Go inside a trauma department.

Hospital emergency departments have gotten the Hollywood treatment over the past 25 years. Current TV shows like Grey’s Anatomy, Chicago Med, and New Amsterdam attempt to capture the fast-paced feeling of emergency departments, in effect mining trauma for drama.

Real-life emergency departments don’t exactly match their fictional counterparts. However, they often do operate in high-stakes situations, with time a crucial factor in whether a patient lives or dies. This is especially true for hospitals with trauma centers, which treat severe injuries, such as traumatic brain injuries, gunshots, or stab wounds.

So, what exactly is a day in a trauma center like? And what is the difference between an emergency department and a trauma center?

What Is a Trauma Center?

Most hospitals have an emergency department, where patients with emergent injuries and illnesses can be treated without an appointment. Some of these patients may have life-threatening symptoms, such as chest pain, shortness of breath, or severe stomach pain.

However, many hospitals are not equipped to deal with traumatic injuries. For patients who have injuries from a car crash, serious fall, severe burn, gunshot, stabbing, or other serious injury, a trauma center is the appropriate level of care. Select hospitals have a trauma center in addition to their emergency department.

The emergency department serves as the entry point for all patients; those who have traumatic injuries are routed to the trauma center and treated by a highly specialized team. These specialized clinicians staff the center 24/7. They are trained to treat the most extreme injuries and usually include trauma surgeons, emergency medicine physicians, neurosurgeons, orthopedic surgeons, radiologists, cardiac surgeons, and trauma nurses.

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The Importance of First Responders

Care often begins before the patient enters the hospital. First responders might not be part of the official trauma team, but they can play an important role in the patient’s outcome. Paramedics and other first responders will evaluate the patient’s condition and determine if they can be treated at a regular emergency department, or if they require care at a trauma center.

Medically trained responders — including paramedics, police officers, firefighters, and others — often are the first to interact with a patient who has suffered a traumatic injury. Stopping a patient’s bleeding is the top priority in most trauma situations, and stabilizing the patient for a trip to the hospital are among the first responder’s top priorities.

Emergency responders also can engage STAT MedEvac air medical services. The STAT MedEvac crew, including a pilot, flight paramedic, and nurse, can provide fast transport to trauma centers, attempting to stabilize the patient along the way.

‘A Very Complex Dance’

Time is crucial. A major factor in whether a patient lives or dies in a trauma situation is time – especially when it comes to stopping bleeding. The White House and Department of Homeland Security in 2015 created the “Stop the Bleed” campaign in response to increased gun violence and mass casualty events.

When a patient arrives at one of UPMC’s trauma centers, the trauma team begins its effort at resuscitating and stabilizing. The process could include drawing or giving blood, starting IVs, taking x-rays, intubating, and more. The trauma team works head to toe, following the ABC method of “airway, breathing, circulation.”

Thinking on Your Feet

What happens in the trauma center will decide where the patient goes next: either for more scans, to the intensive care unit (ICU), or directly to the operating room.

In a patient’s initial procedure, the surgeon will first aim to stop bleeding and fix the initial, life-threatening injuries. After that, the patient will go to the ICU for more stabilization and resuscitation before potentially going back into surgery later for more-thorough repairs.

A successful trauma team requires certain characteristics. Trauma cases can change quickly. Physicians, nurses, and other personnel who work those cases must be nimble enough to address any change.

Certain skills are crucial in trauma cases, including:

  • Critical thinking.
  • Thinking on your feet.
  • Adapting to changing situations.
  • Processing information quickly.
  • Making quick, reasoned decisions.

‘We Need to Be Here’

Trauma medicine is difficult, but it can be gratifying. When a gunman opened fire at the Tree of Life synagogue in the Squirrel Hill neighborhood of Pittsburgh, Pennsylvania, in October 2018, UPMC’s trauma staff rushed to answer the call.

Editor's Note: This article was originally published on , and was last reviewed on .

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.