Featured, from left: Omar Quintanilla, McAllen City Commissioner District 3; Javier Villalobos, McAllen City Commissioner District 1; Verónica Whitacre, McAllen City Commissioner District 6; and Joaquín “J.J” Zamora, McAllen City Commissioner District 2. On Monday, September 10, 2018, these four elected officials were part of a unanimous vote cast by the seven-member McAllen City Commission to support efforts to secure state funding for a Level I Comprehensive Trauma Center for the Valley. In this image, they were participating in the Tuesday, July 10, 2018 grand opening of the McAllen Youth Baseball Complex, which was funded by a $15 million city bond issue, and that has 11 baseball fields and a Miracle Field, which meets the standards of the Americans with Disabilities Act.
Photograph Courtesy of ROY CANTU
McAllen City Commission, Sen. Hinojosa, Rep. Canales throw support behind legislative push for Trauma Emergency Preparedness Funding and for efforts to bring a Level I Comprehensive Trauma Facility for Valley
By DAVID A. DÍAZ
State legislation to provide emergency preparedness funding to strengthen and reinforce the Texas Trauma Network – and to ensure that Rio Grande Valley hospitals and emergency medical care providers have the capacity and capability to adequately respond in times of disaster – have been endorsed by the McAllen City Commission, Sen. Juan “Chuy” Hinojosa, D-McAllen, and Rep. Terry Canales, D-Edinburg.
That legislative goal was first publicly proposed in the form of a city resolution, which was requested by Doctors Hospital at Renaissance (DHR Health), and supported by Med Care EMS, which drew unanimous support from the McAllen City Commission on Monday, September 10, 2018.
“I’m pretty happy that the entire city commission voted to approve the resolution. It’s something that is pretty important,” Javier Villalobos, McAllen City Commissioner, District 1, said after the meeting. “It is something that is overdue for our community.”
The leadership of Doctors Hospital at Renaissance (DHR Health) is working on having state legislation drafted for action by the 86th Texas Legislature, which begins its 140-day regular session in January 2019, to provide emergency preparedness trauma funding for areas such as the Gulf Coast, Houston, and the Rio Grande Valley to reinforce trauma capabilities and capacity.
Med Care EMS strongly supports the legislative efforts and is advocating, alongside DHR Health, for such funding.
Raul Barreda, Jr., MD, Trauma Medical Director for the Level III Trauma Center at Doctors Hospital at Renaissance (DHR Health), Roberto Haddad, Vice President and Counsel for Government Affairs and Policy at Doctors Hospital at Renaissance (DHR Health), and Paul M. Vazaldua, Jr., Legislative Affairs/Special Projects Director for Med Care EMS, attended the McAllen City Commission session.
“We are severely underserved as far as emergency medical response, disaster response and trauma response for our population here,” Barreda explained. “Each geographic Region should have a Level I trauma center for every million people, as far as population growth. You should be able to be provided trauma surgeons within a 30 minute transport time of your injury.”
In general, a Level I Comprehensive Trauma Facility is a regional resource that is a tertiary care facility central to the trauma system. A Level I Comprehensive Trauma Facility is capable of providing total care for every aspect of injury – from prevention through rehabilitation.
A key component of DHR Health’s and Med Care EMS’ push for state funding to strengthen the Texas Trauma Network is to ensure that the Rio Grande Valley has the resources to bring a Level I Comprehensive Trauma Facility and other advanced emergency medical care resources to the region.
The Texas Trauma Network is made up of 288 designated trauma hospitals, first responders, and emergency medical service providers.
According to the McAllen city resolution, of the top nine most populous regions in Texas, only the Rio Grande Valley lacks a Level I Comprehensive Trauma Facility.
Access to the appropriate level of medical care during the first 60 minutes of a trauma (the “Golden Hour”) is critical to saving lives.
Villalobos said bringing more advanced life-saving medical resources to the Valley will be part of the McAllen City Commission’s state legislative agenda, which will be finalized in the next few weeks.
“We are going to hit it as hard as we can,” Villalobos said about city’s state legislative agenda. “You know that the squeaky wheel gets the grease – we’re going to be squeaking.”
Also on that same day that the McAllen City Commission approved its resolution, Hinojosa and Canales, in separate actions, announced their intentions to seek state money to help make a Level One Comprehensive Trauma Facility a reality for the Valley, a metropolitan region with more than 1.5 million residents.
