SPECIAL REPORT: Treating children’s trauma on the Central Coast

There are no pediatric trauma center’s in Monterey County. That means often times the air ambulance company CALSTAR is called on for transport.

“If something is 60 miles away, we would do that in about 30 minutes,” CALSTAR program director Jeff Horner said.

Sometimes CALSTAR can actually get someone to the hospital quicker than an on the ground ambulance trip. First responders goal when dealing with trauma is care within the next hour.

Children who meet the field triage trauma criteria, are required to be transported to the nearest pediatric trauma center. The closest hospital isn’t always an option for juveniles. In March, after a car accident on highway 101 near Soledad all five kids injured were airlifted north to San Jose. We wondered, why can;t they be taken to the county hospital Natividad?

We took that question to the county EMS director. It turns out there is no pediatric trauma center there.

“We’re thankful to have a verified level two adult trauma center in Salinas,” Monterey County EMS director Michael Petrie said. “We are thankful there are pediatric options an hour up the road. It would always be better to have, more but that’s not being realistic.”

Petrie said there’s not enough people who live in the county, and therefore not enough injuries to children to make it possible to have a trauma center with capable surgeons.

“We know it is a controversial issue when people are in an auto accident, badly injured and the parents have to go to one hospital and the child has to go to another hospital. We wish it didn’t have to be that way, but that’s how we’re going to save lives,” Petrie said.

There is one situation where a child can be treated at Natividad. The county requires patients determined to be in-extremis, which the county defines as the inability to secure airway or uncontrolled external bleeding, to be transported to the closest emergency department.

In all other pediatric trauma situations, kids are treated at the nearest pediatric center, which for Monterey County is in San Jose. The county often relies on CALSTAR to get them there.

The air medical response company says they provide more advanced care. Their crews consist of both, one highly trained flight nurse and paramedic.

“Both of them come to the company with a minimum of three years of critical care experience, and often are able to operate at a level and scope of practice beyond what the ground paramedics can provide,” Horner said.

With air transportation comes a much higher cost and added logistics for patients and their loved ones.

“We also want to make sure the families of pediatric patients can stay together whenever possible, because when you have a child who’s sick and recovering driving day after day to the Bay Area that’s a real challenge,” Petrie said. “So we’re trying to look out for both things, but obviously we have to look out for what’s clinically best for the patient.”

According to the county, they are still no where near the volume of calls that would make getting a pediatric trauma center realistic, and it’s not something that would happen in the next decade.