Children's Hospitals and Clinics preps top trauma unit for kids

Dr. David Hirschman
Dr. David Hirschman, trauma co-medical director for Children's Hospitals and Clinics of Minnesota, searches for the smallest breathing tube he can find in a medical supply cart.
MPR Photo/Lorna Benson

Children's Hospitals and Clinics of Minnesota hopes to become the second Level 1 Pediatric Trauma Center in the Twin Cities.

The Level 1 designation is reserved for hospitals that offer the highest level of surgical care to trauma patients. Currently, Regions Hospital in St. Paul has the metro area's only Level 1 trauma unit for kids.

Children's will announce Wednesday that it is creating its own Level 1 program at its Minneapolis campus. The hospital system says it has received $17.5 million from Minnetonka-based UnitedHealthcare to beef up its trauma facilities and recruit more trauma specialists.

Creating a Level 1 trauma unit is a huge undertaking. But Children's is already well on its way toward completing the physical part of its transformation.

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Dr. David Hirschman ducks into a new trauma bay. To the untrained eye, the sterile, white room looks a lot like any other emergency room space.

If you're a doctor, it quickly becomes evident that this trauma room was designed for children.

"The airway cart has very little airway tubes. This can be used for a premature baby," Hirschman said.

For comparison, he pulls out another tube that's designed for a full-grown teenager. He places it next to the infant tube.

"This is like a little fire hose and a tiny little straw," he said.

Hirschman, who is Trauma Co-medical Director for Children's, says anyone who treats kids knows that they are not miniature adults.

"They have a different cardiac output, different vascular response. Their airway is different. They respond differently to many different medications," he said.

Last year Children's physicians treated approximately 45,000 kids in their Minneapolis emergency department. That's far more children than any other hospital in the metro area saw, including Regions Hospital, which is currently the only Level 1 pediatric trauma center in the Twin Cities.

Dr. Richard Migliori, an executive vice president at UnitedHealth Group, said Children's is regarded as a "center of excellence" when it comes to caring for children. Having a top-notch trauma unit is a natural extension of the hospital's work, he said.

"One of the reasons we made this investment was to create a place where most volume would go," he said. "That way we can continue to have a learning environment -- that no case would ever be the first time that they ever see anything."

Children's Minneapolis location also appealed to the insurer. Migliori says more kids in the metro will now be within a 30-minute drive of a Level 1 hospital.

"There was not a pediatric designated trauma center for many of the people who live in the Twin Cities west of the [Mississippi] river," he said. "And this provides an ideal solution."

Whether the situation is ideal for Regions Hospital in St. Paul remains to be seen. "Having another pediatric trauma center come online means that's there's probably going to be a little less for everybody else," said Dr. Michael McGonigal, director of trauma services for Regions. "I have no idea really what the impact of that will be."

For its part, Regions distinguishes its care from Children's by pointing out that its St. Paul hospital can handle any age patient with trauma.

"Let's say that there's a car crash and we'll get the kids and their parents at the same time. Just two to three weeks ago we actually had five major trauma resuscitations come in at once," McGonigal said.

In the future, Regions and Children's may be competing for patients like Jack Barnhart. Three days ago, the 17-year-old was hit by a vehicle and was rushed to Region's trauma unit.

His father Bill says the situation played out like every parent's worst nightmare.

"We got a phone call at 6 a.m. yesterday morning that Jack was in intensive care with a traumatic head injury," Bill Barhnart said.

When Bill and his wife Tracy got to the hospital, their son was in a coma and not breathing on his own. A day later his prognosis was much better.

Bill Barnhart, who's from Cottage Grove, is grateful there was a Level 1 pediatric trauma unit practically in his backyard.

"With the injuries that he had, the head injuries, we're very blessed that he did get to come here and be treated," he said. Children's estimates that it will take three years to satisfy all of the requirements established by the American College of Surgeons.

Mayo Clinic in Rochester earned Level 1 pediatric trauma certification last December. When Children's earns its designation that will give the state three Level 1 trauma units for kids.