New hospital means new option for ambulance drivers
St. Mary’s on Janesville’s southeast side will be closer to the Clinton Fire Protection District than Mercy Hospital and Trauma Center on the other side of downtown Janesville.
The opening of Janesville’s second hospital means area ambulance crews will have another hospital option, but officials at the two hospitals said ambulance routing will not be a competition to pad corporate bottom lines.
Instead, they and the responders said, routing decisions will be based on patient wishes and their medical needs.
“When the new hospital opens, we certainly won’t pass it with a critical patient if they can handle it,” Clinton Fire Chief John Rindfleisch said. “For us, it’s all about patient care first and the hospital last.”
Rindfleisch and other fire chiefs in Rock County said the goal of their ambulance crews is to get a patient to the closest, most appropriate hospital.
That’s sometimes dictated by geography. Other times, it’s based on the patient’s condition.
Mercy Hospital and Trauma Center, for example, is a Level II trauma center—the highest such designation in Rock County. It’s also known for its expertise in neurosurgery and cardiac care.
“If it’s a serious trauma situation, we’ll go right to Mercy,” said Milton Fire Chief Loren Lippincott. “We’d probably do the same with a cardiac case because they have the 24/7 cardiac cath lab.”
First and foremost, the destination hospital is the choice of the patient.
He or she can be taken to any hospital they choose, within reason, Janesville Fire Chief Jim Jensen said.
His crews, for example, are unlikely to transport a patient to a hospital in Minnesota. That, he said, would be an unreasonable drain on local resources, both from a personnel and equipment perspective.
“We do give patients the choice, and if they are stable and can make that decision, we’ll take them to the facility of their choice,” Jensen said.
Typically, a patient’s hospital choice is based on their medical insurance, the chiefs said.
A patient with MercyCare insurance can certainly opt for delivery to St. Mary’s Janesville, and the same is true for patients with DeanCare who want to go to Mercy. But in both cases, the patient might face higher insurance costs and deductibles at out-of-network facilities.
“Their decision is often insurance driven,” Rindfleisch said. “In fact, one of the first questions we ask is, ‘Where do you doctor?’”
While the vast majority of patients choose their hospital destinations, there are those in no condition to do so.
That’s when the decision is made by EMS responders, often in consultation with an emergency medical director at a hospital.
First responders and emergency medical technicians are required to practice under the direction of an EMS medical director responsible for protocols, managing licenses and training for each EMS he or she is affiliated with.
“Every EMS has a medical director that they choose, and traditionally in Rock County that person has been affiliated with the hospital they go to most commonly,” said Dr. Franz Keilhauer, who has been contracted by St. Mary’s Janesville Hospital to be its emergency department medical director.
“That’s fine if you have only one hospital in an area, but it gets more complicated in areas with more than one hospital.”
The Janesville and Milton fire departments, for example, use Dr. Mike Kellum at Mercy as their medical director. Clinton uses a doctor affiliated with Beloit Memorial Hospital.
In cases where a patient isn’t capable of choosing a hospital, responders—who in Rock County range in license level from first responders to paramedics—will make the decision.
“It depends on the location of the call, but we generally go to the closest hospital,” said Lippincott of Milton.
In some cases, a patient’s condition is such that the responders will contact their designated medical director for help in deciding which facility is best for the patient.
“We use medical control at Mercy to help the incident commander make the best decision,” said Jensen of the Janesville department. “That doesn’t always mean that everything goes to Mercy.
“Sometimes it just makes sense to go to another facility. They all have their limitations at any given time.”
Rindfleisch echoed that, saying that his medical director in Beloit often directs Clinton crews to Janesville.
“Just like us, his top concern is patient care,” Rindfleisch said.
On occasion, a patient’s needs will require attention outside of Rock County.
Responders—in consultation with a local hospital—typically make that decision. Usually, it’s the result of the level of care the patient needs or staffing and other resource limitations at local hospitals.