“All Texans deserve to have access to the best health care we can provide in their hour of need, regardless of what part of the state they live in,” said Hinojosa. “Proactively improving our trauma network will save lives every day and help the state weather the next storm.”
Hinojosa agreed that Texas should invest in its trauma network throughout the state, noting that the state funds its trauma system through various funding streams, but many of those sources are dwindling or at threat of disappearing completely.
“This coming legislative session, we need to develop a permanent funding mechanism to support current trauma centers and help defray the costs associated with centers leveling up in an effort to address gaps in our trauma system,” Hinojosa said.
REP. CANALES: LEVEL I COMPREHENSIVE TRAUMA FACILITY WOULD BENEFIT UNIVERSITY OF TEXAS RIO GRANDE VALLEY MEDICAL STUDENTS
In the United States, trauma centers are identified by different levels (Level I, II, III, IV, or V) based on the kinds of resources available in the trauma center and the number of patients admitted yearly. While lower level trauma centers can provide adequate care for many traumas, studies have found that patients with certain severe injuries are more likely to survive if they are treated at a Level I.
Level I trauma centers are the most advanced, serving as a tertiary care facility and capable of providing total care for every aspect of injury, from specialists to secondary care. These facilities provide 24-hour care and access to a wide array of specialists, in addition to important education and research function.
Canales, the House District 40 state representative, expressed confidence that the South Texas state legislative delegation will again be a united force at the Texas Capitol for advances in medical care and health care for the Valley.
“I expect all of my legislative colleagues will be working with me in the upcoming legislative session to meet the pressing demand for better healthcare for all South Texans,” Canales said. “Strengthening our state’s trauma network by providing funding for critical infrastructure and increased capabilities and capacity is needed to save lives.”
Canales in 2013 was a leading House co-sponsor of Senate Bill 24, authored by Hinojosa and sponsored by Rep. René Oliveria, D-Brownsville, that created The University of Texas Rio Grande Valley School of Medicine, which has a major campus in his House District 40 hometown of Edinburg,
“A Level I Comprehensive Trauma Facility would generate tremendous academic and professional benefits for our outstanding medical students now and in the future. We want to have UTRGV’s medical students to be exposed to the highest levels of treatments for advanced disease, pathology and injury because that will make them better doctors, better physicians and better surgeons,” Canales said. “So when they see something during medical training, they will be able to take care of it when they set up their own practices. If they never see it and they are never exposed to it during their training, it’s that much more difficult.”
DHR Health’s Barreda said that a Level I Comprehensive Trauma Facility provided more examples of advanced emergency medical care not available at Level II, III or IV trauma centers.
“Examples of surgical specialties would be oral and maxillofacial surgeons, facial surgeons, ear, nose and throat surgeons, and specific plastic reconstruction surgeons,” said Barreda. “A Level II trauma center would be able to care for most patients in that hospital, but would still have to transfer out to a Level I the higher-level acute patients, the more advanced orthopedic bone injuries, the more advanced neurosurgical injuries, the more advanced plastic reconstruction injuries, as well as pediatrics injuries. That would be the main difference between the Level I and Level II trauma centers.”
For first responders such as Med Care EMS, having a Level I Comprehensive Trauma Center in the Valley will help those emergency medical professionals save more lives, said Vazaldua.
“Many people in this community have to travel between three to five hours or more to San Antonio or Dallas or Houston to get health care because of the subspecialties in nature that are not available in the Valley today,” said Vazaldua. “Whether it be neurology, or cardio care, there are certain requirements and protocols that a paramedic must follow in order to take the patient into the facility.”
Candelario Ontiveros is President/CEO of Med Care EMS in McAllen.
Med Care EMS holds transportation contracts for Doctors Hospital at Renaissance, South Texas Health System, Mission Regional Medical Center, and Knapp Medical Center.
“Whether it be neurology, or cardio care there are certain requirements and protocols that a paramedic must follow in order to take the patient into the facility,” said Vazaldua. “In our profession, we see first-hand how having this level of advanced life-saving resources right here in deep South Texas would benefit all of deep South Texas.
