Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2017-000091 on 3 July 2017. Downloaded from Open Access Review The history of Harborview Medical Center and the Washington State Trauma System Eileen M Bulger,1 Janet Griffith Kastl,2 Ronald V Maier1 1Department of Surgery, ABSTR ACT pediatric trauma populations. Harborview faculty University of Washington, Harborview Medical Center serves as the sole adult and are also recognized as leaders in trauma and burn Harborview Medical Center, research and participate in multiple national clinical Seattle, Washington, USA pediatric level I trauma center for Washington State, and 2Washington State Department its faculty have led efforts to develop comprehensive trials networks to advance the care of the injured of Health, Office of EMS and systems of trauma care across the country. The patient. Trauma, Olympia, Washington, Washington State trauma system is an inclusive system The Washington State trauma system is an inclu- USA that was developed based on data-driven decisions to sive system, which was thoughtfully designed to distribute resources based on population need. This distribute trauma centers based on population need Correspondence to and ensure access to trauma care even in the most Dr Eileen M Bulger; ebulger@ u. article seeks to explore the history of Harborview Medical washington. edu Center and the development of the Washington State rural areas of the state. This article seeks to explore trauma system to identify the guiding principles and the history of Harborview Medical Center and Received 16 May 2017 lessons learned, which can facilitate system development the development of the Washington State trauma Accepted 5 June 2017 for a host of time-sensitive medical conditions. system to identify the guiding principles and lessons learned, which can facilitate system development for a host of time-sensitive medical conditions. INTRODUCTION HISTORY OF HARBORVIEW MEDICAL CENTER Harborview Medical Center in Seattle serves as The territory of Washington became an organized, the sole level 1 adult and pediatric trauma and incorporated territory of the USA in 1853 and burn center for the State of Washington (figure 1). its legislature first met in 1854. One of their first In addition, Harborview serves as the safety net rulings was to make counties responsible for caring hospital for the community and is a mission-driven for all ‘poor, sick, and homeless people whose healthcare facility seeking to serve the most vulner- relatives could not support them’. In 1877, King able residents of King County, while providing County opened a county ‘poor farm’ just south tertiary specialty care to the Pacific Northwest. The of Seattle to meet this need. Harborview Medical mission statement of the hospital speaks directly to Center began as King County Hospital, which was the special groups of patients and programs that a six-bed facility operating within the ‘poor farm’, are given priority for care (box 1). In addition, and patients were cared for by nuns from the Sisters Harborview serves as a leader in the community for of Charity of the House of Providence. In 1894, disaster preparedness and is the Disaster Medical a new 125-bed county hospital was commissioned http://tsaco.bmj.com/ Control Center for the region. for $80 000 and was located in Seattle’s George- The hospital is owned by King County, governed town neighborhood. A new wing was added in by the Harborview Board of Trustees and managed 1908 expanding to 225 beds. In 1928 there was a under contract by the University of Washington. ballot measure to construct a 500-bed hospital for All attending physicians are faculty of the Univer- care of the ‘indigent sick, injured, and maternity sity of Washington. Harborview also serves an cases’, and $2.75 million was allocated to construct important educational mission and is committed to the new hospital on First Hill in Seattle, which is support undergraduate, graduate, postgraduate and the site of the facility today. The Seattle Times held on October 1, 2021 by guest. Protected copyright. continuing educational programs for health profes- a contest to name the new hospital and the award sionals from the University of Washington as well went to the name ‘Harborview’ due to the location as several other partner organizations. Harborview on a hill overlooking Puget Sound and the Seattle is the home for the regional paramedic training waterfront.1 program, and Harborview faculty provide medical Harborview was home to one of the first nursing direction for the Seattle Medic One program and schools in the region opened by the University of the Airlift Northwest flight programs, both of Washington in 1931. Nursing students lived on which were founded by Harborview clinicians. campus in a building across the street from the As a result of its unique role in the community, hospital. In the mid-1940s, Harborview was the Harborview is one of the busiest trauma centers in primary facility for treatment of patients suffering the country, with an average of 6000 