A Busy ED Earns Level II Trauma Status

After two years of planning and training, Pomona Valley Hospital Medical Center’s (PVHMC's) Level II Trauma Center opened its doors in March 2017. As a busy emergency department (ED) serving Eastern Los Angeles County, the new designation allows the hospital to receive patients who have been critically injured from gunshot wounds, car accidents, industrial accidents, and other incidents.
As an Assistant Medical Director and Director of Operations over the ED at PVHMC, I was asked to lead the planning for the trauma center. My background is in trauma care, and I truly enjoy the specialty, so I eagerly accepted the role. In today’s post, I will share PVHMC’s journey to earning trauma center designation.

Responding to the Needs of the Region

Each year, more than 1,200 patients in Eastern Los Angeles County require trauma care. Prior to the opening of PVHMC’s trauma program, the two closest trauma centers were both more than 25 miles away from PVHMC. So, both the county and our hospital administration recognized the need for additional trauma services in the area. Our center would deliver lifesaving care to patients in Eastern Los Angeles County much more quickly and allow them to recover closer to home.
Preparing to become a trauma center is no small undertaking. Fortunately, our ED has a history of innovation, adding new services over the years to improve care to our patients.
For example, to deal with rising volumes, our staff had previously implemented a capacity alert system in the ED that improved turnaround times and patient and staff satisfaction. In response to the growing and specialized need for cardiac, stroke, and sepsis emergency treatment, alert systems and protocols have
been developed to better serve our community and expedite lifesaving measures. Planning and launching a new program was familiar territory for our team.

Building a Trauma Program

To get started, we recruited representatives from all of the specialties and departments involved in trauma care, including orthopedic surgeons, neurosurgeons, anesthesiologists, physical therapists, social workers, and ED and trauma nurse managers to serve on the operations committee.
The team met at least monthly to ensure that our hospital would be ready to meet the rigorous trauma care criteria set forth by the American College of Surgeons. During those meetings, we covered every aspect of getting the program up and running, including establishing a call panel, planning training sessions, and developing trauma center policies and procedures.
Our hospital administration supported extensive training and education for our ED physicians, nurses, and ancillary staff. We wanted to ensure they were comfortable with common trauma procedures like intubating patients maintained in C-spine precautions and auto-transfusing blood from chest tubes. Through trauma simulations, we prepared the team for the higher acuity cases they would see once we opened our doors as a designated trauma center.
We established round-the-clock surgical staffing for the trauma center as required by the American College of Surgeons in order to respond to any critical situation. PVHMC also made significant infrastructure improvements to prepare for trauma designation. We added 22 beds to the ED, built a parking structure with a helipad, created a dedicated trauma entrance to the ED, upgraded our equipment with state-of- the-art technologies, and added 12 beds to our intensive care unit.
Drawing upon Vituity’s resources and experience was instrumental as we developed our trauma program. It was helpful to network with Vituity sites that had opened trauma centers and to hear about their experiences in getting a program up and running. In addition, Vituity’s online Continuing Medical Education (CME) program made it easy to meet the 16 hours of trauma CME required annually for each ED physician.
Several Vituity leaders also were key players in preparing for trauma center designation, including Ken Nakamoto, MD, Vice President of Medical Affairs for PVHMC, and James Kim, MD, ED Medical Director at PVHMC.
We also worked closely with our county EMS services during the planning process. We wanted to be sure our center was at the forefront when EMS personnel were considering their trauma center options for patients. It was also critical that they understood the new trauma criteria and saw that we had the capability to care for these higher-acuity patients.
We provided one-on-one education to EMS personnel, visited fire stations in our catchment area, and went on ambulance ride- alongs to share information about our new program.

A Soft Launch

After many months planning, we were ready to begin operations as a trauma center. A month before the official March 1 designation date, we began activating trauma protocols for cases that met trauma criteria. That transition period helped us work out the kinks before the program went live.
For the first month, the county gave us a smaller catchment area to ensure we had some time to get comfortable running through trauma care before expanding to the our full catchment area on April 1.

As our trauma programs grows and receives more patients, we know we will have some physically and emotionally difficult cases coming through our doors like mass casualty incidents and pediatric traumas. That is the nature of this specialty. We have prepared the staff for these eventualities and have already debriefed certain cases to help them process the emotions that go along with difficult traumas.
Earning trauma designation was a tremendous effort by our team that required extraordinary leadership, engagement, and collaboration. I couldn’t be more proud of the support of hospital administration and Vituity and the hard work of our physicians, nurses, and staff to bring this higher level of care to our community.

Achieving a trauma-center designation is a huge undertaking for any hospital. For suggestions on engaging physicians in your hospital's next big initiative, download this white paper.