Trauma decides destination

The theories are plenty, and also without merit.

Claims that Hoag Memorial Hospital Presbyterian doesn’t take injured, uninsured patients or that Hoag doesn’t want people critically injured because it will affect their mortality statistics come up every now and then.

A perfect example: a Mexican immigrant seriously injured Feb. 1 by a hit-and-run driver at Placentia Avenue and Hospital Road in Newport Beach, literally footsteps away from Hoag.

Where did paramedics take him? Western Medical Center in Santa Ana, 11 miles away.

Why? The Trauma Center. Just picture what you see on the television show “ER” when surgeons wait by the double-doors for the ambulance to pull up with an injured patient bloodied and battered so they can immediately begin treatment.

Hoag, and most hospitals in Orange County, can’t do that. What you see on TV is not actually an emergency room team, it’s the trauma-center team, and they’re on-call every minute of every day.

Only three hospitals in Orange County have them, and that’s where anyone with moderate to critical traumas will go.

Either to UCI Medical Center in Orange, Western Medical Center in Santa Ana or Mission Hospital in Mission Viejo.

“Hoag isn’t set up to do surgery on the spot,” said Newport Beach Fire Department paramedic Chris Fanti. When you go to Western Medical Center, “they’re going to call in the world.”

The “world” that meets injured patients at Western Medical Center depends on how bad the person is injured.

When someone suffers moderate trauma from say, a rollover accident on the freeway, six people will be waiting for them when they arrive in Santa Ana — a surgeon, two nurses, a respiratory therapist, a lab technician and an X-ray technician.

If they are critically injured, such as from a stabbing or shooting, they’ll have those six plus an operating room nurse, operating room technician and an anesthesiologist.

A patient can be under the knife within 10 to 15 minutes of arriving at Western Medical Center.

That kind of readiness — maintaining operating rooms, beds, equipment and the staff — costs millions to hospitals annually and is cost-prohibitive to most facilities.

A trauma is when a person is injured by some outside force, and paramedics have specific guidelines on what automatically qualifies. Falling from at least 15 feet, or a pedestrian being hit by a car going at least 20 mph automatically qualifies as a trauma, as does certain levels of breathing or heart rates and blood pressure.

Only on iffy situations, such as a rollover where the person appears uninjured, do paramedics consult with the local hospital to see if they’d treat them or if they should defer to the trauma team.

When they arrive at Western Medical Center, or the other county’s centers, they’re immediately taken to a room only steps away and diagnosed and treated.

“It’s kind of like a pit stop,” said Humberto Sauri, medical director of Western Medical Center’s Trauma Center. If they require surgery, that’s just down the hall, hospital officials said.

The entire process begins the moment paramedics arrive on the scene.

Medics at the scene assess the incident and injuries, and immediately call their base hospital. For Newport-Mesa paramedics, that’s Hoag. If it’s a trauma situation, the dispatcher at Hoag will tell them which trauma center is open and where to go.

En route, paramedics relay the patient’s injuries to the team standing by. It takes an average of 8 minutes for paramedics to get to Western Medical Center, hospital officials said.

The trauma center is able to treat multiple traumas at once, and recently had five in one night, doctors said.

Usually, public safety officials try not to bombard one hospital with all the patients.

“It has to be the same treatment at 10 a.m., 10 p.m. or 2 a.m.,” said Janet Hewson, clinical director of Western Medical Center’s trauma and emergency services.

Whenever someone arrives at their center from another city and questions why they weren’t treated locally, “they look around the room and understand,” she said.

The only time paramedics will take a trauma patient to the nearest receiving hospital is for a cardiac arrest, paramedics said.

Otherwise, if you were to take a gunshot victim to somewhere like Hoag, you’d simply delay their treatment, Fanti said.

Hospital leaders would just call paramedics to come pick them up and take them to Western Medical Center, UCI Medical Center or Mission Hospital.

“It’s all about that Golden Hour,” Fanti said.

Doctors and paramedics said the survival rate of people treated within the 60 minutes of being injured rise dramatically.

If a person needs a chest tube, a bullet removed or internal bleeding stopped, “a trauma center can take all of that and shrink it into a 15- to 20-minute window,” said Newport Beach paramedic Mike Sodargren.

“Ultimately, taking them to a trauma center is in the best interest of the patient,” Fanti said.

“We don’t work for the hospitals. We work for the city of Newport Beach.”QUICK FACTS

 There used to be two more trauma centers in Orange County: St. Jude Medical Center in Fullerton and Fountain Valley Medical Center.

 If all three Orange County trauma centers are full, Newport-Mesa paramedics will take patients to Long Beach Memorial Medical Center

 Trauma centers have a list of people on call eight to 10 people-long for each position in case someone is not available.

 Trauma surgeons work on 12- to 24-hour shifts and have more training than your average surgeon.

Reporter JOSEPH SERNA may be reached at (714) 966-4619 or at joseph.serna@latimes.com.