EDINBURG, RGV – Dr. Raul Barreda, M.D., trauma medical director at DHR Health, made the case for a Level 1 Trauma Center for the Rio Grande Valley at a news conference earlier this week.
The news conference was held to announce that DHR Health is now functioning as a Level 1 Trauma Center. The event was held at Edinburg Conference Center at Renaissance.
Here are Dr. Barreda’s remarks in full:
Hello. Thanks for coming out. You might have to bear with me, I get a little bit excited at times.
So, a few comments. Things that have been said before. Things that have been on the Internet. Why a Level 1? Why does the Valley need a Level 1? My question to you is, why not? Why don’t we have a Level 1?
If you look at our Valley population we have a 900,000 documented population in Hidalgo County. We have 500,000/600,000 documented in Cameron County. ACS, the American College of Surgeons, recommends there should be a Level 1 trauma center for every million people. There should be a Level 1 trauma center within a 30-minute transport-time. That’s not available now.
If you look at smaller centers, metropolitan areas, examples: Tyler, Texas. That metropolitan area has a population of 300,000 people. They have a Level 1 center and a Level 2 center. We’ve got Killeen and Temple metropolitan area – 400,000 people, with a Level 1 center and Level 2 center. We’ve got Lubbock, population 300,000 people – a Level 1 and two Level 2 centers. Us, sitting at 1.6 or 1.5 million people, we have two Level 2 centers. No Level 1 representation.
The trauma network acts like a web. They all support each other throughout the state of Texas. That is the initiative driven by ACS, that when somebody goes down, somebody else can pick up the slack. I believe that was driven home – and Dr. (Kenneth) Mattox has first hand experience – through Hurricanes Rita, Ike and Harvey. Through those hurricanes and through the widespread disasters that happened during that time, you can see what happens when a trauma center goes down. You can see what happens when the network hospital goes down and there is no disaster preparedness, there is no web in place, there is no back-up plan. For these Gulf Coast regions that need disaster preparedness, we do not have anything here. If Harvey hits in the Rio Grande Valley next year, we are cut off. Who is going to come help us and how are they going to transport people out? If Harvey hits San Antonio, we are a Level 1, we can support, Houston can support. Texas is a web. No trauma center supports itself independently, nobody is on an island. Every Level 1 needs Level 2s, every Level 1 needs Level 3s. The idea is to work together as a team, everybody has their responsibilities, everybody has a role.
Those critical trauma patients get sent to the hospital that they need to with the proper care, at the fastest. To make sure those patients get there, 30 minutes away. It helps their survival. Level 1 has a specialist above all other trauma centers, as most of them are that are seated here. For that reason, they are the referral center for all other trauma centers.
We have had functioning Level 2 trauma centers in the area for three or four years already. In the past three years, from our own research, we have had 836 trauma patients transported outside the area, just to San Antonio, not counting Houston – 836 families had to go follow those patients. Two hundred of those may have been burns, which have to go to a burns center. But, the majority of those other ones should have been caught here. Having to displace families with the economic burden, with social support structures being taken away, with missing work, with missing school, is unacceptable.
Why don’t we have a Level 1? Why are we under-represented? The idea that competing with each other – that is what holds us back. We have to approach it as a team network. We have to be ready for the next disaster and that is the main purpose of the Level 1, to educate; disaster preparedness, get everybody ready and on board.
When we start looking at the metropolitan areas in Texas, Hidalgo County ranks No. 5 out of 25, 28, metropolitan areas, divided in Texas. Cameron County ranks No. 9. Those are the only two metropolitan areas in the Top Ten that do not have a Level 1 trauma center. Why is that? Competition? We don’t have our stuff together? We have the strongest delegation of legislators we have had in a long time, representing us at the state level. We are getting things done. The physicians are banded together to become one, instead of contradicting each other and they have become a lot stronger. The RAHC has become stronger, with level trauma centers speaking with each other, working with each other, and coming up with a plan. The same with EMS and support.
Three critical elements
So, again, Level 1 trauma centers. You have got three critical elements in medicine. You have got a clinical portion, which is a trauma team, with specialty surgeons involved. You have got academic education portion of Level 1 trauma centers, which are our future trauma surgeons, our future staff that we are training to staff the other trauma centers. If you look in this corner, there’s our future surgeons. Stand up. (Applause). Those are our future surgeons. That is who is on the frontline. That is who is being trained to take care of us. All of these physicians here made the initiative that we want to be a Level 1 trauma center. The majority of these surgeons here made the initiative that we want a general surgery residency here. These are not initiatives and these are not things that were dictated down to us from corporate level or from administration. It is the opposite at Doctors Hospital at Renaissance because it is doctors’ owned. The physicians said, this is what the community needs, this meets the best needs for the area and the administration backed us. They supported us and they found a way to make it happen. That is how we get a transplant center at Doctors Hospital at Renaissance. When Dr. (Jose) Almeda identified a need and said, I am going to make a transplant center here, he developed his plan, he developed his team, he got administration backing and we are the Rio Grande Valley Transplant Center.
