LRMC receives Level II Trauma Center verification from American College of Surgeons
August 9, 2007
LANDSTUHL REGIONAL MEDICAL CENTER, Germany - The American College of Surgeons has verified Landstuhl Regional Medical Center as a Level II Trauma Center, making it the only medical facility outside the United States to hold that distinction and only one of three Level II trauma centers in the Department of Defense.
The July 16 verification, consisting of compliance with 230 criterion focused on immediate and comprehensive care following trauma incidents geared specifically to support servicemembers injured in Iraq and Afghanistan, is both an honor and a statement to the hospital staff and its patients, said Col. (Dr.) Stephen Flaherty, chief of surgery and the Trauma Center director.
"To have an external agency such as the American College of Surgeons say, 'Yes, you are doing exactly the right things that helps save lives,' that is a huge morale booster for the entire staff," said Doctor Stephen Flaherty. Equally important, he noted, is the message it sends to families that LRMC is providing the best care possible to their loved ones.
That aim for quality service was the main reason driving the effort to achieve Level II verification in support of the wounded servicemembers who arrive at LRMC daily from downrange, said Kathleen Martin, the Trauma Program Nurse Director for LRMC. Level II is linked to improved performance and enhanced patient outcomes, she said.
"Hospitals that have committed the resources to achieve Level II verification have shown a statistically significant decrease in morbidity and mortality," said Ms. Martin.
In some cases, Level II can mean significant improvement, said Dr. A. Brent Eastman, one of 18 members of the Board of Regents for the American College of Surgeons who was also recently at LRMC as part of its Visiting Surgeons Program and at the request of Brig. Gen. David Rubenstein, the Europe Regional Medical Center Commander. He noted a decline in mortality from about 20 percent to approximately 2 percent in only one year at a hospital in San Diego after it achieved Level II verification.
The origin of LRMC reaching Level II status occurred in 2004 through the efforts of Col. (Dr.) Warren Dorlac and Col. (Dr.) Ty Putnam, two Air Force trauma surgeons who were stationed at LRMC. Their vision to implement a trauma and critical care service and the development of a trauma performance improvement program spearheaded efforts to achieve Level II.
But it has been a long and extensive journey that has required a tremendous commitment from the entire LRMC staff, said Ms. Martin. Unlike a civilian stateside trauma center that may focus on the needs of a particular region, LRMC is part of a trauma network that stretches from Iraq and Afghanistan to stateside hospitals such as Walter Reed Army Medical Center in Washington; Brook Army Medical Center in San Antonio, Texas; and the National Naval Medical Center in Bethesda, Md.
Treatment often begins within minutes of a Soldier injured in combat. He or she may be treated first by a medic and shortly afterward at a forward surgical unit. A day later, many make the six-hour flight to Germany where they receive the next level of care and are stabilized at LRMC before flying stateside.
"It's 55 moving parts at one time," is how Ms. Martin described the coordination of care along the continuum, which includes communication consisting of video teleconferencing among medical staff downrange, LRMC and stateside; CAT scans pushed forward from combat support hospitals downrange; and in-flight communication concerning patient updates from aeromedical doctors and nurses to the staff at LRMC.
Specifically, the trauma center verification includes requirements such as having board certified surgeons, anesthesia services available 24/7, operating rooms meeting prescribed standards for equipment and staffing, and a continuing education program. For LRMC it has meant the addition of providing critical care services and dialysis treatment.
Under the category of education, Dr. Eastman said it is vital that LRMC physicians make time to document their work here because "virtually all that we've learned about trauma has come from war," and that LRMC has adapted what he described as a "revolutionary approach to trauma systems."
Among the advances he noted are screening all servicemembers injured downrange for brain injury, prevention of extremity compartment syndrome, more aggressive uses of tourniquets and the development and implementation of Critical Care Air Transport Teams that deliver patients from downrange and hand off to the intensive care unit at LRMC.
Implementing similar CCATT teams in civilian practice, especially in future disasters and in remote areas such as Alaska and Wyoming, "is going to saves lives in the U.S. and many many other countries," said Dr. Eastman. "It's all about getting the right patient to the right place at the right time, and LRMC does it as good as anyone."
LRMC was inspected June 13-14 by four leaders in trauma care from the American College of Surgeons who found zero deficiencies, said Ms. Martin. LRMC was commended for its demonstrated commitment to provide superior trauma care. The verification will remain valid for three years.