For the first 16 years of my career, Louisiana didn't have a comprehensive trauma system.
I sure miss those days.
Up until a couple of years ago, we labored under a fragmented and inefficient system of competing hospitals offering varying levels of care. There were only two Level I Trauma Centers, situated in Shreveport and New Orleans – opposite corners of the state. For several years after Hurricane Katrina, we were down to only one, and LSU Interim Hospital in New Orleans is only beginning to approach the capabilities of Charity Hospital, pre-Katrina. Here in southwest Louisiana, we're three hours away from either of them.
The state level bureaucrats recognized the need for a comprehensive trauma system, and for years we labored to make it happen. We held countless meetings and trauma town halls around the state, and tried to get all the various stakeholders on board for creating such a system. For a brief time, I was one of those bureaucrats who had to help organize and attend those interminable meetings and town halls, and those are wasted months of my life I will never get back.
But finally, all that work came to fruition, and they had the necessary buy-in from all the various stakeholders to create a comprehensive, streamlined and organized statewide trauma system, to be phased in over all the Department of Health and Hospitals regions over several years.
Thus was born LERN, the Louisiana Emergency Response Network, which is far from comprehensive, anything but streamlined, and hopelessly disorganized. It does, however, lend itself to a catchy acronym that rolls easily off the tongue, even though "Colossal Goatfuck And Waste of Time For Paramedics Too Busy Treating Patients To Answer Pointless Questionnaires Over The Phone" may be more accurate.
LERN was sold to the rural and community hospitals as one-stop shopping for their trauma transfers. No more calling every tertiary care center or regional hospital in the state to find one to accept transfer of your critical trauma patient. LERN would be a single point of access; simply call them, and they'd direct you to the nearest facility with the proper capabilities. Acceptance was pretty much automatic, all you had to do was call the ambulance to make the actual transport. I know, I was present at the orientation LERN made at PGHNSTRACH before it was implemented in our region.
It hasn't turned out that way. Those smaller hospitals still have to call multiple hospitals to get acceptance of their trauma transfers, and they often know better which hospitals to call than the LERN Call Center. Only now, they have the added layer of bureaucracy and aggravation of calling LERN first.
For the bigger hospitals, LERN was supposed to be an easier way of handling diversions than calling multiple EMS agencies. If your CT scanner was down, or if you didn't have ortho coverage for the weekend, simply call LERN, and they'd make sure the ambulances took those patients somewhere else.
Yet, I am frequently directed by LERN to certain Emergency Departments because they have the physician specialty coverage my patient needs, only upon arrival to be greeted by an exasperated triage nurse, complaining, "Why does LERN keep sending y'all here? We've told them five times today we don't have neurosurgery coverage!"
Oh, but it's the interface with EMS providers where they sink to new lows in suckitude. Allow me to demonstrate for you the typical EMS call to LERN:
The scene: An ambulance sits parked on the side of the Interstate, surrounded by fire trucks and rescue vehicles, state troopers, a dozen or so personal vehicles from the volunteer fire department, and a couple of miles of stalled traffic. The medics are working feverishly to assess and package a victim who has been ejected from a rollover MVC. As far as they can tell, he has no major orthopedic or thoracic trauma, but judging from his combativeness and the injuries to his face, he's got the potential for a serious head injury. Amidst all of this, the lead medic stops what he is doing, digs his phone out of his pocket, and dials a number.
[phone rings for roughly 90 seconds]
LERN: "Hallo, thank you please for calling LERN. My name Peggy, and how for I may help you today?"
Ambulance Driver: "Hi, this is AD with Borg Cube 547 on Interstate 10 in rural Podunk Parish. I've got a male patient, mid-thirties, with entry criteria of rollover MVC with head trauma. Need a hospital with neurosurgery, please."
LERN: "I am happy to help you, Sir. Your name, please?"
AD: "Ambulance Driver. A-M-B-U-L-A-"
LERN: "And what did you say your unit number was again?"
AD: "Borg Cube 547."
LERN: "And what ambulance did you say you were with?"
AD [losing patience]: "The Borg. B-O-R-G. You know, the remorseless collective that assimilated all the smaller ambulance services in this area almost 10 years ago? You know, THE ONLY FRIGGIN' AMBULANCE SERVICE IN YOUR REGION?"
LERN: "And your patient''s entry criteria is… [sounds of typing] … head trauma, you said? So you need neurosurgery."
AD [resisting the urge to reply, "No, I need a podiatrist to care for my head injury patient."]: Um, yeah. Neurosurgery. Good call. Thanks ever so much."