trauma admis- from the polio epidemic, and the first blood bank sions per year, of whom 1000 are under the age of in King County was established at Harborview. In 18 and 700 are burn patients. Thirty-eight percent 1946, the University of Washington School of Medi- of trauma admissions have an Injury Severity Score cine was established and the first chair of surgery, T Bulger EM,o cite: Kastl JG, >15% and 50% of these are transfer patients. Dr Henry N Harkins, was based at Harborview Maier RV. Trauma Surg Acute National benchmarking data suggest excellent until construction of the new University Hospital Care Open 2017;2:1–7. risk-adjusted mortality for both the adult and was completed in 1959. In 1956, the first open Bulger EM, et al. Trauma Surg Acute Care Open 2017;2:1–7. doi:10.1136/tsaco-2017-000091 1 Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2017-000091 on 3 July 2017. Downloaded from Open Access general surgery faculty with an average of $2 million per year in research funding. The general surgery service has always func- tioned as an acute care surgery (ACS) service covering all general surgical emergencies as well as running an elective practice in addition to trauma care. This model is important to maintain surgical skills as blunt trauma has become increasingly nonop- erative for general surgeons. All ACS faculty are also board-cer- tified in surgical critical care and attend in the trauma/surgical ICU. Harborview Medical Center also had a cadre of dedicated subspecialty surgical faculty, including thoracic surgery, vascular surgery, plastic surgery, neurosurgery, orthopedics, urology, gynecology, otolaryngology, oral maxillofacial surgery, and inte- grated services for spine and hand surgery. These services have multiple fellowships for advanced trauma care and contribute to the robust research environment. Figure 1 Aerial photo of the current Harborview Medical Center Another advantage of the development of the University of campus, Seattle, Washington. Washington Department of Surgery at both Harborview and the University Hospital is that it has allowed separation of the major heart surgery on the West coast was performed at Harborview surgical programs between the two hospitals. Trauma and burn by Alvin K Merendino, MD.1 care are provided solely at Harborview, whereas transplantation In 1967, the University of Washington entered a formal and elective cardiac surgery are provided solely at the Univer- agreement with King County to take over clinical manage- sity Hospital. Many other University of Washington surgical ment of Harborview, and all physicians were recognized as specialties have followed this approach. The result is that the academic faculty of the University of Washington. In 1969, OR and ICU capacity at Harborview can focus extra time and the Seattle Medic One program was founded by Dr Leonard resources on all aspects of trauma and emergency surgical care. Cobb, a Harborview cardiologist, and Seattle Fire Chief Gordon The regionalization of care established by the trauma system has F Vickery. As detailed below, this pilot program became one been extended to a wide variety of surgical emergencies, such of the most successful paramedic training programs in the as necrotizing soft tissue infections, ruptured abdominal aortic country, and although the initial focus was on resuscitation from aneurysms, spontaneous intracranial hemorrhage, etc. In the cardiac events, advances in prehospital care for the injured soon current climate of increasing competition and the economic followed. As a result, Harborview became known as the regional pressures facing safety net hospitals, the broad clinical spectrum referral center for emergency care especially for the seriously of emergent and elective surgical care ensures the resilience and injured patient. sustainability of the institution. In 1973, Dr G Tom Shires was recruited as the chair of surgery at the University of Washington, and Drs James Carrico and Peter HISTORY OF SEATTLE MEDIC ONE AND DEVELOPMENT OF Canizaro became the co-chiefs of surgery at Harborview. Their interest in trauma care led to the development of Harborview as EMERGENCY MEDICAL SERVICES (EMS) In the late 1960s Harborview physicians recognized the the premier trauma center for the region for both adults and chil- need for more rapid intervention for patients suffering from dren. In 1974, Dr P William Curreri became the director of the http://tsaco.bmj.com/ cardiac events. Dr Leonard Cobb, a cardiologist, approached new regional burn center at Harborview. Harborview continued Seattle Fire Chief Gordon F Vickery about a pilot program to to expand its facilities with expanded operating room (OR), improve the medical training for Seattle firefighters and orga- emergency room (ER), intensive care unit (ICU), and clinic space nize an approach to medical emergencies. In 1969 the first opening in both 1997 and 2008, with a current licensed bed class of 15 Seattle department firefighters began a training capacity of 413 beds, of which 98 are critical care beds.