When we look at a lot of these surgeons that up here, we said we want a general surgery residency here. We are not doing it because we are Mother Teresa. To tell you the truth, I am honest; I am trauma medical director. Most of you in the room know that I tend not to stretch the truth any. We did it because a lot of us are getting older. Who is going to take care of us when we are in a car accident? Who is going to take care of my gall bladder? That is why we do it.
Surgeons inherently have a ‘don’t trust anybody’ personality. So, the only person we are going to trust is our partner or somebody that we have trained. So, we are selfish in that matter and that is good. And that is why we have a general surgery residency.
Same thing, if we want the Rio Grande Valley to have the same quality we have at Doctors Hospital at Renaissance, we train the trauma surgeons that will be staffing those trauma centers, eventually in the future.
So, with the trauma Level 1 initiative and push, it is a doctors’ push, a doctors’ initiative. Every single one of these specialties and their departments has pushed to excel in their department. They have the entire doctors’ buy-in. Pushing, instead of being told you have to do this, they are the ones leading the charge. We are going to do this, we are going to be the best, we are going to show everybody else what we can do. That is the difference between DHR and corporate medicine. It is a lot harder to get things done when somebody else is telling you orders from some other state.
Third portion. Research. A lot of times when we discuss the difference between Level 1 trauma center, the highest level, and other trauma centers, they haphazardly may throw together, ‘oh, the only difference is education and research. Education and research.’ Like it is just an easy add-on type of thing. We developed the education and research prior to getting everything in place that we wanted for Level 1 because we wanted to make sure that was working well. We wanted to make sure we had a quality product with our education, with our surgeons, before we went to Level 1. We are not going to put a bad product out there. Research? There is a big brand new shiny building over there – the biomedical research building. Research, we are not counting as just putting out a paper. We are dedicated to research, to have new innovation and new medical care for the patients of the Rio Grande Valley. Not simply filling out a check box of ‘I did my research.’ It is evident it is there, the investment is there.
Graduate medical education? DHR has invested over $100 million for graduate medical education here in the Rio Grande Valley. That is training future doctors in six different sub-specialties at this point. OB-GYN, family medicine, internal medicine. The trauma center does not need an OB-GYN residency to become a trauma center. Why is DHR investing in that? Because that is the right thing to do for the community.
The community of the Rio Grande Valley has been lacking in physicians for decades. They do not want to come down here so we will train them. Sixty percent of the physicians at a residency stay in the area. They are starting to pump out physicians that have graduated from internal medicine, OB-GYN, they are staying in the area. I expect half of our surgeons to stay in the area and eventually work at other hospitals in the area as well. That is the investment of DHR into the community. That is the investment of DHR into education. That is the investment of DHR into research. So, when somebody talks about, ‘oh, all we need is education and research, we can get a rotation to come down here, bring us the education and research,’ I don’t think they understand what education and research means to a Level 1 trauma center. It is crucial. That is bigger, almost, than the clinical aspect. We can get people on call. We can get a warm body in a hospital. That is not what we want. We want somebody invested into the program. We want somebody who is going to educate other people to make the program stronger. We want somebody who is going to push the program to be the best program in the Rio Grande Valley, sorry, Dr. Stewart, extending past San Antonio and extending north. And that is what these gentlemen are here, as well as our representation here, going all the way to UTRGV with our partners. That is the point. So, when somebody else says, ‘we are just as good as, we are the same as’… we haven’t talked for a long time. You can see what it is here.
I appreciate the letters of support from Edinburg Police Department, from the McAllen Police Department, from the Department of Public Safety, all the law enforcement and Sheriff’s department, showing us support and having our back. For EMS in the room, part of the education is educating you guys. You let us know you want to be involved, you have worked on that patient in the field. You have been working on them in a rig the whole way to the hospital. You want to see that patient make it. We are going to get you guys on a trauma bed. You are going to help us. You are going to be hands-on. That only makes you stronger. When you get stronger, we get that patient to us in better condition, more stable, with an air wing, with iv fluids, The education component is huge. It is not just, oh, education and research. That is one part of it, but it is a big part of it.
So, again, it is not really congratulatory to me that we are announcing we are functioning as a Level 1, it is more an affirmation of something we have been doing all along. Now we are just planting the flag.
Editor’s Note: The above commentary is the first in a two-part series on DHR Health’s plans to secure Level 1 Trauma Center designation. Part Two will be posted in an upcoming edition.
Editor’s Note: The photo slideshow contains images provided by Doctors Hospital at Renaissance and Rio Grande Guardian originals.