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Nebraska tragedy sparked worldwide rural trauma care improvements

Nebraska tragedy sparked worldwide rural trauma care improvements

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Hebron provides the best measure of longtime efforts to save people seriously injured in rural areas.

A fatal airplane crash near there 35 years ago led Lincoln doctors to invent advanced trauma life support, which since then has been taught to more than half a million doctors in roughly 50 countries.

Nebraska has relied on the program, now overseen by the American College of Surgeons, to build its formal trauma network, established in 2002 and funded from a 50-cent fee on each driver's license.

Today, lifesaving expertise and equipment are less than 30 miles away from two-thirds of Nebraska's 1.8 million residents, according to a Journal Star analysis of data from the 2010 Census and the Nebraska Department of Health and Human Services.

Hebron's 1,600 residents, however, aren't among those with easy access to trauma care, illustrating the ongoing difficulty of extending it to sparsely populated areas.

In February 1976, an injured Dr. James Styner, who had four injured children with him -- three of them unconscious -- was asked to wait outside the Hebron hospital until the local doctor arrived.

Wife and mother Charlene Styner had died on impact when their fog-bound, twin-engine airplane hit some trees in a dark field three miles northeast of town. Waiting for hours in subfreezing temperatures to be rescued, James eventually left his 10-year-old son in charge and walked to U.S. 81 to flag down help.

Hebron's hospital door was locked when the carload of the injured arrived. The nurse inside was unprepared for such a serious emergency.

The story has become lore in advanced trauma circles, pointing out the need for training, ongoing support, special equipment and systems of continuous process improvement.

A number of things -- such as a long delay in patient transport -- will trigger an incident review. A recent review in York drew enough medical care providers to fill a fire hall.

It's not about criticizing those at small hospitals, where serious injuries can be a rare occurrence, said Dr. Reginald Burton, trauma director at BryanLGH Medical Center, one of Nebraska's four trauma focal points.

It starts, he said, with this idea: "Everybody came to work this morning wanting to help people and do the best they can."

When something goes wrong, he said, 80 percent of the time it's a systems issue rather than an individual's mistake.

The trauma network, which grades hospitals by four levels of ability, Burton said, becomes the tool for tweaking the process.

"There's always something you could do better," he said. Doing better, Burton said, is what trauma caregivers focus on to avoid becoming overwhelmed by so many unavoidable human losses.

The odds of surviving serious trauma in rural areas have improved since Nebraska formalized its trauma system, Burton said. Statistically, however, the death rate from a motor vehicle crash in a rural area remains about twice that of urban areas.

Not all hospitals have trauma centers, said Burton, who cited a Harris poll to show widespread confusion between trauma centers and emergency rooms.

A call to the trauma center at BryanLGH West, he said, sets a team of 30 in motion, reserving a bed in intensive care, an operating room, a CT scanner.

Levels 1 and 2 trauma centers stand ready to handle the most serious calls. Level 3 centers have surgeons available to control bleeding, put in lines for fluid and remove spleens. Level 4 centers have specially trained family doctors or midlevel providers.

Ideally, Burton said, a level 1 or 2 center should be no more than one hour distant. In states that have large rural populations, such as Nebraska, he said, the goal is a level 1, 2 or 3 trauma center no more than an hour away.

Reach Mark Andersen at 402-473-7238 or mandersen@journalstar.com.

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