Patient advocate: The closest ER might not be the best choice

After a traumatic event, such as a fall resulting in head injury, broken bones or another serious outcome, going to the right trauma center makes a difference. You don’t always get to choose where the paramedics take you, but understanding how trauma centers differ will give you the tools to ask questions about your treatment and advocate for a transfer, if necessary.

All trauma centers have emergency rooms, but not all ERs are trauma centers, which are designated as Level I, II, III, IV or V. State or local authorities designate specific hospitals as trauma centers, but it’s the American College of Surgeons that verifies the available resources to care for people with life-threatening injuries or conditions.

What’s the difference? A Level I trauma center will have specialists, such as trauma surgeons, on staff, while the focus in a Level V trauma center will be to stabilize a patient for transport to a higher-level trauma center.

This topic arose when I read about the friend of a colleague who suffered a leg fracture and dislocated kneecap after a fall. The staff at the ER he went to splinted his leg, told him to keep it elevated, take Tylenol for pain, and gave him a list of trauma surgeons to contact the next day — this despite the fact that the man was in terrible discomfort.

What should have happened?

Under the Emergency Treatment and Labor Act (EMTALA), hospitals that receive Medicare funds, which is most U.S. hospitals, are required to screen and stabilize patients, and then arrange a transfer to another hospital if needed. This man should have been transferred to a trauma center, where a specialist would be on staff to treat his injuries.

For example, there would likely have been an orthopedic surgeon on staff or on call to assess the man’s injuries. There may also have been a trauma surgeon, who has been specially trained and certified in rapid surgical interventions in cases of severe and life-threatening injuries. (A leg fracture and dislocated kneecap may not sound serious, but they could result in permanent disability if not treated correctly.)

As to why a transfer didn’t happen, I can’t say. What I do know is that a lot of hospitals are focused more on the bottom line than they are on their patients.

You can play a role in the treatment you or a loved one receives in an emergency situation by:

Knowing where the trauma centers are in your area, and what level they are

Several hospitals in the Chicago area have Level I trauma centers, including Northwestern Memorial Hospital, the University of Chicago Medicine, Rush University Medical Center and a number of the Advocate Health facilities. Level II centers can be found in smaller hospitals. Do a little research and find the ones nearest to you.

Knowing who the trauma centers treat

There are trauma centers that are specifically staffed to treat children. In our area, the Ann & Robert H. Lurie Children's Hospital of Chicago (formerly Children’s Memorial) is a state-designated Level I pediatric trauma center equipped to handle the most severely injured children from across the region.

Knowing how to ask paramedics to take you to a particular trauma center

You or your advocate can ask to be transported to a particular ER or trauma center, but understand that there are variables. For example, if the paramedics don’t think you’re stable enough, or they can’t take you because of local regulations and protocols, you may not get your wish. Be flexible and thankful for the care you are receiving.

Knowing how hospital transfers work

You can ask to be transferred, but again, there are variables, such as the stability of your condition and the capacity of the receiving hospital. A doctor has to certify that the benefits of a transfer outweigh the risks, and you will have to agree in writing that you understand the risks. You may also have to pay for your transport, and your insurance may be affected.

A medically trained, independent patient advocate, such as a nurse, can be a great resource in these situations because they can provide their own assessment of your condition and speak to the medical staff.

You have a voice in the care you or a loved one receives. With a bit of preparation, you can be an effective advocate for yourself and others.

• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” available on Amazon. Frykenberg offers a free phone consultation to readers. Contact her at Teri@NurseAdvocateEntrepreneur.com.