Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=202666
Story Retrieval Date: 12/5/2013 11:40:42 AM CST
The intersection of 61st Street and Cottage Grove Avenue is like many other intersections on the South Side of Chicago. There are a few empty lots, some low lying buildings, and express buses flying past.
But one block away sits the ivy-covered towers of the University of Chicago. And a mere two blocks away, the metal and glass structures of the University of Chicago Medical Center gleam in the sunlight.
On a muggy summer night in August 2010 Damian Turner, an 18-year-old youth activist was gunned down in a drive-by near this intersection. He bled out at Northwestern Memorial Hospital, approximately 10 miles away on N. Lakeshore Drive.
Friends, family and activists blame Damian’s death on the inability of the nearby University of Chicago Hospital to treat him.
“Damian did not deserve this. He was two blocks away from this hospital and he should have been taken until he was at least stabilized,” said Damian’s mother, tearfully, at one of the many rallies commemorating his death and birthday.
The University of Chicago Medical Center closed its adult trauma center in 1988, citing financial reasons and wanting to concentrate resources elsewhere. It still operates a pediatric trauma unit.
Given the severity of his injuries Damian needed a Level 1 trauma center, a specialized facility with round the clock staffing and access to specialists in treating traumatic injuries, such as those from auto accidents or gunshot wounds.
While the University of Chicago became the focus of community anger after Damian’s death, closure of its trauma center did not create a treatment desert at the time. But after Michael Reese Hospital closed in 2008, emergency services had no choice but to whisk trauma patients like Damian far away from the South Side.
Would Damian, or anyone in the same position, have an increased chance of living if the ambulance had been able to bring him to the University of Chicago? National and local experts have maintained the answer is no. However, new research specific to Chicago indicates that it might.
Dr. Marie Crandall, an associate professor of surgery at Northwestern University, is putting the finishing touches on a paper about trauma deserts and gunshot wounds.
“We finished our analysis of Illinois State Trauma Registry gunshot wounds from 1999-2009 and we did find that there was a difference if you lived more than five miles from a trauma center both with respect to transport and mortality,” Crandall said.
No South Side residents live within five miles of the four Chicago Level 1 trauma centers. From 61st and Cottage Grove, where Damian was shot, Advocate Illinois Masonic is 13 miles away, John H. Stroger Hospital is about 10 miles away, Mount Sinai on the West Side is about 11 miles away, and Northwestern is 10. Some South Side trauma victims are taken to Advocate Christ Hospital in Oak Lawn, which is 11 miles southwest of this particular intersection.
“If you are critically ill, having been in an ambulance for a longer period of times means you are less likely to survive,” said Crandall. “For patients that require surgical care immediately, if they don’t get it immediately you are more likely to die.”
Since 2008, those South Side communities witnessed more than 40 percent of Chicago’s homicides due to trauma.
Dr. Adil Haider, a trauma surgeon at Johns Hopkins Medical Center in Baltimore, sees a strong correlation between time and mortality.
“Think way back to Vietnam. Out in the field their survival went up if they were treated right away. If you have a big bleeder, time makes a big difference.”
According to Haider, some serious injuries are non-negotiable when it comes to time.
“For patients who are shot through the heart the difference between five minutes and 15 minutes is the difference between life and death.”
Disparate at best
To a layperson this seems to make a lot of sense. We imagine that in life or death medical situations the minutes and seconds must matter. But according to Crandall “the research is disparate at best.” Many previous studies have indicated that time might not be so important in recovery times for trauma patients.
A March 2010 study of North American trauma centers published in the Annals of Emergency Medicine examined 3,600 patients and found that transport time had no impact on mortality. This is because ambulance care has advanced so far — the patient only needed to get to an ambulance to begin the healing process. The study even went as far as to suggest that light-and siren transport, a staple for trauma patients, might not be warranted.
