Las Vegas tragedy helps highlight what’s right with nation’s health care system

LV100117-300x215Caregivers and the community in Las Vegas, Nev., deserve a salute for their response to the gun violence last week, which could have overwhelmed a less-prepared community’s medical system.

Las Vegas  isn’t a giant metropolis (pop. 2 million in its metro area), and, due to the high costs to operate such a facility, it has just one Level 1 trauma center. That’s a facility staffed and equipped to provide a “gold standard” of emergency care. In the state of Nevada, the only such center is at the 541-bed University Medical Center of Southern Nevada.

It was slammed with more than 100 critical patients, many with life-threatening or fatal gunshot wounds.  A torrent of patients also was routed to the hospital, some for treatment of injuries they suffered while fleeing Stephen Paddock’s rampage. First-responders soon were flooding another facility, Sunrise Hospital and Medical Center in Las Vegas—a Level II trauma facility—with hundreds more.

Both the Washington Post and Los Angeles Times have reported about the harrowing night medical staff made their way through, as they confronted waves and waves of injuries rarely seen at such overall and individual scale. Experts said the shooter’s rounds came with enormous velocity from powerful weapons, then not only tore directly into some victims and created one type of havoc there, many bullets also bounced off pavement and other hard surfaces to cause terrible injuries to dozens of others.

The carnage was something more akin to what surgeons and nurses might see while treating soldiers on a major battlefield. Medical staff in Las Vegas, who poured in as quickly as they heard about the emergency conditions, said they were appalled to encounter so many patients in such bad condition and so much blood.

Their courageous and professional response—as well as the heroic rescue efforts of police, fire fighters, ambulance drivers, and other first-responders and amazing Samaritans of all kinds—deserves huge praise and thanks. News reports have emphasized how swiftly, well, and compassionately medical caregivers and the Las Vegas community have responded to the health crisis caused by yet another mass shooting. Sadly, the constantly growing number of these incidents has increased the knowledge and preparation needed to cope with their horrors.

Still, questions and concerns arose quickly in Las Vegas—and the Western city’s woes echoed those persisting in storm-ravaged areas like Puerto Rico and Texas.

In Vegas, the public costs of the emergency response are only mounting. Some officials have started to ask about casino-hotel security, the safety of outdoor concert venues, and whether the city needs an expensive, second, Level 1 trauma center, just in case.

And with the thousands rousted from the concert crime scene not yet even allowed to return to retrieve their cars and other personal items, some mental health experts fear that the area’s already stretched trauma response resources may not hold up as help from outside, volunteer counselors slowly drifts away. The Washington Post says that tens of thousands of people may need short-in-supply psychological support after this incident.

Questions, of course, dominate as to what the public policy response should be to this terrible shooting, with some consensus seeming to form around bans on “bump stocks,” devices that can be attached to semi-automatic rifles—which may legally be purchased—to make them automatic weapons, which can fire continuous rounds and are illegal.

This is only a fragment of how state and federal officials might respond. The Second Amendment argument, no doubt, will rage, hot and long—and without much resolution. Members of Congress, however, continue to cower from powerful interests in allowing what may be one of the excellent options the nation has: to allow and to fund scientific research on gun violence.

Since 1996, partisans—yes, they’re Republicans—have blocked sensible efforts to allow independent, nonpartisan researchers to gather data and to study how guns and gun ownership can be made safer in a country where more than 30,000 Americans die annually due to gun violence.

To be clear, no one has said so much as a peep that this study would result in weapon or ammunition bans or restrictions on guns or their ownership. Instead, advocates note how effective similar research proved over the decades with vehicular deaths. No one banned cars. But safety advocates, notably crusader Ralph Nader, used the overpowering force of public opinion, consumer power, and the civil justice system to get automakers to manufacture safer vehicles—with restraint systems (safety belts and air bags), steering wheels that didn’t turn into bayonets in collisions, windshields that didn’t fracture into deadly shards, and reinforced cabins that didn’t crush on front-, side- or rear-impact. Tens of thousands of lives have been saved and many more injuries averted.

But the Trump Administration and the current Congress, as the recent debates on the Affordable Care Act have shown, don’t seem to see much value in fact-based action, preferring partisan belief bordering on theology over hard evidence.

In Puerto Rico—as partisans insist the disaster relief has been excellent when it clearly has not been— federal, U.S. military, state, and local authorities keep slogging through heat, humidity, and presidential and congressional indifference to try to help residents on the island and the nearby U.S. Virgin Islands recover from hurricane damages. Power problems and a dearth of supplies continue to plague hospitals and doctors trying to treat patients in need, though the military is opening medical facilities and providing more care, including on a hospital ship, and recovery efforts only now are starting to get to far reaches of Puerto Rico where health conditions are still desperate.

Puerto Rico’s woes also soon may hurt patients on the mainland, too. That’s because the island, as the New York Times has reported, has become a leading manufacturing center for Big Pharma with 80 or so factories. As the paper has noted:

Pharmaceuticals and medical devices are the island’s leading exports, and Puerto Rico has become one of the world’s biggest centers for pharmaceutical manufacturing. Its factories make 13 of the world’s top-selling brand-name drugs, from Humira, the rheumatoid arthritis treatment, to Xarelto, a blood thinner used to prevent stroke … With business of nearly $15 billion a year at stake in Puerto Rico, drug companies and device makers are confronting a range of obstacles on the island: locating enough diesel fuel for generators to run their factories; helping their employees get to work from areas where roads are damaged and blocked, electricity is down and phones don’t work. Companies have taken out radio ads pleading with workers to check in. The pharmaceutical and device industries contribute to the employment of nearly 100,000 people on the island, according to trade groups.

In Texas, hurricane damages also are wreaking financial havoc on one of Houston’s civic prides—its sprawling, affluent, and influential community of academic medical centers and hospitals. Officials typically are loath to discuss their institutions’ finances, particularly after a weather emergency and with the exact circumstances of the region’s recovery so uncertain.

But experts know that facilities across eastern Texas shut for days, canceled all manner of procedures, upped their emergency staff, moved some patients to other facilities, then declined to treat others just as a precaution. These moves all ran up costs—an estimated $2 million hit at just one midsized hospital in Beaumont. Meantime, storm-staggered Houstonians and other Texans may slow or eliminate their medical spending for a time.

This all suggests that the Lone Star state’s health care system may have to struggle with persistent red ink in areas for a while. How long is uncertain. So too is the extent of the potential fiscal damage.

In my practice, I see the significant harms that patients can suffer while seeking medical services and their giant struggles to afford medical care under still tough but more normal circumstance. Americans have allowed themselves to spend $3-trillion-a-year on our health care system, which comprises 17.5 percent of the nation’s GDP. As medical care has grown ever more expensive, it also has become ungodly complex, too. At its best, as doctors and hospitals have shown in Las Vegas, Houston, Miami, San Juan, and elsewhere, our system is to be talked up and admired. But we also must realize it is fragile and vulnerable, too. Politicians in the nation’s capital may want that to be their big lesson from this wicked season: The system has sufficient burdens without partisan toying with it. We all need to work to make it better, based on need, hard evidence, and common sense.

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