Don’t endanger Alaska’s progress in trauma care

Alaska is a beautiful state, but it can be very dangerous. Often we read or hear of lives ended or changed forever by traumatic injury. Trauma is the leading cause of death for all Americans under age 44, and Alaska’s injury death rate is 50 percent higher than the U.S. average. Currently, we have the seventh highest trauma death rate in the nation and in Alaska, injury deaths cause more years of potential life lost than heart disease and cancer combined.

Trauma systems have been developed nationwide to address the under-recognized public health crisis of serious injuries. Based on scientific evidence and long-term military experience, trauma systems include designated trauma centers with a regional pre-planned emergency medical services response. All aspects of care, from trained bystanders to transport and specialty services, are coordinated to achieve the best outcomes. Trauma systems have been shown to reduce deaths from serious injuries by as much as 20 percent.

As recently as the 1980s, Alaska’s death rate from injury was more than twice the U.S. rate. Our improvement has come from successes in injury prevention and the development of EMS and trauma care systems. These improvements though coordinated by state government involved local communities, hospitals and medical providers and utilized federal, state and foundation funding. A tremendous amount of volunteer work has been essential, as most ambulance services in rural areas are staffed by local volunteers. Volunteers also contribute countless hours to regional and statewide committees that oversee our EMS and trauma care systems. The state plays a vital role in bringing these different entities together for a common good.

Alaska did not have an effective trauma system until recently, and ranked among the worst states for access to quality trauma care. In 2008, a review by the American College of Surgeons Committee on Trauma offered several recommendations. Many were implemented through the bipartisan leadership of legislators such as Sen. John Coghill, the late Sen. Bettye Davis and former Rep. Beth Kerttula. In 2010, after unanimous legislative approval, Gov. Sean Parnell signed the Trauma Fund Act, which provided a small amount of funding ($4.25 million over 9 years) to help hospitals meet national trauma care standards. The Alaska Department of Health and Social Services hired a trauma program manager and a state trauma registrar. With assistance from many volunteers, this small program increased facility participation in our system from 20 percent to 75 percent of all the hospitals in the state.

Alaska now has two Level II Trauma Centers (definitive care facilities) – Providence Alaska and Alaska Native Medical Center in Anchorage, which are also designated as pediatric trauma centers. Fifteen other smaller hospitals across the state participate as Level IV Trauma Facilities (stabilization facilities). They all meet state and national standards.

A 10-year follow-up review in 2018 praised Alaska as now having one of the most inclusive trauma systems in the nation. The system saves lives every day and has resulted in cost savings through more efficient movement of patients to definitive care. In Alaska, deaths from transportation-related trauma, including motor vehicle crashes, ATVs, snowmachines and pedestrian injuries, decreased 25 percent between 2007 and 2014. Air medical transports in Alaska typically cost tens of thousands of dollars. An analysis of injured patients’ transports during this period showed improved efficiency, with those requiring a second transfer from one hospital decreasing by 30 percent. Ongoing analysis of Trauma Registry data continues to improve the quality of care and assists system leaders in making the system more efficient.

State program leaders have driven this progress with minimal funding. Now, in an era of austerity, we face choices about the role of state government. The trauma care system potentially affects all Alaskans, no matter where they live or who they vote for. Access to quality trauma care makes life here a little less fragile and ensures that the best care possible is available when needed. When legislators review a multibillion-dollar budget, a small item like the Trauma Program in DHSS may seem insignificant. In fact, relatively small state programs have big impacts on the lives we live here in Alaska. Now, at a time of budget cuts and position freezes, we strongly urge our fellow citizens and state leaders to appreciate how effective our EMS and trauma care system is in helping make Alaska a safer place to live.

Frank Sacco, MD, FACS is chairman of the Alaska Trauma System Review Committee and former Trauma Director at the Alaska Native Medical Center.

Mark S. Johnson, MPA served as Chief of EMS and later Chief of Community Health and EMS in the Department of Health and Social Services for more than 25 years, and he is a member of the Alaska Trauma System Review Committee.

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