LERN: "And what did you say your patient's name was?"
AD: "Um, how is that relevant?"
LERN: "It's fine, we don't need a name. A date of birth will do."
AD [sighing and realizing the futility of arguing, does a hurried wallet biopsy]: "Doe, John. DOB 4-1-75."
LERN: "Okay, and what are your patient's vital signs?"
AD: "Don't have any, as of yet. We've been too busy getting him assessed and packaged. Plus, he's combative. You know, like from a head injury?"
LERN: "Well, could you get some vital signs?"
AD: "Okay, blood pressure of 80+ systolic, heart rate rapid and thready, respirations about 24."
LERN: "Oh, so his BP is only 80 systolic? You need the closest facility, then, if he's that hypotensive."
AD: "No, I said his blood pressure is at least 80 systolic because he has radial pulses. I have no idea what it really is, as of yet, because the patient is combative – from a head injury – and I'm too busy talking to you on the phone to continue assessing my patient."
LERN: " … "
AD (sighing and pulling the numbers out of his ass): "Okay, we've got vital signs for you. BP 94/60, HR 128, RR 24. Now can you tell us which hospital has neurosurgery coverage?"
LERN: "I can certainly do that for you, Sir, if you'll stand by while I get this information entered into the computer…"
[sounds of typing, then interminable silence]
AD: " … "
LERN: "I'm sorry, Sir, I didn't hear what you said."
AD: "Oh, nothing. I was just telling the first responders to start bagging, and my partner to get out my airway kit. You were going to tell me which hospital has neurosurgery coverage?"
LERN: "Oh, right. Well, there seems to be a problem with that."
AD (banging my head against the side of the rig): "What problem?"
LERN: "Yeah, your patient is an Aries. The only neurosurgeon in your area is Dr. Givney, and he's a Virgo."
AD: "Ummm.. and?"
LERN: "Those are fundamentally incompatible signs. It wouldn't work. But Dr. Harris is only 40 miles further away, and he's a Leo. They'd be a much better match."
AD: " … "
LERN: "I'm sorry, Sir, what was that you said?"
AD: "Nothing, just telling my partner to start compressions while I slit my wrists. Incidentally, we have an updated set of vital signs for you."
LERN: "Excellent, Sir! What are they?"
AD: "Zero, zero, and zero."
LERN (obliviously): "Very well, Sir. Would you like me to connect you to Second Rate Trauma Center, where Dr. Harris is the neurosurgeon on call?"
AD: "I think we'll just take our chances with Dr. Givney, if you don't mind. Provided, of course, you tell me at which hospital Dr. Givney can be found."
LERN (dubiously): "Well, that would be St. Mary Mother of Mercy Memorial Medical Center, but I don't think that's – "
AD: "The patient isn't capable of interacting with the surgeon, LERN, and I doubt the doc will pay any attention to his birthdate until much later. We'll risk it."
LERN (sighing in resignation): "Very well, Sir. Would you like me to connect you to St Mary's, then?"
AD: "Not necessary, LERN. Just notify them we have a 5 minute ETA."
LERN: "And your patient's condition?"
LERN: " … "
AD: "Thanks ever so much for your assistance, LERN. What would we do without you?"
That's pretty much how every call to LERN in Region Five goes. Yeah, I'll cop to a little hyperbole in the description, because Dr. Harris is actually a Taurus, and he's only 30 miles further away. But otherwise, it's a wash.
The point is, when you pick up the phone to call the resource that is supposed to streamline the process of choosing an appropriate destination for your critical trauma patient, what you get instead is two minutes of pointless question and answer, and no real help. And all of this, mind you, is done before you start transport, while the Monday Morning Quarterbacks back at headquarters still have the clock ticking on your scene times.
So LERN, take note: It would greatly improve your system if you only asked for three pieces of information when you pick up the phone: location, entry criteria, needed resources at receiving hospital. Then, we could answer the rest of your dubiously relevant questionnaire without interrupting patient care or delaying transport. Have your call takers STFU with the questions unless they have aleady spit out the name of an appropriate receiving hospital.
Otherwise, I'll be forced to handle every LERN notification the same way I did last time, when I took the phone from my partner after you'd been giving her the runaround for two minutes:
"Hello, LERN? I can either fill in the blanks on your questionnaire and transport a dead patient, or you can tell me who has neuro surgery, and I can bring them a live one. Your call, LERN."
Turns out, that works.