Hospital aims to become Level II Trauma Center

Maui Memorial to create a 24/7 trauma surgery team starting in June

Maui Memorial Medical Center, pictured in April, is taking steps to become the second Level II Trauma Center in Hawaii, starting with the launch of a 24/7 trauma surgery team on Tuesday. The Maui News / MATTHEW THAYER photo

Seeking to become the second Level II Trauma Center in the state, Maui Memorial Medical Center will dedicate a team of four surgeons strictly for trauma patients and cut activation times in half starting Tuesday.

The island’s only acute-care hospital currently has general and trauma surgeons who rotate on an on-call schedule to ensure there is always a qualified surgeon available for Emergency Department patients.

But the newly established 24/7 trauma team “means that there will always be a surgeon on call that is dedicated to trauma patients — and this is the only surgery these physicians will do,” hospital spokeswoman Tracy Dallarda said Thursday.

The team will be “activated in minutes” to respond to a trauma event at the hospital, including injuries that may require immediate resuscitation and interventions to save life or limb, as well as injuries from motor vehicle accidents, fires, shark attacks or breaking waves.

Maximum response time to full trauma activation will now be 15 minutes as opposed to 30 minutes, the hospital said in a memo to employees.

Kahului Airport Rescue & Fire Lt. Troy Demello (left) and Maui Health Trauma Program Manager Jeff Later stand next to a new “Stop the Bleed” kit installed at Kahului Airport this month. About 40 percent of trauma-related deaths worldwide are due to bleeding or its consequences, according to Maui Health, which is expanding its Trauma Program to include four surgeons dedicated to trauma patients beginning Tuesday. MAUI HEALTH photos

The improvements are part of the Wailuku hospital’s path to obtain American College of Surgeons verification as a Level II Trauma Center, the ACS’ highest ranking for a community hospital.

ACS defines a Level II Trauma Center as one that “is able to initiate definitive care of all injured patients,” according to the American Trauma Society. Elements of a Level II facility include 24-hour immediate coverage by general surgeons, as well as coverage by specialists in orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care.

Level II centers provide trauma prevention and continuing education programs for staff along with a comprehensive quality assessment program. They may refer care needs such as cardiac surgery, hemodialysis and microvascular surgery to a Level I Trauma Center.

Because of the many requirements involved, it will take Maui Memorial nearly two years to fully implement everything before the official ACS certification survey, Dallarda said.

Maui Memorial, operated by Maui Health, is currently a Level III Trauma Center, designated by the state Department of Health in 2013. Under the designation, the hospital must adhere to specific guidelines and undergo an evaluation every three years to maintain its status.

DR. ART CHASEN – Trauma director

The ACS does not designate trauma centers but rather verifies that the facility has the resources to provide optimal care for an injured patient, such as commitment, readiness, policies, patient care and performance improvement, Dallarda said.

She noted that the ACS requirements for Level II call for “even more dedicated trauma services” than the hospital’s current designation, including the dedicated surgeons. The ACS verification is nationally recognized.

Currently the only Level I Trauma Center in Hawaii is the Queen’s Medical Center on Oahu. The designation requires ample personnel and facility resources only available at teaching institutions, Dallarda said.

Tripler Army Medical Center on Oahu is the only Level II Trauma Center in the state, Dallarda added.

Maui Memorial treats around 1,000 trauma patients a year, and the number is growing with the addition of sub-specialty surgeons, according to Dallarda.

Dr. Art Chasen, trauma surgeon and Maui Health Trauma Director, said there is a need for directed trauma care, noting Maui’s active population and participation in sports as well as land and water activities “that have potential for traumatic injuries.”

“We also have a growing kupuna population who commonly experience falls and other injuries that require trauma care,” he said.

He also pointed to the quick return of tourists as pandemic restrictions have eased and the visitors’ need for trauma care.

“Verification with ACS aligns the level of care and services we provide with some of the top trauma centers in the nation,” Chasen said.

The three other surgeons on the team are Drs. Sergio Lugo, Beth Jarrett and Stephanie Yan.

Dallarda said Maui Health will be hiring additional mid-level providers such as nurse practitioners and physician assistants to support the trauma surgery team directly.

Other departments that are involved in caring for trauma patients will be looking at their own teams and expanding to meet the requirements of ACS as well as to provide quality care to the increasing volume of patients that they see and that the hospital expects to admit if it eventually expands, Dallarda added.

Over the last several years, Maui Health has expanded its surgical services, including orthopedics, plastic surgery, intervention radiology, oral and maxillofacial surgery, vascular surgery and neurosurgery, all of which has decreased the need for trauma patients to be transferred off island.

Since 2018, the number of Maui Memorial trauma patients requiring transfer off island has decreased from 19 percent to only 3 percent, Dallarda said.

To provide more awareness of traumatic injuries, the Maui Health Trauma Program has community outreach and education efforts. Prior to the pandemic, the program worked with Maui County Ocean Safety on spinal cord injury prevention and education. There were also “Stop the Bleed” courses for the public that trained teachers on techniques for controlling bleeding after an injury and helped emergency medical personnel learn to instruct others on the technique as well.

Stop the Bleed is a national campaign that encourages bystanders to become trained, equipped and empowered to help in a bleeding emergency before professional help arrives, Maui Health said. Uncontrolled bleeding is a major cause of preventable deaths.

About 40 percent of trauma-related deaths worldwide are due to bleeding or its consequences, according to Maui Health, whose Trauma Program donated eight Stop the Bleed kits to Kahului Airport this month.

* Melissa Tanji can be reached at mtanji@mauinews.com.


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