Experts have said demand for hospitals with advanced trauma care capability is growing in rapidly developing areas like Harris County because of the need for immediate response to traumatic injuries.
The American College of Surgeons recommends at least one Level I trauma facility—the highest level of state-certified trauma care—for every 1 million residents.
Residents of Spring and Klein who experience traumatic injuries currently require transport to Memorial Hermann The Woodlands Medical Center in Montgomery County or downtown Houston for high-level care. Although the population in Harris County exceeds 4 million, including about 280,000 residents in the Spring and Klein area, no hospitals in the county north of the Texas Medical Center have yet received the highest trauma center ratings—Levels I and II—designated by the ACS.
As of May 1, Houston Northwest Medical Center became the first Harris County hospital in the Spring and Klein area to begin seeking the Level II designation to fill that North Houston gap in service, CEO Tim Puthoff said.
“When you look at our community, [HNMC is] situated in the geographic center of North Houston, right on I-45, halfway between Beltway 8 and the Grand Parkway,” Puthoff said. “Our EMS partners have been wanting to advance our trauma capabilities so they don’t have to drive patients up to The Woodlands or down to the [Texas] Medical Center, so it made perfect sense for our community, and it made sense for our hospital.”
Darrell Pile, CEO of the state-contracted Southeast Texas Regional Advisory Council, which coordinates the provision of trauma services, said he predicts in the next two years the nine-county region covered by SETRAC will be served by eight or more Level II hospitals, which provide nearly the same services as Level I facilities, but require a faster rate of response and more surgical specialities than Level III facilities.
“The region has seen a tremendous growth,” Pile said. “Those factors have justified business decisions by multiple hospitals to seek Level II trauma designation.”
The number of regional trauma cases reported to local emergency responders has increased alongside Spring and Klein’s growing population. Cypress Creek Emergency Medical Services, which serves Spring and Klein, reported urgent trauma calls increased by 52 percent from 2013 to 2018, while population in the area has increased 12.5 percent in that time, CCEMS Public Information Officer Norm Uhl said.
However, CCEMS has seen a drop in the number of patients it has transported to Texas Medical Center since Level II trauma facilities began opening north of Houston, Uhl said.
“Since Cypress Fairbanks Medical Center began operating as a Level II [trauma center] in summer of 2017, we’ve seen an 18 percent drop in transports to hospitals in the Texas Medical Center,” Uhl said. “Now that Houston Northwest Medical Center is operating as a Level II, it will likely have a major impact, especially since it is right in the middle of the CCEMS coverage area.”
One difference between a Level II and a Level III facility is the availability of trauma surgeons, Puthoff said.
“The biggest change operationally is that we will have trauma surgeons 24/7,” Puthoff said. “Before, they were on call [and] they would have to drive in. We will [now] have immediate response from a surgical standpoint.”
Other changes include improving response times. For example, a Level III facility normally provides trauma surgeons within 30 minutes, but a Level II facility requires a response within a 15-minute window, HNMC Trauma Program Manager Leanne Beaudet said. Level II hospitals also must also have surgeons available in a variety of fields within that 15-minute window, she said.
Surgeons specializing in fields including orthopedics, neurosurgery, urology, obstetricians, cardiovascular surgery and hand surgery are available at a Level II facility, Beaudet said.
A study carried out by the ACS Trauma System Consultation program in 2009 provided a recommendation for the number and distribution of Level I and Level II trauma centers in the state.
The study concluded that, even assuming a ratio of one Level I trauma center per 1 million in population, the Greater Houston area came up short because the city’s actual population—2.2 million at the time—was much smaller than the population served by the center. In 2009, the Greater Houston area included about 5 million people, according to the study. Today, that number is much greater, Beaudet said.
“We have 6 to 8 million people … so we should have six to eight trauma centers,” she said.
Reaching Level II
The process of achieving a higher level trauma center designation begins with increasing response capabilities, said Dr. Shiree A. Berry, interim trauma medical director for HNMC.
Berry said the facility has hired an additional 12 surgeons this year, and it will need to make additional hires to fulfill the Level II requirements of having surgeons available 24/7.
The process of achieving certification takes about 18 months, Puthoff said.
ACS conducts a site survey after a year and makes recommendations for improvements before submitting its findings to the DSHS for final approval, said Dr. David Persse, EMS director for the Houston Fire Department.
During that year, the hospital functions at the higher level designation.
“Once the hospital says, ‘This is what we want to do,’ they apply to the state, the state gives you this conditional permit [stating that] you’re in pursuit of becoming a level II,” Persse said. “That means EMS can treat you like you are verified.”
Several other regional hospitals with locations in Spring and Klein are not currently trauma designated and have not announced an intention to do so, hospital officials said. There are no other Level III or Level IV facilities in Spring and Klein.
CHI St. Luke’s Health, which operates two hospitals in Spring and Klein—in The Vintage and Springwoods Village—does not intend to seek trauma designations immediately, said Jim Parisi, president of The Woodlands, Lakeside and Springwoods Village hospitals.
“We are always evaluating where we can better serve our patients and may pursue the opportunity at our Woodlands facility in the future,” Parisi said.
The purpose of increasing trauma care capabilities and reducing response times is ultimately to save more lives, health care professionals said.
“What happens when other trauma centers come on board is that we rely on our EMS partners to take the most appropriate patients to the most appropriate centers,” said Robin Garza, trauma program manager at Ben Taub Hospital, the downtown Houston hospital funded by Harris Health System through Harris County taxpayer dollars.
The addition of more Level II-IV trauma hospitals can help keep the Level I hospitals available to respond to the most severe trauma cases, she said.
“We rely on our EMS community to use a very developed triage schematic to take the patient to the right location,” Garza said.
Proximity can be key for survival rates in instances when external bleeding is the issue, Persse said.
“There are cases where the person’s chances of survival are directly proportional to how quickly we can get the bleeding to stop,” Persse said.
Uhl said some cases will still require transport to Texas Medical Center by ambulance. Burn and pediatric cases are examples of trauma that would require transport to the Level I facilities downtown, he said.
In Spring and Klein, response times to transfer patients to hospitals have improved by as much as 50 percent since hospitals north of Houston in Tomball, the Cypress-Fairbanks area and The Woodlands began operating as Level II facilities in the past three years, he said.
“As more Level IIs come online transport times continue to drop, and that’s great news for our patients,” Uhl said.