HCA Houston Healthcare Tomball was awarded its Level III trauma center designation in late May, HCA officials announced May 30. The American College of Surgeons and the Texas Department of State Health Services designated the Tomball hospital as a Level III trauma center after operating with Level III capabilities since last spring and receiving a formal survey assessing the hospital’s trauma capabilities.
Previously, the closest trauma-designated facilities to Tomball were HCA Houston Healthcare Northwest, Memorial Hermann The Woodlands Medical Center and HCA Houston Healthcare Conroe, located at least 15 miles away.
The shorter trip means a better outcome for the patient, said Darrell Pile, the CEO of the Southeast Texas Regional Advisory Council, a state-contracted group focused on improving trauma care in its nine-county region.
“The Level III hospital—the Tomball hospital—should now be able to receive all trauma patients and stabilize them and only transfer out a few,” Pile said.
In Texas, trauma centers range from Level I—the highest designation—to Level IV, according to the DSHS. A Level III hospital can treat most traumatic injuries except for severe pelvic injuries or those requiring neurosurgery, said Dr. Ata Ahmad, trauma medical director for the Tomball hospital. If needed, patients can be stabilized in Tomball and then transferred to a Level I or Level II facility.
“The quicker we can get patients to receive care of [a] physician, the better the outcome, generally,” said Marco Kimassi, the special projects manager for Northwest Community Health, which contracts with Emergency Services District 8 to provide services in the Greater Tomball area. “What it means for the community is it increases their level of care that they have close by. They receive more efficient care, more specialized care, and it helps keep them at home.”
Gaining a designation
Eric Evans, the CEO of HCA Houston Healthcare Tomball, said although the hospital announced it was in pursuit of a Level III trauma center designation last spring, the desire to bring trauma care to Tomball stems back to the hospital’s previous owner, Community Health Systems, in 2015. HCA purchased the hospital in 2017, Community Impact Newspaper reported.
Trauma Program Manager Anna Marie Dickey was brought on about a year ago to oversee trauma services and data collection, Ahmad said. The hospital had to build up its trauma patient base and demonstrate it could have a surgeon on-site within 30 minutes, Ahmad said.
“I wanted our community to know that they have a facility capable of providing extensive and excellent care to their loved ones in the event tragedy strikes,” Dickey said in a statement.
Tomball saw its number of trauma patients double from 2017 to 2018, growing from 385 patients to nearly 700 patients, said Laura Littlejohn-Lupton, the director of North Quadrant Strategic Communications for HCA Houston Healthcare, in an email.
To gain the designation, Dickey said emergency room protocols changed, and the hospital purchased rapid warming fluid infusers, which allow trauma patients to receive high volumes of warmed blood or fluid quickly.
Level III facilities must show they have an emergency physician and trauma staff available in-house at all times with additional specialists—such as orthopedic surgeons, general surgeons, neurosurgeons and anesthesiologists—on-call and available within 30 minutes, Pile said.
Ahmad said the Tomball hospital can treat most traumatic injuries but with no neurosurgeon, complicated head injuries are transferred to a more comprehensive facility.
“You used to [have] to Life Flight everybody downtown. Now you’ve got this point instead,” he said. “It’s a life-saving mechanism because they don’t have to fly as far; they don’t have to go as far. [There is a] better response time and better ability to save people.
Specialty patients like pediatric patients may still need to be transferred to a Level I or II facility, Pile said.
“There’s no longer a situation where you have to regard your injury as life-threatening and [think], ‘I need to get to the Texas Medical Center,’” he said. “Tomball hospital should be your destination and allow them to decide.”
Filling a need
Evans said the majority of traumatic injuries in the Tomball area come from motor vehicle crashes or falls greater than 2 feet, including falling off a horse or being kicked by one.
Additionally, Pile said having a trauma center in the community is an asset for Tomball’s elderly population, who are more likely to fall.
Kimassi said Northwest previously had to drive trauma patients to the The Woodlands or Conroe.
“[This] decreases the stress on our emergency response system because instead of having the medic unit travel 30 [or] 45 minutes to an hour to drop a patient off, we can now drop [the patient] off in five minutes,” he said. “It allows us to go and service more quickly so we can be available to other emergencies in the district.”
SETRAC’s nine-county area includes 34 trauma-designated facilities, including four Level I centers—two of which specialize in pediatrics—five Level II centers and nine Level III centers, Pile said.
“If you think back [three or four] years ago, just about everyone with a serious traumatic injury were dependent upon being transported to the Texas Medical Center,” Pile said. “It became clear that as our population grew, the needs out in the suburbs grew. … It created a demand for hospitals regionwide to step up and be able to handle more complex cases.”
Providing lifesaving care
With the Tomball hospital stepping up, traumatically injured patients in Tomball and Magnolia can receive care quicker, said Samuel Kordik, the senior clinical supervisor for Cypress Creek EMS—which services the southern tip of the Greater Tomball area.
“The biggest determinant for severely injured patients in terms of their survival is the time to get them from the scene of injury to that definitive care,” he said.
According to Stop the Bleed, a national awareness campaign, a traumatically injured person can die from blood loss within 5 minutes.
“Seconds can matter when it comes to traumatic injuries,” Pile said.
To secure its trauma designation, the Tomball hospital had to grow its partnership with EMS agencies to activate trauma response at the scene of the injury and bring those patients to the hospital, Evans said.
“With time being of the essence with a traumatic injury, it’s vital that they have that close relationship with EMS so they are prepared to act as soon as the patient arrives,” Littlejohn-Lupton said.
Kimassi said the percent of trauma patients Northwest Community Health has transported to HCA Houston Healthcare Tomball rose from 75.8% in 2015 to 85.8% in 2018. Prior to its pursuit of the designation, Tomball could receive minor trauma, such as minor falls, cuts, burns and injuries, Kimassi said. Now with the designation, EMS can transport a patient to the Tomball hospital with severe injuries, such as a broken leg and pelvis, a collapsed lung and multiple broken ribs, he said.
“We definitely have seen an increase [in] the number of trauma patients we’re taking there [and] the number of total patients we’re taking to Tomball as their trauma program’s come online,” Kordik said.
CCEMS transports about 25% of its trauma patients to Tomball, he said.
Montgomery County Hospital District transported 504 trauma patients to the Tomball hospital from June 2018-May 2019, MCHD data shows.
To keep its trauma designation—which expires June 1, 2022, according to the DSHS—the hospital must be resurveyed every 2-3 years, Evans said. The hospital will also submit data to SETRAC and the state on a quarterly basis to evaluate its performance, Pile said.
“This trauma certification is just another validation to the community that we are providing world-class care here at Tomball, right here in the community, right here at home,” said Maggie Yacoubian, the chief nursing officer at HCA Houston Healthcare Tomball.