Inside the action at Shock Trauma


The phone rings and the 'organized chaos' begins

September 17, 2013|By Scott Dance | The Baltimore Sun

Just to answer the dated tan plastic phone at the R Adams Cowley Shock Trauma Center, you have to take an annual two-hour course. And when it rings, with its two-tone signal like an old British ambulance, everyone pays attention.

A voice on the other end, an EMT somewhere in Maryland, rattles through the need-to-knows over a speaker: age, gender, and manner, severity and location of injuries. Whether a patient is lethargic, immobilized, disoriented or unresponsive. All is scribbled shorthand onto translucent marker board, known to all as “the board,” as a crowd of staff looks on.

The board reads as a preview of what’s to come for the doctors, nurses and other staff of Shock Trauma, and what they already have on their hands. On one Friday evening, as Marylanders everywhere head off to start one of the last weekends of summer, it’s a lot of car accidents; one woman is found fallen from a horse, another grazed by a car’s side-view mirror. Other nights, in the wee hours of morning, street violence pervades.

Once the details are there in writing, it’s only a matter of time. Within minutes, the patients are wheeled into the Trauma Resuscitation Unit, rushed from the ambulance bay two floors below or the helipad on the roof six floors above. More than a dozen bodies in those pink scrubs surround each patient until they are stable or no longer have a pulse.

It’s a rush of what staff and veterans call “organized chaos” that was responsible for saving more than 8,000 lives last year. The routine at Shock Trauma, the nation’s oldest — and, they say, busiest — trauma center, meanwhile has informed trauma care around the country and world with its focus on the “Golden Hour” — the idea that rapid treatment of traumatic injuries prevents deaths.

It evokes a pride, if not an arrogance, in the health care workers there that has helped drive both high admissions and survival rates.

“I’m not allowed to say, ‘Oh my God, that’s awful,’ ” says Dr. Thomas Scalea, physician-in-chief. “I absolutely believe I am saving that person’s life, even right up until they die. We believe we can do the impossible, and sometimes we do.” 

The staff swarms

In a snap, Shock Trauma doctors evaluate whether what they have heard from EMTs in the field warrants bringing a patient there. Shock Trauma is the only hospital in Maryland deemed a Primary Adult Resource Center, the highest level of trauma care for adults.

The decision tree reads like a menu of death. After a traumatic event like a fall or car crash, any combination of low blood pressure, difficulty breathing or reduced ability to open the eyes, speak or move is enough to get a patient to Shock Trauma, particularly when there is a possibility of internal injuries. More serious benchmarks include crushed or mangled extremities; auto crashes involving ejection from a vehicle or damage that intrudes a foot or more; falls of more than 20 feet for adults and 10 feet for children. The most common admissions are from crashes (a third), falls (a quarter) and violence (one in six).

The patients, for the most part, do not stay more than three to four hours in the trauma unit, and 40 percent of patients are sent home from it, but each case varies. On this night, at one end of the unit’s horseshoe of 13 bays, a teenage boy sits up awake and alert, a man and a woman at the foot of his bed; across the room, an elderly woman is alone in the corner and breathing through a ventilator, part of her hair shorn off and white tape holding tubes to her upper lip.

Much of the scene is what you might expect to hear or see on an episode of “Grey’s Anatomy.”

When a patient is wheeled in after her car was T-boned, the staff swarms. More than a dozen surround her, each with his or her role, and six or so more stretch beyond a curtain. They quickly cut right down the middle of her jeans and blouse.

“Can you hear me?” a doctor shouts.

“Are you allergic to anything?” a nurse asks.

Nurses, standing to the left of the bed, are responsible for inserting IVs and taking samples of blood. Residents, doctors who are still in training, stand to the right while the attending physician stands at the head, responsible for ensuring that the patient can breathe, through a ventilator kept by each trauma bed if need be.

Once the woman is stabilized, the area clears. Technicians wheel in a portable X-ray machine to check for bone breaks while nurses go through the woman’s purse, documenting every item down to the cash inside her wallet and scanning through her cellphone for emergency contacts.

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