With more trauma patients coming to Concord Hospital from rural areas, the trauma center gets an upgrade

  • A recent training session for trauma treatment is shown being held in the Forrest D. McKerley Simulation and Education Center at Concord Hospital. Training and staff education are part of getting certified as a Level II trauma center. CourtesyDave White

  • A recent training session for trauma treatment is shown being held in the Forrest D. McKerley Simulation and Education Center at Concord Hospital. Training and staff education are part of getting certified as a Level II trauma center. CourtesyDave White

  • A medical helicopter is shown at Concord Hospital.  Courtesy—Concord Hospital

Monitor staff
Published: 6/23/2019 7:55:35 PM

The recent designation of Concord Hospital as a Level II trauma center, one of only three in the state, is good news for people who need treatment for serious injuries, and it’s proving to be good news for other patients, as well.

“One of the changes is a massive transfusion protocol – our blood bank has been beefed up, if you will, and is able to respond to massive bleeding cases very quickly,” said Dr. Richard Murphy, medical director of the hospital’s Trauma Program. “When we first started it, an anesthesiologist came up and said ‘That protocol worked well last night and we saved a life.’ I was surprised because I hadn’t heard of any trauma. It turned out to be a patient who was bleeding out after childbirth, and as a result of having a massive transfusion protocol, the blood bank was able to respond in time.”

“That benefits the entire hospital, not just trauma,” said Pam Paris, director of the Trauma Program.

Earlier this month Concord Hospital got official notice that the Level II designation had been verified by the American Council of Surgeons, following an April review and years of preparation.

A trauma center is not a physical part of a hospital like an emergency room, but a designation that reflects what medical services are available at the hospital for critically injured patients. A major part of upgrading to Level II designation is being able to provide services such as anesthesiology at any time of the day or night, which in Concord Hospital’s case required hiring “dozens” more staff.

“It lets (emergency) providers know the capabilities and resources that we have and can take care of,” said Kathryn Hartford, Trauma Program manager. “The big hurdle was preparing staff to operate the O.R. 24/7, as well as anesthesia providers and MRI.”

“This was a major commitment from the hospital,” said Murphy.

Concord Hospital joins Elliott Hospital in Manchester and Portsmouth Regional Hospital with the designation. Dartmouth-Hitchcock Medical Center in Lebanon is the state’s only Level I trauma center, and the only Level II center for pediatric trauma.

One of the big reasons Concord Hospital decided to upgrade was the changing face of hospital services in rural areas. Many smaller hospitals can no longer afford to maintain trauma centers, which means that more people are coming to Concord after being critically injured elsewhere, particularly from the North Country.

The difference is reflected in the number of trauma patients transferred to Concord Hospital from other facilities as compared to the number that Concord transfers elsewhere.

“Last year we transferred in about 100 patients and transferred out about 50. … About seven years ago, we transferred in about 20 and transferred out about 100,” said Hartford.

Most of the trauma patients transferred out of Concord Hospital last year were either burn patients who needed a specialty burn center or were children who needed a pediatric Intensive Care Unit, she said.

“One of the very big changes we made to put us on the road (to Level II) was having 24/7 neurosurgical coverage,” said Murphy. Level III trauma center, the hospital’s designation, only requires neurosurgeons to be available half the time. “There were a lot of patients with head injuries we would stabilize and send out. Not anymore.”

“There really is nothing between Concord and the Canadian border in terms of trauma centers. Most of the hospital are small, critical-access facilities. … Surgical capabilities are really stressed right now,” said Murphy. “It’s not that there are more injured patients, it’s that the ability to care for them elsewhere has declined.”

Concord Hospital’s Trauma Program treats approximately 3,000 patients a year who live in the 28 communities in the Hospital’s primary service area or are transferred from other hospitals throughout central and northern New Hampshire.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)



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