Good Day all. As a relatively newcomer to this forum, I don't know if any of you remember me. Either way, I am curious about your opinions regarding a situation in my neck of the woods. I live in Virginia Beach, Virginia where I will be starting Nursing school this fall. I have been a paramedic for 13 years in Baltimore, Anne Arundel County, MD, and Prince Georges County, MD. In Virginia, there is a company called Sentara Healthcare Group. They run the local hospitals. These include Norfolk General, a Level II trauma center, Sentara Virginia Beach, which is the hospital highlighted in this story, as well as Riverside, Bayside, Leigh, etc.....
Sentara Virginia Beach had been a Level II trauma Center for years. The Sentara Healthcare Group downgraded it to a Level III Trauma Center last week because there is a shortage of local phycians that are willing to continue putting in the time and expertise in the E.R. needed to maintain the requirements for a Level II Center. To maintain the status of Level II, the hospital is required to have a certain number of specialists available 24 hours a day. These specialists are claiming that their own practices and patients are suffering due to the "free" time they have to put in as on-call Trauma Staff.
Sentara Norfolk is going to remain a Level II Trauma Center, and the seriously injured and ill patients are going to have to be transported to Norfolk for care. They will be stabilized at The Center in Virginia Beach, then transferred.
Looking at this from an EMS point of view makes me question some things. In EMS, if an EMS worker is providing care to a patient, they are not permitted to turn the care of the patient over to anyone who is not trained to a level of carre equal to, or exceeding their own. It is considered abandonment, and is dealt with quite severely.
In this situation, I wonder where the abandonment issue comes into play. First of all, the ALS unit will be forced to go to another city to deliver the patient to the necessary level of care. That is going to extend the length of time the unit is unavailable for calls. Additionally, if the patient is brought to the Level III Trauma to be stabilized, it obviously means that they need intervention from a physician in order to be stabilized. When that patient is ready to be transported to the Level II Trauma Center 25-30 minutes away, the same EMS unit that brought them in, or whichever one happens to be available at the time, will now have to go into an unavailable status in order to transport. Since the patient is being stabilized by a physician, how can that same patients care be turned over to a paramedic or EMT for transport, without the physician going along for the ride? That seems to me to be a much more drastic case of abandonment than from a paramedic to an EMT: A Trauma Surgeon to a paramedic?
Personally, I think that for Virginia Beach to be the largest City in the state of Virginia, and to be such a tourist mecca, having a Level II Trauma Center is the least that should be done. Also, allow me to add, the entire EMS system in Virginia Beach is volunteer. All rescue squads, paramedics, Trauma Technicians, EMT's, are unpaid professionals. The largest "All Volunteer" EMS system in the country.
Does anyone have any thoughts on this issue? I am hoping that an E.R. nurse out there might be able to provide me with some more insight as to the way the Trauma Centers operate. Is this an issue that has been raised anywhere else? I would like to research it further.
Thanks for your indulgence.
Jul 4, '03
I too live in Hampton Roads! I just left Virginia Beach last year, and now live in Norfolk. Which nursing program are you in? I'm starting at TCC's nursing program this fall.
So, obviously I am not an ER nurse that can you any input into this issue from a provider's point of view.
Another point raised in the paper regarding VBGH downgrading their trauma level was that there are too few Level II traumas in VB to support the ER as a level II. (I think the number I read was under 100 a year).
I though Norfolk General was a level I? If not, then do we have one in this area?
Another kicker for the city of VB that I saw in yesterday's paper... Expectant mother's that are ineligible for Medicaid and do not have health insurance, will no longer be able to deliver in any of the hospitals in VB. They will all be sent to Norfolk to deliver. The OB's claim that they are losing too much $$$ by providing indigent care. The paper said that in the early 90's it was the same way and they used to put the mother in a cab and send her off to Norfolk. Then the city had a contract with a physicians group to provide indigent care. That expired and they had 25 physicans volunteer to provide care. Then that number dwindled to 1, and that MD finally said "no more". Once again caught the city by surprise, 2x in a week.
Remember folks...this is the largest city in Virginia! VB General was the only level II trauma in the city...now they are all level III.
Jul 4, '03
Greg, what station in Anne Arundel county did you work out of?