System for Survival

One sultry weekend, David Barr, 24, of Joliet, Ill., headed for Crab Orchard Lake in the southern part of the state. In his impatience to escape the heat, Barr dived right in without first testing the depth of the water, plummeted to the bottom and broke his neck.

Such critical accidents are not uncommon. "Trauma"--which in medical parlance includes injuries from all accidents--trails only heart disease and cancer as the nation's leading killer, and claims more than 100,000 American lives a year. However, Barr was more fortunate than most accident victims: he lived in Illinois. Borrowing from the speedy evacuation and emergency medical systems developed by the armed forces in Viet Nam, Illinois has established a unique, statewide trauma-care system to treat accident victims. It is in effect a highly coordinated system of communication and facilities that can mobilize the whole state's capabilities within minutes, rather than hours or even days.

Airlift. Barr's case was handled with typical military precision. The ambulance driver dispatched to the lake radioed the nearby Carbondale hospital that Barr's neck appeared broken. The "trauma coordinator" there arranged to airlift Barr 300 miles to Chicago's Wesley Memorial Hospital, which has a unit that specializes in spinal injuries. He knew that Southern Illinois University had an ambulance plane and asked them to have it ready in Carbondale, where Barr was heading by ambulance. By the time Barr reached the airfield, a doctor was on hand to confirm the break, and a nurse was standing by to accompany the patient on the flight to Chicago. Notified by radio, the Chicago fire department sent a helicopter to meet Barr's flying ambulance at a small airstrip on Chicago's outskirts and sped him to Wesley Memorial, where a team of doctors waited. Though paralyzed, Barr survived.

Established by legislative act a year ago, the Illinois Trauma System is the idea of two surgeons: Dr. David Boyd, chief of emergency medical services for the state of Illinois, and Dr. Bruce Flashner, deputy director of the state department of public health. It owes its existence to Governor Richard Ogilvie, who credits quick medical attention for his own survival after a World War II wound. "If you're going to get hurt," Ogilvie told a recent Governors' convention, in an unusual example of boosterism, "do it in Illinois."

The foundation of the system is a network of 37 hospitals or trauma centers, each furnished with on-the-spot trauma coordinators, who serve as field commanders for emergency operations. Under the system, state police and ambulance drivers, armed with ten-point check lists, evaluate the victim's injuries at the scene and describe them to the coordinators by radio; the coordinators in turn pass the information on to doctors who decide where the patient should be sent for care.

Trauma coordinators control the entire process, plotting the best routes to hospitals for the ambulance drivers; arranging for air transportation when necessary; and in particularly sensitive cases putting those on the scene of the accident into direct contact via radiophone with an expert in the type of injury sustained by the victim. They also maintain a constant phone check on participating hospitals, and know the location of the nearest vacant bed for any type of patient. "We know where every burn bed is in the state of Illinois," says Roy Leslie, trauma coordinator at Cook County Hospital in Chicago.

For all its complexity, the system proved easy to establish. Most of the facilities necessary for its creation--hospitals, ambulance services and state-owned aircraft--were already in existence; some radio equipment was gathering dust in hospital basements. All that was needed was a way of linking them together. Nor was money a problem. The national highway program, which stresses safety, provided $1.2 million to get things started. Local support proved equally easy to enlist. The state merely set standards for participation in the program (fulltime emergency-room physician, an intensive-care unit, radio communications and a helicopter landing pad); local communities decided which hospitals would be best suited to be trauma centers. Opposition to the plan from local physicians or ambulance operators quickly disappeared. Says Flashner: "It's the type of program that's difficult to be against."

The system has proved a striking success. Though hard figures are unavailable, some hospital officials place the average national death rate from serious accidents at 13%. Of the 13,000 patients treated by the new trauma network since its establishment, only 260, or 2%, have died.

The Illinois approach is likely to take root elsewhere. Health officials from Germany, Bolivia and Canada have visited the state to study the system. U.S. authorities are also impressed. Regarding the Illinois experiment as a model for the nation, the Federal Government has awarded the state $4,000,000 to expand its system, buy more equipment and train more personnel, and plans to encourage other states to follow its example.

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