopen in the future, he explained that the hospital’s recruitment difficulties make it unlikely at this time.
Krupp confirmed CMMC has the data the committee requested available, but needed more time to process it.
“I can say in general the number of neurosurgical cases from a trauma standpoint that come to Central Maine Medical Center make up 10% or less of our calls here, but in terms of the full scope, I think that’s something that we’re finalizing, that sort of information, and will share it in the short term, but we’re not ready today,” he said.
He requested a smaller, private meeting to discuss the data, however State EMS Director Dr. Sam Hurley said all business meetings related to the Trauma Advisory Committee must be public under Maine’s open meetings law. A subcommittee meeting focused on reviewing the data will take place within the next two weeks and before the full committee meets again.
In a conversation following the meeting, committee Chairman Dr. Rick Petrie explained that it’s difficult to make decisions on diverting patients to different hospitals because every hospital in Maine is at capacity and short staffed. Additionally, there is a critical shortage of emergency medical technicians in the state, leaving patients to wait hours, sometimes even days, for interfacility transfers.
He said the committee is discussing transitional measures, however it will be necessary to discuss a long-term plan in the future. The Maine EMS trauma system operations manual, which guides decisions related to trauma care systems in Maine, was written over two decades ago and does not take into account the severe strain health care providers face during the COVID-19 pandemic, he added.
Send questions/comments to the editors.
