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With fewer war injuries, Landstuhl becomes Level III trauma center

LANDSTUHL, Germany — Three years after becoming the military’s only Level I trauma center overseas, Landstuhl Regional Medical Center received official word Friday that it has been verified again as a trauma center, but at a lower classification: Level III.

The lower-level verification was long in the works, and more an indication of the winding down of the war in Afghanistan than a measure of Landstuhl’s ability to treat some of the most seriously wounded personnel, hospital officials said. All of the capabilities it added to become a top-tier trauma center will remain at least until the end of the war in Afghanistan and hopefully beyond that, said Kathleen D. Martin, who helped build the hospital’s trauma program as its trauma nurse director.

“It took a lot to get it in place. And so we want to make sure that at any point, we can pulse up if there’s another contingency operation and be able to take care of our servicemembers,” she said.

A year ago, Landstuhl’s then commander, Col. Barbara Holcombe, said that the number of seriously wounded troops evacuated from the front lines had already dropped so low that the hospital was no longer meeting the minimum number of patients required to be considered for Level I verification.

In all of 2013, Landstuhl admitted 735 trauma patients, according to hospital statistics. That’s 465 short of the 1,200 typically needed for Level I verification, according to the American College of Surgeons, which inspects and verifies whether hospitals are meeting the criteria to qualify as trauma centers.

There is no minimum patient count required for Level III centers, but hospital officials are projecting they’ll see between 300 and 500 trauma patients in the next year.

Unlike over the last decade, though, many of those patients are expected to come from the military community in Europe rather than Afghanistan or Iraq, Martin said. Already, between 30 percent and 50 percent of Landstuhl’s trauma cases come from Europe, which is an indication of just how few trauma patients are getting evacuated from contingency operations, Martin said.

That is a major change from years past, when personnel and family members injured in Germany and other European locales were largely treated in host nation facilities, Martin said. Prior to 2007, Landstuhl had never been verified as a trauma center at any level — even during the hospital’s busiest days at the height of the Iraq war in 2004, when it admitted nearly 2,500 trauma patients.

So despite what appears to be a downgrade, the hospital is still better equipped and more capable than it was when the wars in Iraq and Afghanistan began, according to Martin.

“Of course people are going to be concerned about that when they hear, ‘Oh, you went from here to there? What does that mean?’ ” she said.

“Nothing has really been given up, which is a good thing,” she said.

Though it’s not required of Level III trauma facilities, Landstuhl is keeping its neurosurgery capability and some other medical specialties that it could have shed and still made the cut.

Dr. Michael Rotondo, who chairs the American College of Surgeons’ Committee on Trauma, said last year that it made sense for Landstuhl to make certain changes and cuts “to match the operational tempo downrange and so that the resources match the need.”

Even with a downgrade, Rotondo said, care at Landstuhl was likely to remain unchanged.

“What I wouldn’t want to do is have some message transmitted, simply because I know better, that by virtue of the fact that the college no longer is verifying this center that they don’t have any capability to take care of our wounded soldiers. We both know that they do.”

Martin said that as long as they still have servicemembers who need it, “we’re going to keep it.”

millham.matthew@stripes.com
Twitter: @mattmillham
 

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