Hospital emergency departments got the Hollywood treatment over the past quarter-century. Television shows like “ER” and “Grey’s Anatomy” attempted 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.
“Not everybody is suited for this type of environment, but those who are do really well,” says David Bertoty, clinical director of Emergency and Trauma Services at UPMC Presbyterian.
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 suffered from a car crash, serious fall, severe burn, gunshot, stab wound, 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 fate. 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 more, are often the first to interact with a patient who has suffered a traumatic injury. Stopping a patient’s bleeding – 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.
“The No. 1 preventable cause of death in trauma is uncontrolled bleeding,” says Bertoty, who also coordinates UPMC’s Stop the Bleed efforts. “Someone can bleed to death in as little as four minutes if you don’t stem the tide of bleeding.”
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.”
Bertoty says the goal is to complete the process in 15 minutes or less.
“Because we’re one of the busiest trauma systems in the country, we get a lot more practice on our processes to make sure they are efficient and standardized,” he says. “So when it happens and they’re needed, it literally just happens because we’ve done it so many times. It’s a very complex dance that happens each time a patient comes in.”
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Thinking on Your Feet
Trauma surgeons begin with “damage control.” 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 aim for what Bertoty called “damage control”: stopping bleeding and fixing the initial, life-threatening injuries. After that, the patient will go to the ICU for more stabilizing 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.
According to Bertoty, 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
“Being able to be cool under fire, but yet being able to think quickly and change gears quickly, that’s the hallmark,” Bertoty says.
‘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, Pa. in October 2018, UPMC’s trauma staff rushed to answer the call. Bertoty says off-duty physicians and nurses came in to the hospital to help.
Bertoty says there’s a sense of accomplishment when the trauma team helps a patient survive in critical situations.
“When we need to be here, we come together to help,” he says.
A $21 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates more than 90,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a 3.8 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.4 billion in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution, and paid more than $500 million in federal, state, and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial, and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America’s Best Hospitals and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. For more information, go to UPMC.com.