AUGUSTA — A subcommittee of the Maine EMS Trauma Advisory Committee voted Monday to recommend that all trauma patient transfers from area hospitals and all from-scene transports by LifeFlight of Maine to Central Maine Medical Center in Lewiston be discontinued immediately and that the TAC immediately begin revising the state’s trauma plan to account for these changes.
The subcommittee met Monday to review data from CMMC on the volume of neurosurgical patients to their emergency department. The full committee requested the data from the Lewiston hospital at their meeting last week.
According to data provided by CMMC on average over the past five years, a quarter of all 720 trauma patients presenting to CMMC’s emergency department required a neurosurgery consult; 60% of those patients were transfers in from another facility.
That means that less than half of patients requiring a neurosurgical consult were “from scene,” meaning they arrived to CMMC’s emergency department directly from an incident scene, such as the site of a car crash.
Patients transported from a trauma scene that needed a neurosurgical consult were only 10% of patients overall, which is why CMMC decided to eliminate their coverage, Central Maine Healthcare Chief Medical Officer Dr. John Alexander said after the meeting.
The hospital will maintain its general and orthopedic trauma programs and serve as a stroke center, he said.
“We continue to provide neurosurgical services to patients requiring spine surgery; however, we do not have continuous neurosurgery coverage on-call for trauma services,” Alexander said.
But with CMMC’s elimination of its 24/7 neurosurgical trauma program within 60 days, that leaves the state’s two other trauma centers, Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor, as the only hospitals able to absorb CMMC’s patient volume.
It’s most likely that the majority of transfers that would have been bound for CMMC would end up at Maine Med instead, Tammy Lachance, a registered nurse and CMMC’s trauma program manager, said.
Dr. Elbert White, a neurological surgeon at Maine Med, said that the hospital would be able to handle the extra capacity to the agreement of Dr. Joe Rappold, a trauma surgeon there.
“I feel like we’re in good shape to handle 10-15 more consults per month, (which) I think is what we’re looking at,” White said.
“Beds and (operating room) suites are just so valuable right now because of COVID,” he said.
Under the recommendations made at Monday’s meeting, virtually all trauma patients would go to Maine Med or EMMC when possible and especially if a patient has suspected neurological injuries.
Eight members of the subcommittee voted in favor of sending these recommendations to the full TAC. There was one abstention, from a member who joined the meeting late, and the only “no” vote was from Dr. Richard King, a general trauma surgeon at CMMC.
“Dr. King understands the importance of continuity of care and has been a key contributor to the development of Central Maine Healthcare’s transfer system between our three hospitals: Bridgton Hospital, Rumford Hospital and CMMC,” said Alexander, the chief medical officer.
In a statement, he added: “The current recommendations to constrain the availability of trauma services unrelated to neurosurgery in central Maine are not in the best interest of Maine people and would force trauma patients to unnecessarily travel to Bangor or Portland.”
“We continue to stand ready for trauma patients appropriate for our robust capabilities and will work to maintain the access that is so vital to patients, especially in the midst of the pandemic and the severe capacity constraints that affect Maine hospitals.”
King and Lachance did ask the subcommittee to consider maintaining transfers from Bridgton Hospital and Rumford Hospital to CMMC.
“I strongly support preserving our ability to accept patients within our same system,” King said. Though the three hospitals are under separate licenses, many of CMH’s emergency department physicians work at more than one hospital.
Lachance added that about 75% of all transfers to CMMC are from the two critical access hospitals.
Several members of the subcommittee also urged CMMC to waste no time downgrading its American College of Surgeons trauma center certification from a level two to a level three.
“I would propose as a baseline we need to admit to the fact that CMMC can’t be a level two trauma center and they need to reverify electively and decertify as soon as possible so we can start working on solutions,” Pret Bjorn, a registered nurse and trauma program manager at EMMC, said.
Bjorn said that this process would “preserve CMMC as a strategic hospital” for trauma care access, but that it would require revisions to the state’s trauma plan.
“First step is to change CMMC’s trauma center certification level,” he said. “Then I think we have lots of work to do figuring out how to compensate for that, keep people safe (and) keep CMMC operational.”
The ACS certifies trauma centers on a scale of one to three, from the highest level of trauma coverage to the lowest. A level two certification, which EMMC also has, requires neurosurgical coverage. Maine Med is a level one trauma center.
“This is a dramatic change to the contours of the system,” Bjorn said. “We need to write some new language to accommodate it.”
King said hospital leadership is supportive of changing their certification.
“We are committed to remaining a trauma center, minus neurosurgery,” King said. “Obviously, the details we’re going to need to discuss to remain within the (state’s) trauma plan.”
The full committee will take up this issue and vote on the adoption of the subcommittee’s recommendations at a meeting next week.
In the interim, EMS providers are advised to follow the latest guidance approved last week by the TAC and the Medical Direction and Practices Board.
The TAC voted last week to halt all neurological trauma patient transfers from other hospitals to CMMC.
And a clinical bulletin posted by the MDPB Thursday said that patients with neurological injuries should be transferred to Maine Med in Portland or EMMC in Bangor if transport time is under 45 minutes.
If transport time exceeds 45 minutes, EMS should bring those patients to the nearest hospital for initial stabilization before being transferred to Maine Med or EMMC.
The MDPB also recommended that LifeFlight take all trauma patients to Maine Med or EMMC whenever possible.
This story was corrected to reflect that the there are three levels of American College of Surgeons-certified trauma centers.
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