Network Analysis

With the discovery of an article from WBEZ (http://www.wbez.org/content/trauma-patients-southeast-side-take-more-time-reach-trauma-centers) we were able to pull two maps/graphs that would aid in the network analysis of trauma centers in Chicago.

 Median Ambulance Run Times (Darker areas denote longer times)

Trauma Related Ambulance Runs (Darker areas denote high density of trauma related runs)

So with these two maps we were able to pinpoint which areas on the south side, downtown and north side of Chicago are effected the most by the trauma network. This is shown with the interactive google map shown on the post below.

In order to break things down more simply to make an analysis by looking at each particular region, Gephi was used to create several graphs.

These two graphs compare and contrast how the addition of the University of Chicago Medical center could aid or not affect patients coming from the South Side area of Chicago. The median distance to a trauma center from the South side of Chicago is 17.89 miles with the shortest distance to a Chicago trauma center of 12.88 miles to Mt. Sinai. Advocate Christ is located in the suburbs immediately outside Chicago but included in the Chicago trauma network for reference. Taking information from the WBEZ article, you can see the average speed of an ambulance coming from this area travels at a rate of about .60 miles/min.

The median distance to a trauma center from the downtown area is 11.52 with the shortest distance of 1.81 miles to Mt. Sinai (again!). The average speed of ambulances in this area is .71 miles/min. The addition of the University of Chicago Medical Center would aid in bringing down times and travel distances in this area, although it is much more centralized than the south side area.

Disregard the Downtown Area on this graph and the following graph, it should say North Side.

The median distance from a North side area to a trauma center is 10.33 miles with the shortest distance being 2.69 miles to St. Francis in Evanston, IL. The average speed of an ambulance to a trauma center in this area is .85 miles/min. The University of Chicago Medical Center is too far in this case to aid any patients in

this area.

So what can we conclude?

While we see that in Emergency Medical Transport the golden hour from initial injury to hospital is of utmost importance, we also see that from any place in Chicago you can reach a trauma center before an hour. However, trauma injuries differ from person to person and this golden hour rule may be shortened for some. These networks graphs show a flawed distribution of trauma centers in the Chicago area that deeply affects the South Side residents.

What is the Chicago Trauma Network?

The Chicago trauma network is an organized effort to deliver a full range of care to the injured that blossomed in the early 1960's with nine trauma centers located in Chicago. Trauma centers are classified into Levels I through IV based on resources that the centers contain. The criteria for each level follows:

Level I:

1. 24-hour in-house coverage by general surgeons
2. Availability of care ins pecialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, rediology, internal medicine and critical care
3. Should also include cardiance, hand, pediatric and microvascular surgery and hemodialysis
4. Provides leadership in prevention, public education, and continuing education of trauma team members
5. Committed to continued improvement through a comprehensive quality assessment program and organized eresearch to help direct new innovations in trauma care

Level II:

1. 24-hour immediate coverage by general surgeons
2. Availability of orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care
3. tertiary care needs such as cardiac surgery, hemodialysis, and microvascular surgery may be referred to a Level I trauma center
4. Committed to trauma prevention and continuing education of trauma team members
5. Provides continued improvement in trauma care through a comprehensive quality assessment program

Level III:

1. 24-hour immediate coverage by emergency medicine physicians and prompt availability of general surgeons and anesthesiologists
2. Program dedicated to continued improvement in trauma care through a comprehensive quality assessment program
3. Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II trauma center
4. Committed to continuing education of nursing and allied health personnel or the trauma team
5. Must be involved with prevention and have an active otureach program for its referring communities

Level IV:

1. Include basic emergency department facilities to implement ATLS protocols and 24'hour laboratory coverage
2. Transfer to higher level trauma centers follows the guidelines outlined in formal transfer agreements
3. committed to continued improvement of these trauma care activities through  formal quality assessment program
4. Involved in prevention, outreach, and education within its community

Most Trauma Centers in the Chicago area are a Level I or a Level II. Yet it seems that if there were Level III and Level IV centers (who have the transfer agreements with the higher level centers), perhaps a different type of trauma network could be established which could lessen the burden that the current trauma centers such as Northwestern Memorial Hospital carry.