TEXAS HOSPITALS CARE FOR MORE THAN 120,000 TRAUMA PATIENTS ANNUALLY
Other reasons cited by supporters of the McAllen City Commission resolution are:
• Texas hospitals care for more than 120,000 trauma patients annually and provide more than $253 million in uncompensated trauma care yearly. Despite the vast Texas Trauma Network, approximately 40 Texans die every day due to traumatic injuries (14,000+ deaths a year). Additionally, for every Texan that dies from a traumatic injury, at least six are injured. Texas can do more to reinforce its regional trauma capabilities; and
• Robust capabilities and capacity in the Trauma Network is especially important in times of disaster when existing facilities and providers can be forced offline or be quickly overwhelmed. Hurricanes Rita, Ike, and Harvey have highlighted the need to be proactive and make the needed investments in our trauma network’s infrastructure and capabilities before the next crisis.
“There are rural areas of the state and there are even metropolitan areas that do not have as much trauma capabilities as they need,” Haddad explained. “DHR Health is doing an awareness campaign, meeting with legislators, meeting with the other hospitals to see what we can do to have the state put up some money, a grant program, to help facilities across the state increase capacity and build on infrastructure to make sure the trauma center network is strengthened, so that when the next (Hurricane) Harvey, the next disaster, hits, we are well-prepared. South Texans should not ever go without timely access to high-level trauma facility.”
The need for a Level I Comprehensive Trauma Facility is also needed to save lives in many situations, he added.
“No matter where you are in the state, if you are in a car accident, you should be minutes away from that high-level care you need to ensure that you survive,” Haddad said. “Otherwise, it could result in death or a life-long disability, versus a full recovery.”
HURRICANE HARVEY SUPPLEMENTAL FUNDING PACKAGE EYED AS SOURCE FOR MONEY
Money is proposed to come from the Hurricane Harvey Supplemental Funding Package and create a grant program administered by the Texas Department of State Health Services to provide trauma facilities with the needed resources to invest in strengthening the trauma network.
Last year – on Friday, September 8, 2018 – President Trump signed federal legislation to provide billions of dollars to help communities, including those in Texas hard-hit in late August 2017 by Hurricane Harvey, which narrowly missed the Rio Grande Valley.
According to the American Trauma Society, elements of Level I Comprehensive Trauma Facilities include:
• 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, and internal medicine;
• Referral resource for communities in nearby regions;
• Provides leadership in prevention, public education to surrounding communities.
• Provides continuing education of the trauma team members
• Incorporates a comprehensive quality assessment program
• Operates an organized teaching and research effort to help direct new innovations in trauma care.
• Program for substance abuse screening and patient intervention; and
• Meets minimum requirement for annual volume of severely injured patients.
RESOLUTION IN SUPPORT OF STRENGTHENING THE TEXAS TRAUMA NETWORK
The text of the approved McAllen city resolution follows:
WHEREAS, the Trauma Network in the State of Texas is comprised of 22 regions and includes 18 Level I Comprehensive Trauma Facilities, 21 Level II Major Trauma Facilities, 56 Level III Advanced Trauma Facilities and 193 Level IV Basic Trauma Facilities;
WHEREAS, Region V encompasses the Rio Grande Valley counties of Hidalgo, Cameron, Starr and Willacy and have a combined population of over 1.5 million residents and continues to be one of the fastest growing areas in the State of Texas;
WHEREAS, the Rio Grande Valley is situated along the Texas Gulf Coast and is therefore at risk of experiencing widespread and catastrophic flooding and damage which may pose significant threats to life and property due to tropical storms, hurricanes, and other inclement weather events;
WHEREAS, approximately 40 Texans die every day due to traumatic injuries, and for every Texan that dies from a traumatic injury, at least six are injured;
WHEREAS, studies show that access to the appropriate level of medical care during the first 60 minutes of trauma incident (the “Golden Hour”) is critical to saving lives and the American College of Surgeons recommends that each geographic region include a Level I or Level II trauma facility at its center and within a 30-minute transport time and have a Level I trauma facility per 1 million residents;
WHEREAS, approximately 25 percent of Texans live in a county not accessible to a Level I trauma facility, and the nearest Level I trauma facility to Region V of the Texas Trauma Network is located over 240 miles away;
NOW, THEREFORE, BE IT RESOLVED that no Texan should ever go without timely access to the highest level of care when they need it, the City of McAllen hereby supports legislative efforts to make funding available to strengthen the Texas Trauma Network and ensuring the residents of the Rio Grande Valley have timely access to the highest level of care when facing a severe traumatic incident.
CONSIDERED, PASSED, APPROVED, AND SIGNED this 10th day of September, 2018, at a regular meeting of the Board of Commissioners, of the City of McAllen, Texas, at which a quorum was present and which was held pursuant to Chapter 551, Texas Government Code.