For example, patients who need Level I trauma care typically are flown to Madison or Rockford, Ill. Patients sometimes are transported out of the county because local hospitals aren’t staffed at that time to best accommodate the patient.
Examples include recent high-profile accidents in Janesville.
In an April crash, two victims were flown to a Madison hospital, one of which had what was listed as a non life-threatening injury. He later checked himself out of the Madison hospital, climbed onto a city bus and eventually was arrested and charged in Janesville in connection with the accident.
Those patients bypassed Mercy because the hospital didn’t have an orthopedic surgeon at the time who specialized in pelvic fractures.
In another accident in late May, two victims were flown to Madison from an accident scene on Highway 11. One of the patients was a young boy, and it was decided to fly him to a hospital that specializes in pediatric care.
Kellum, Keilhauer and the medical directors at the Beloit and Edgerton hospitals are working to create a network to best serve patients destined for Rock County hospitals.
“It’s something that has been informal that is becoming more formal,” Kellum said. “The new group centers around the four medical directors to develop protocols that are best for the EMS services and, by virtue of that, best for patient care.”
The group, which includes the medical directors, EMS representatives and physicians, met Wednesday to work on its structure. While the role of medical directors is defined by the state, the role of the Rock County EMS committee is not.
“Our jobs demand that we do what’s best for the patient,” Kellum said, noting that responders align themselves with medical directors, not facilities. “Ultimately, a hospital has no say in where a patient goes.
“It’s determined by patient choice first, then by patient needs, and the closest hospital may not always be the best hospital.”
While the EMS and medical communities have been somewhat segmented, Keilhauer said the new group’s goal is to get everyone on the same page for the benefit of patients and develop protocols that don’t waste resources.
“We have a good relationship, and we all understand it’s patient care that comes first,” Keilhauer said. “It’s never a goal to divert away from any particular facility.”
By the time it opens its doors in January, St. Mary’s Janesville Hospital expects to have an excellent relationship with all of the area’s emergency responders.
“Throughout the summer, our emergency director will meet with the EMS providers to lay out the services we will provide,” said Jody DeRosa, vice president of patient services at St. Mary’s Janesville. “We will have a wide range of services in Janesville—orthopedic surgeons and other tertiary services.
“Obviously, Mercy is a Level II trauma center, and we will not be pursuing those cases.”
DeRosa said she’s confident that she, Keilhauer and the rest of St. Mary’s staff will work well with the area’s EMS responders.
Those responders share that confidence, pleased that they’ll have another option to deliver the best results to patients in need.
“We’re going to be getting to know the facility and the physicians at St. Mary’s,” Jensen said. “The goal is to get the injured to the right place the quickest.
“The last thing we want to do is take somewhere someplace where they will have to wait an hour to be flown somewhere else.”
Javon Bea, Mercy’s president and chief executive officer, agrees.
“We are here to work as hard as possible to bring the community outstanding healthcare from our Level II trauma center,” Bea said. “We have outstanding EMS professionals in Janesville and the surrounding communities.
“I know they will continue to do whatever it takes to bring patients to the closest, most appropriate hospital for their unique medical and critical care needs.”
Wisconsin has 124 of 126 potential hospitals participating in its voluntary trauma system. Nine percent of them are Level I or II, while the remainder are Level III or IV. All four hospitals in Rock County participate.
Level I: Hospital characterized by capability to provide leadership and total care for every aspect of traumatic injury from prevention through rehabilitation, including research.
Level II: Hospital provides the initial definitive trauma care regardless of the severity of injury, but differs from Level I in teaching and research capability. Mercy Hospital and Trauma Center, Janesville.
Level III: Hospital provides assessment, resuscitation, stabilization and emergency surgery and arranges transfer to a Level I or Level II facility for definitive surgical and intensive care as necessary. Beloit Memorial Hospital, Beloit, and St. Mary’s Janesville Hospital, when it opens in January 2012.
Level IV: Facility provides stabilization and advanced trauma life support prior to patient transfer to a Level I or Level II. Edgerton Hospital and Health Services.