Pediatric Trauma Centers Require Unique Expertise

The city Fire Department helicopter that crashed, killing 11-year-old Norma Vides and three rescue workers, was part of a countywide emergency system that relies on speed to ferry critically injured children for treatment at one of nine pediatric trauma centers.

The limited number of hospitals, and the crucial minutes that can separate life and death, mean a child seriously injured in the San Fernando, east San Gabriel or Antelope valleys must be transported by air ambulance crews, said David Thompson, the emergency medical services liaison for the Los Angeles County Fire Department.

Caring for children under the age of 16, say medical experts, is not simply like treating smaller adults.

“A child’s head is much larger in proportion to the body than an adult’s,” said Alan Nager, acting head of emergency medicine at Childrens Hospital, where Norma was being flown for treatment. “There is a difference in body fluids. Children can have injuries that go unrecognized by those that do not regularly treat them.”

Pediatric trauma centers use special medical equipment, including custom-designed sphygmomanometers to measure blood pressure and smaller-gauge needles.

The distinction between pediatric and adult care is important in a 4,000-square-mile county that has 13 trauma centers for adults, but only nine certified for children.

Escalating emergency care costs combined with fewer numbers of insured residents has prompted the closure of 11 trauma centers in Los Angeles County since 1985. More than 13,000 adults were treated at county trauma centers last year. About 1,700 children were treated at local pediatric trauma centers, according to the County Department of Health Services.

“If we had a pediatric trauma center in the San Fernando Valley, that would mitigate the need for most of those air ambulance runs,” said Dr. Marc Eckstein, medical director for the city Fire Department.

But opinion in the medical community is divided over whether or not the current trauma care system is adequate.

Alan Heilpren, an emergency room physician and president of the Los Angeles County Medical Assn., said the county system works well. He said the concentration of trauma centers at a handful of hospitals allows for physicians to become expert in the treatment of devastating injuries.

“There is absolutely not enough pediatric trauma to support pediatric critical care centers at every hospital,” he said. “If I’m a pediatric surgeon on staff at a hospital that rarely sees pediatric trauma, I’m not going to be very good.”

But his immediate predecessor at the association, emergency room physician Brian Johnston, said surviving an accident may depend on proximity to the nearest trauma center.

“The care that the little girl who was hurt was receiving was necessary and appropriate,” said Johnston of the rescue crew’s decision to fly Norma from Sun Valley to Childrens Hospital in Hollywood. “But she had to go there because there was no place locally that could treat her. There was no place locally because we aren’t willing to pay for it.”

Los Angeles City Councilman Richard Alarcon said it is distressing the Valley has no children’s trauma center, and called Tuesday for a city study.

Northridge Hospital Medical Center, which (along with Providence Holy Cross in Mission Hills) is one of two trauma centers in the Valley, is considering applying for status as a pediatric trauma center.

To be designated a pediatric critical care center, a hospital must be staffed with pediatric surgeons and physicians 24 hours a day, and have pediatric specialists no more than 20 minutes away.

Ladonna DellaGala, manager of pediatric care at Northridge, said it is an expensive but possibly worthwhile undertaking, considering there are nearly 1.5 million Valley residents.

“Even after a child is treated, parents have to keep running over the hill to visit, even if they live just down the block from a hospital in their neighborhood,” said DellaGala.

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Trauma Network

Last year, an estimated 14,000 people, including 1,800 children, were served by Los Angeles County’s 13 trauma centers, nine of which are designed to treat children 14 and younger. There are no pediatric trauma centers in the San Fernando Valley.

1) Cedars-Sinai Medical Center

2) Children’s Hospital Los Angeles

3) Henry Mayo Newhall Memorial Hospital

4) Huntington Memorial Hospital

5) Harbor-UCLA Medical Center

6) King/Drew Medical Center

7) USC Medical Center

8) Long Beach Memorial Medical Center

9) Northridge Hospital Medical Center

10) Providence Holy Cross Medical Center

11) St Francis Medical Center

12) St. Mary Medical Center

13) UCLA Medical Center

Source: L.A. County Department of Health Services