SEN. HINOJOSA: TEXAS MUST INVEST IN TRAUMA NETWORK BEFORE NEXT DISASTER STRIKES
Hinojosa wrote and and distributed an editorial in support of state funding for a Level I Comprehensive Trauma Facility(ies) for the Valley. Highlights of his perspectives follow:
The time to invest in emergency preparedness and our trauma network and infrastructure is now.
Hurricane Harvey serves as a somber reminder of the potential devastation facing any of our coastal communities, causing an estimated $125 billion in damage and resulting in more than 100 deaths. Hospitals up and down the coast were impacted, with some having to evacuate patients.
Our trauma network saves lives and is an absolutely critical component of disaster response. We need to invest in the trauma network to ensure the infrastructure and personnel are in place before the next Hurricane Harvey strikes.
But filling the gaps in our trauma system will require significant capital investments. Currently, these costs are a substantial barrier to hospitals making the facilities upgrades, equipment purchases and personnel hires they need to provide the highest level of care around the clock. Every day, approximately 40 Texans die due to traumatic injuries, many of these from car accidents. In fact, trauma is the leading cause of death for Texans 44 years and under, and ranks 4th for all ages. Furthermore, for every Texan who dies from a traumatic injury, at least six are seriously injured.
Trauma results in billions of dollars of lost productivity, revenues, and local and state assistance, but we can reduce the devastating impact by making investments in trauma care. Studies have shown that getting trauma victims to a trauma center, a hospital equipped and staffed to provide care for patients suffering from traumatic injuries within the first 60 minutes of a trauma (the “Golden Hour”) is critical to saving lives and preventing disability.
Similarly, studies have found that immediately transporting severely injured patients to a Level I trauma center reduces morbidity and mortality.
These facilities provide 24-hour care and access to a wide array of specialists, in addition to important education and research functions. A frequently mentioned recommendation is to have one Level I trauma center per one million population in the service area. Despite a population of more than 1.5 million and growing, the Rio Grande Valley does not have a Level I trauma center.
In fact, of the top nine most populated regions of the state, only the Rio Grande Valley lacks a Level I facility. The Rio Grande Valley currently has a Level II trauma center, but certain trauma patients have to be transported more than 200 miles to San Antonio for the proper care.
In an emergency, these patients are often airlifted at a cost of up to $30,000. This arrangement is costly in both terms of time and money to trauma victims. However, the Rio Grande Valley is not alone in its lack of access to a Level I trauma center.
Approximately 25 percent of Texans – almost 7 million people – live in a county not accessible to a Level I. In fact, Texans in many rural counties are more than an hour away from any trauma center. This is unacceptable. We need to take action to reduce the gaps in our state’s trauma system. A person’s ability to survive or not be disabled by an injury should not depend upon their zip code.
Texas has one of the best trauma networks in the country. However, we can and should do more to reinforce our regional trauma capabilities. We must create a more robust trauma system by ensuring that we have the proper level of trauma facilities distributed throughout the state, not just located in a few urban areas. Not only will this improve the lives of Texans on a day-to-day basis, but it will vastly improve our disaster preparation.
Texas funds its trauma system through various funding streams, but many of those sources are dwindling or at threat of disappearing completely.
On average, it costs over $20 million annually to operate a Level I in Texas, but hospitals must operate at the level they are seeking to be designated for at least a year before they receive the actual designation. This means that hospitals are not compensated for millions of dollars of costs during this transition period even though they provide a higher level of care during this time.
Further, hospitals face millions of more dollars in startup costs. To ensure we are ready and able to respond to any disaster, Texas should invest in our trauma network throughout the state. This coming legislative session, we need to develop a permanent funding mechanism to support current trauma centers and help defray the costs associated with centers leveling up in an effort to address gaps in our trauma system.
All Texans deserve to have access to the best health care we can provide in their hour of need, regardless of what part of the state they live in. Proactively improving our trauma network will save lives every day and help the state weather the next storm.
For more on this and other Texas legislative news stories which affect the Lower Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature. For more information, please contact Paul M. Vazaldua, Jr., Legislative Affairs/Special Projects Director for Med Care EMS, at 956-668-9111, Roberto Haddad, Vice President and Counsel for Government Affairs and Policy at Doctors Hospital at Renaissance (DHR Health), or Jesse Ozuna, Government Affairs Officer at Doctors Hospital at Renaissance (DHR Health), at 956/362-7165. Paul Townsend contributed to this article.