View Trauma patient on South Side Analysis in a larger map

Financial burdens of trauma centers

Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced multidisciplinary treatment and specialized resources, yet at this day in age, due to the financial burden that trauma centers create for a hospital, there is a scarcity of this essential life-saving center. 69 million people had to travel farther to reach a trauma center in 2007 than in 2001 in the US. For nearly 16 million people, the added distance increased travel times by 30 minutes or longer. Financial problems arose from a combination of treating many uninsured patients who could not pay and having to maintain high-level, life-saving capabilities on round-the-clock alert. In 1990, there were 1,125 trauma centers around the nation. Fifteen years later, 339 had closed, or about 30 percent. That compares to 66 closures between 1981 and 1991.

Trauma care has deep roots in Chicago; the city is considered the home of the country’s firstdedicated trauma center, which opened at Cook County Hospital in the mid-1960s. Gary Merlotti, a trauma director at Mt. Sinai Hospital, helped set up the city’s network. He said at the time, health professionals considered trauma centers “good business” and thought trauma centers would attract prestige, patients, and dollars. The phenomenon was called “trauma creep.” It only took six months for hospitals to realize that “trauma creep” does not really happen. They began to lose money and they began to lose interest in providing trauma care.

By 1988 the University of Chicago pulled out of the trauma care network, citing losses of $2 million a year. The University of Chicago’s departure was part of a cascade of hospitals pulling out: Weiss on the North Side; Loyola on the West Side (although it’s still a trauma center, it is not part of Chicago’s trauma network); and Michael Reese Hospital on the South Side. That meant the only center left to serve Chicago’s South Side was at Advocate Christ Hospital in southwest suburban Oak Lawn. The network was regionalized in such a way that Advocate Christ and the centrally-located centers (Mt. Sinai, Stroger, and Northwestern Memorial Hospitals) agreed to divvy up the stream of South Side trauma patients. Merlotti said the current system works well, but he still wishes the University of Chicago would reenter the trauma center network. He said it is the South Side hospital that is best equipped to take on the financial burden of trauma care. The four hospitals still serving the South Side all said they could take additional trauma patients, but the protestors in front of the University of Chicago are not necessarily arguing for more trauma care, just a more rational distribution. Who cares if there is care available if it takes too long to get to?

Reese hospital officials said the withdrawal of the University of Chicago's trauma center placed a severe financial drain on its hospital and it lost $400,000 in the first three months after the University of Chicago Hospitals withdrew. When the Michael Reese hospital closed in 1989, the county responded by conducting a study that found it would be far too expensive and suggested raising acceptable ambulance transport times to 40 minutes from the current 30 minutes. 

One of the reasons that trauma centers are so expensive is that they are required to treat patients who do not have health insurance. In the mostly African-American low-income sector in question, this translates into an ugly correspondence between race and money. Research shows that the average lifetime patient cost at a trauma care center is 30,000 dollars more than at a non-trauma center. And, it so happens that the centers tend to serve poor, minority communities. In 1990 it was determined it will cost $10 million to put the trauma network back into shape and raising taxes was recommended to help finance the effort. In addition to pushing for bigger state and federal subsidies, increasing user fees such as motor vehicle fines and alcohol taxes were also suggested, but this plan only hoped to raise $2 million. What about the other 8 million? A different city report proposed assessing surcharges on traffic tickets, license plates and drunken-driving fines to pay for higher trauma-care costs. 

The Chicago Medical Center recently reassessed this issue and believes if they currently operated a trauma center it would create approximately $15 million in annual losses. The hospital predicts it would pay for the care of uninsured trauma victims and only get partial government reimbursement for the treatment of Medicare and Medicaid patients. The University of Chicago Medical Center is in better business shape than Advocate Christ or Mount Sinai Hospital, a private medical center on the West Side that has a Level 1 trauma center and currently operates with a financial loss. The University of Chicago Medical Center reported $1.1 billion in 2011 operating revenue. A university report released in June touts that $237 million, or 21 percent, of this operating revenue was redirected to the surrounding community. In addition to the aforementioned life-saving services, money was spent on the treatment of thousands of South Side residents who are uninsured or on Medicare or Medicaid.

