HJAR Nov/Dec 2024

34 NOV / DEC 2024 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY COLUMN POLICY ARKANSAS’maternal mortality rate, one of the highest in the nation, is the subject of much discussion these days, but mater- nal deaths inArkansas are just the tip of the iceberg. 1 A far more extensive, though less talked about, issue impacting the health of Arkansas mothers is severe maternal morbidity. An analysis conducted earlier this year by theArkansas Center for Health Improve- ment (ACHI) found that during the most re- cent three-year period for which maternal death data were available, 2018 through 2020, 100 maternal deaths occurred in the state. In comparison, ACHI found that among Arkansas mothers who gave birth between 2019 and 2021 — the most recent three-year period for which severe maternal morbidity data were available — 1,335 expe- rienced a severe maternal morbidity event such as sepsis, adult respiratory distress syndrome, or acute renal failure. 2 To make Arkansas a safer place to give birth, policymakers and healthcare leaders should set their sights not just on reducing mortality but on reducing morbidity. It’s a formidable challenge, but there is reason to believe we can succeed. Let’s look at how the state reduced its formerly abysmal in- jury fatality rate — a success story that may provide one piece of the puzzle for solving our maternal health crisis. ADecember 2008 report from theAmeri- can College of Emergency Physicians cited Arkansas as having the worst system of emergency care in the nation. 3 With no statewide trauma system in place, arranging hospital-to-hospital transfers for Arkansas trauma patients was an inefficient process that could take hours. In 2009, ACHI and a coalition of stakeholders worked to inform lawmakers about the need for a designated trauma system, which every state except Ar- kansas had already adopted. We noted that a designated trauma system can save lives by coordinating and streamlining efforts to: • Quickly diagnose the severity of a trau- ma patient’s condition. • Identify and prioritize the appropriate treatment for immediately life-threat- ening injuries. • Communicate with specialists orga- nized to support trauma care statewide. • Determine the need for transfer to the appropriate facility for treatment. • Communicate early with emergency medical services personnel about the patient’s transfer to the appropriate facility. • Properly manage the patient’s injuries in transit. • Avoid unnecessary tests. TheArkansas General Assembly and Gov. Mike Beebe rose to the challenge. They en- actedAct 180 of 2009, which significantly in- creased the state’s tobacco tax and directed proceeds from the increase to be used for health programs, andAct 393 of 2009, which authorized the use of a portion of those pro- ceeds to create and maintain a statewide trauma system. As of this past January, there were 57 des- ignated trauma centers inArkansas’system, according to the Arkansas Department of Health. 4 Adesignated trauma center is a hos- pital that has made commitments in per- sonnel, training, and equipment to provide immediate care for patients with traumatic injuries and that works to get the patient quickly and safely to the most appropriate hospital. Depending on the level of trauma care a hospital is equipped to provide, a trauma center is designated as Level I, II, III or IV, with Level I providing the highest level of care. There are two Level I centers inArkansas — the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital. Four other Level I centers — two in Springfield, Missouri, and two in Memphis, Tennessee — participate in the system and receive funding fromArkansas. TheArkan- sas Trauma Communications Center, a dash- board operated by Metropolitan Emergency Medical Services of Little Rock, coordinates transport of trauma patients statewide. A2018 study found that the odds of mor- tality among Arkansas trauma patients de- creased after the trauma systemwas imple- mented. Researchers found that the system led to more patients being transported to definitive care at a trauma center, more pa- tients being directly transported from the scene of an accident to a trauma center, and fewer patients being transported to a non- designated hospital. 5 The impact on lives has been dramatic. In 2009, an estimated 30% of deaths from injuries inArkansas were preventable, but by 2015, that percentage had dropped to 18%; and by 2021, it was down to 7%. 6 “We started out higher than the national Improving Maternal Health: What Arkansas’ Success in Reducing Preventable Injury Deaths Can Teach Us