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Agreement Saves Trauma Care Services Vital to Training

By Douglas J. Gillert
American Forces Press Service

SAN ANTONIO, Texas, Jan. 31, 1997 – A historic agreement between city leaders and DoD has kept alive a decades-old trauma care service that benefits both.

Until 1993, the Air Force's Wilford Hall Medical Center and Brooke Army Medical Center provided the city free emergency medical and surgical treatment. The agreement benefited both sides -- the city got trauma care and military medics gained valuable training for contingencies.

"These are the kinds of injuries we'd see in war, including gunshot wounds and traumatic injuries from car accidents," said Air Force Col. James Vande Hey, Wilford Hall administrator. "We didn't seek reimbursement, because DoD reimbursement rates were extremely low and we could afford to absorb the cost."

In the 1990s, however, DoD raised reimbursement rates, bringing them in line with the federal government's Medicare rates. At a cost of $3 million a year, the military no longer could afford to offer its trauma services gratis. "We began talking to city leaders about the possibility of reimbursement," Vande Hey said. "At the same time, we began scouting for other locations to send our doctors for training."

Sending physicians elsewhere for training wasn't a good solution, Vande Hey said. "The team concept is so important in trauma care. While we could send our physicians off to get training, we couldn't send the support cadre with them. So we wanted very much to stay in the trauma agreement with the city."

Negotiations lasted two years, during which the city's University Hospital System and the two military hospitals continued to share the trauma care burden. Some community leaders believed military-provided trauma services were a government benefit they shouldn't have to pay for. DoD, however, was adamant. Continuing to provide the services at no charge drew from resources required to care for military beneficiaries, Vande Hey said. If the city didn't begin paying, the military would stop delivering.

"The city fathers and business leaders realized it was in their interest to have us remain involved in trauma care," Vande Hey said. They struck an agreement early in 1996. The first agreement extended the service through the end of last year. A subsequent agreement signed in October 1996 extends the service through 1998.

The agreement allows Wilford Hall and Brooke to provide emergency trauma care originating in Bexar County, of which San Antonio is the county seat. Cases originating outside the county are rotated among the university hospital and the two military trauma centers.

At least one other military hospital -- William Beaumont Medical Center at Fort Bliss, Texas -- treats civilian emergency patients. In addition, all military medical facilities can accept civilian emergencies on an individual basis, Vande Hey said, but normally would transport them as soon as possible to the nearest civilian hospital able to provide care.

Vande Hey sees the current trauma care agreement expanding later to create what he calls "Destination San Antonio."

"The trauma center not only helps us in training but provides the platform for the care of military trauma casualties from anywhere in the world," he said. "We have this synergism here to be able to create a capability no one else can provide to the same degree."

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