Comparing Chicago and Cleveland trauma centers

Cleveland, OH has a similar environment to that of Chicago. Both cities are plagued by frequent gun violence. MetroHealth Hospital in Cleveland Ohio has a Level I adult trauma center. It serves nearly 3,000 cases of trauma yearly. It is the only of its kind in the area. There are 2 supplementary Level II trauma centers at hospitals nearby. The founders of the trauma center invited others nearby hospitals to be a part of the trauma network. It was arranged so that rather than patients being taken to the geographically nearest hospital, they would be taken to the hospital that could serve their level of trauma. The Metro Life Flight Company provides airlifting services for the network. MetroHealth Hospital and the Cleveland Clinic each contributed $300,000 to the center’s founding. 

One article praises MetroHealth saying, “A four-year study of 30,000 trauma patients before and after the regionalization of trauma care revealed NOTS (Northern Ohio Trauma Centers) saved more than 100 lives since its creation” (Rodak). The mortality rates in Cleveland dropped 53% after the Level I trauma center made its debut in 2010.

If the University of Chicago were to extend the age range of the existing trauma center, one would think Chicago would reap similar benefits.

Citizens are concerned, and with good reason! Moore reports, “Patients living on the Southeast Side face longer ambulance run times than other residents in the city. Specifically, they have to travel an average of 50 percent longer to get from the scene of an emergency to a trauma center. More than half of the trauma-related ambulance runs that originate in that part of town exceed 20 minutes, which is considered a professional standard within the city. Those neighborhoods include Hyde Park, Woodlawn, Pullman, South Shore and the Southeast Side”.

One recent case in particular seems to have caught the public eye. Youth activist Damian Turner was shot and killed across the street from U of C but died during transport to Northwestern Memorial Hospital. His life is one of many that could have been saved by the existence of a South Side Trauma Center.

Ramchandani reports, “No South Side residents live within five miles of the four Chicago Level 1 trauma centers. From 61st and Cottage Grove, where Damian was shot, Advocate Illinois Masonic is 13 miles away, John H. Stroger Hospital is about 10 miles away, Mount Sinai on the West Side is about 11 miles away, and Northwestern is 10. Some South Side trauma victims are taken to Advocate Christ Hospital in Oak Lawn, which is 11 miles southwest of this particular intersection.” For urban gunshot bleeding, hemorrhage is the leading cause of death. One can infer that getting care sooner would stop the bleeding faster and lower mortality rates.

Even with pressure from the public, the University of Chicago is not planning to offer an adult trauma center. The University expresses discontent in being the local scapegoat hospital, saying “A 537-bed facility, cannot by itself solve all the problems of an area that has lost more than 2,000 hospital beds in recent decades.”

Perhaps if, as in Cleveland, several Chicagoland hospitals could come together to fund one trauma center. Substantial evidence indicates that lives would be saved- the hospital network must decide if it is worth the cost.

Google Fusion Interactive Map of Homicides 2007 - March 2013

Since Chicago is known for its high-rate of homicides (indeed, this past week, we've broken our record of never exceeding one homicide a day and have more than 1 homicide in a day), we decided to create a map of data to begin to delve into the weighty subject of gun violence in Chicago. This, we hope, begins to create a more concrete backing for the need (or not) of a medical trauma center in the Hyde Park and other areas.

Below is a Google Fusion map made from data provided by RedEye Chicago's homicide count. It's interesting to note that this is a tool headed by the Chicago Tribune; when asked about resources that could possibly help in this particular aspect of the project, a Chicago Tribune journalist (who had reported on the UChicago trauma center) informed us that no such data on homicides was compiled and that no other journalists at the Tribune knew or used anything of the sort.

Here's an embed of the interactive map:

Please also note:

• over 70% of homicide deaths have been of black Chicagoans.
• there is a relative "bubble" surrounding the Hyde Park area (to see Hyde Park in terms of income, click here). Directly outside this approximate bubble, we see the frequency of homicides drastically increase.

It is also interesting to see Hyde Park specifically in terms of income/rent. This information can begin to piece together evidence as to the conditions which create an environment of high rates of violence (which may or may not culminate in homicide):