JOHNSON CITY, Tenn. (WJHL)–Johnson City Medical Center is now home to the only level one trauma center in Northeast Tennessee and Southwest Virginia.

Ballad Health completed phase one of a controversial plan to downgrade the trauma center at Kingsport’s Holston Valley Medical Center from a level one to a level three on Tuesday, October 1st.

MORE: Ballad set to downgrade Holston Valley Medical Center trauma services this fall

Ballad is expected to change Bristol Regional Medical Center’s trauma facility from a level two to a level three in 2021.


What’s changing at Holston Valley Medical Center?

According to Ballad, serious medical emergencies like heart attack and stroke will still be covered at HVMC.

Dr. Herb Ladley, chief medical officer for Ballad’s northwest market, said highly specialized orthopedic trauma will now only be offered at JCMC. He said the residency program that assists in the management of those patients and some general surgery residents also moved to JCMC.

Ladley said Ballad is committed to maintaining specialties at HVMC not required under a level three designation.

“All of the surgical subspecialties are still on call, still available: neurosurgery, ENT, vascular surgery, general surgery, orthopedic surgery, urology,” he said.

Ladley confirmed one trauma surgeon is currently employed at HVMC after two others resigned earlier this year. He said Ballad plans to fill those positions.

“Previously there was a requirement for a trauma surgeon to be in-house, that won’t necessarily be the case although it will be the case the majority of the time,” said Ladley. “General surgeons in the community who previously weren’t really called on to assist in trauma except on fairly rare occasions are prepared to do that on a regular basis.”

Ladley said anesthesiologists will also be at HVMC “most of the time,” though that’s not a requirement for a level three center.

Is Johnson City Medical Center ready for an increase in trauma cases?

Dr. J. Bracken Burns, Ballad’s trauma medical director, said he’s confident JCMC can handle an increase in patients.

He said the hospital has already seen an 11 percent increase in trauma cases, comparing calendar year 2019 to date and the first three quarters of 2018.

“That wasn’t something that was probably anticipated going into all this but that’s something that we’ve worked through and developed processes and personnel to be able to deal with that,” he said.

He said JCMC opened a “trauma-specific step-down unit” about a month ago and introduced a new nurse designation to specialize in trauma resuscitation and emergency care.

Further infrastructure improvements to JCMC meant to, in part, improve traffic flow for EMS and air medical professionals won’t be complete until late Spring 2020, according to Ballad’s press release.

“It’s a process, not an overnight change,” said Burns.

Are EMS providers ready for the change?

Antia Perry, Ballad’s EMS liaison, said expanding their call center to streamline communications with first responders was a critical part of preparations.

“They had started with Holston Valley and Bristol [Regional Medical Center] and now they also answer all the radio traffic for Johnson City so that they have standardized processes for all three of our tertiary care centers,” she said.

“There have been some hiccups along the way but there’s not been anything that I know about myself that’s been detrimental to anything,” said Duffield Fire and Rescue Chief Roger Carter when asked if the call center has functioned efficiently so far.

Carter said there’s been times crews didn’t know certain hospitals were on diversion.

“It’s because their dispatch center has been called however they then did not pass that information along to the EMS agency,” said Perry.

Gregory Woods, executive director of Southwest Virginia’s EMS Council, said before consolidation was complete they modified their trauma-triage guidelines to align transport decisions with hospital capabilities, rather than trauma center destinations.

Woods furthered in a statement:

While only 2-percent of EMS calls in our region typically meet Level 1 trauma criteria (approximately 159 calls annually), we believe that changes to regional trauma-triage guidelines will further reduce the impact of the immediate change, particularly since Ballad Health plans to maintain capabilities above the minimum requirements of a Level 3 Trauma Center.  We have already begun holding training sessions for EMS providers in Virginia to help with trauma destination decision-making.  Obviously, we will continue to monitor the actual impact of these changes and work with EMS agencies and Ballad Health to mitigate any adverse impacts on the citizens of southwest Virginia.

Gregory Woods, Southwest Virginia EMS Council Executive Director

Carter said “none of the crews in Scott County” wanted to see HVMC’s trauma center downgraded but he said Ballad could help mitigate the impact of longer transport times to level one care by helping fund additional vehicles and personnel costs.

“I can’t speak directly for the funding because that’s something that we would have to evaluate as time goes on but we work very, very closely with the Southwest Virginia EMS Council so that we can look at resources and needs,” said Perry.

What do protestors think?

On Tuesday, protestors remained outside of HVMC, where they’ve been camped out for more than 150 days in opposition to Ballad’s changes to trauma services.

Advocate Dani Cook said they have no intention of leaving: “Our healthcare still matters even after Ballad Health has taken actions that are not in the best interest of the public.”

Cook said she’s concerned Ballad will not maintain specialties that aren’t required at HVMC long-term.

She also said Ballad should’ve made more investments in resources for rural EMS and waited until upgrades to JCMC were complete before they consolidated level one trauma services.