Closer to home, Lee Friedman, a professor at the school of public health at the University of Illinois at Chicago, conducted a study on the closing of the Olympia Fields Trauma Unit in the south suburbs of Chicago. The study found that the increased distance that the patients had to travel didn’t have much effect on whether they lived or died.
"We didn’t see any negative impact in terms of an increase in hospital mortality. We didn’t see a real substantial increase in length of stay, or medical complications because of a delay in treatment,” he said.
He added that on the South Side of Chicago, the distances are still much shorter than the distances he was looking at in the south suburbs.
“Intuitively we’re not talking about more than 10 minutes, usually at night when traffic is less anyway. We’re talking really only five to 10 minutes away.”
But for those who think decreased transport time is important to trauma care, the devil is in the details.
Crandall points out that the national study might not apply directly to the urban density of Chicago, and to the specifics of penetrating gunshot trauma.
“It may not be true for the country and in cities that only have one trauma center,” she said. “It’s just really impossible to know. As a population you could say it doesn’t really make a difference, but here in Chicago my data are suggesting that it does.”
For Haider, it’s the specific symptoms that result from gunshots that make time so important.
“For urban gunshot bleeding, hemorrhage is the number one cause of death,” he said.
If a patient goes into cardiac arrest before they reach the hospital the chances they will survive plummets.
“Ten minutes of having no pulse will exclude you from a resuscitative thoracotomy [open heart surgery]” Haider said. “So if you’re very far away that’s a huge problem.”
It’s impossible to disentangle the issue of transport times from the South Side to the nearest trauma center from the larger political and social issues at play, and greater questions about access to quality care for South Side residents.
“It crosses lines,” Friedman said. “I don’t think it’s simply a medical issue. The access to medical care has social issues and political issues, and they’re all interwoven. On the social-political front there is a lack of high-level specialized trauma facilities in the south side of Cook County and the southeastern side of Chicago.”
Crandall and Haider coauthored a 2010 study that shows that minorities, especially those who are uninsured, are twice as likely to die in a trauma situation. This is particularly alarming given that trauma care should be the same regardless of race or insurance.
Crandall isn’t sure the exact reason for this disparity yet.
“Some [cases] may be because of institutional bias, though I’d like to think not. Some may be distance from a trauma center; some may be postoperative care. Some may be what you bring to the table.
“Patients who live in high-stress disadvantaged environments may be disadvantaged in ways to adapt to the stress of surgery and the stress of a trauma, and we don’t have ways to measure that yet.”
The 15-million dollar question
Despite community pressure, the University of Chicago Medical Center is not planning to offer an adult trauma center anytime soon. In a press release, it reasons that even if it did, it wouldn’t completely cover the area, which has lost so many hospitals. “A 537-bed facility, cannot by itself solve all the problems of an area that has lost more than 2,000 hospital beds in recent decades.”
It also says it is using its resources to provide other important care in the area.
“The South Side also faces profound shortages of primary care, as well as many forms of complex specialty care that are provided only at the University of Chicago. The Medical Center has chosen to concentrate resources on the clinical specialties where it can play the greatest role and has the most to offer,” it said in the press release.
Crandall hopes that her study will be published and lawmakers will pay attention.
“I think it needs to be published, it needs to be peer reviewed,” Crandall said. “I hope that that it will give policymakers a way to make informed decisions about how to provide trauma care to the city.”
Some options include beefing up the services at Level 3 and Level 4 trauma centers in the area, or offering government funding for new care.
No matter what the solution, trauma care doesn’t come cheap.
“The question is would that data persuade any hospitals to want to spend the $15 million a year or so that it takes to run a trauma center. And that we don’t have the answer to,” Crandall said.
For Haider, the money pales in comparison to the lives that could be saved.
“Things may look expensive, but a bridge is expensive, too. You need it so you’re going to build it.”
One thing we can count on: This coming August, the second anniversary of Turner’s death, protesters will gather, crying out for what they feel is missing in their neighborhood.