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Published in CenterView on March 01, 2010
Representatives of Trauma Team
Representatives of Trauma Team

When seconds matter, UMMC is the place to be

By Patrice Sawyer Guilfoyle

When the media report news of an accident involving traumatic injuries, one of the following phrases is sure to follow: "transported to UMC," "airlifted to UMC," or "listed in serious condition at UMC." Emergency responders and community hospitals know the state's only level one trauma center is at the University of Mississippi Medical Center, so when a life hangs in the balance, the patient comes here. Time is critical.

Time is critical.

"Ten to 15 minutes are the difference between life and death," said Dr. John Porter, chief of the Division of Trauma and Critical Care Surgery.

More than 4,700 patients received trauma care at the Medical Center in 2009, according to trauma registry data. That's about a 26 percent increase between 2008 and 2009, mainly because some hospitals don't treat certain types of trauma.

With a 3.4 percent mortality rate for trauma cases, an overwhelming majority of those patients returned home. Compare that to the national average of a 4 percent mortality rate, and the results are impressive.

Porter believes trauma care is a team effort, beginning at the time of the incident and ending when the patient is discharged. The well-orchestrated drama unfolds for each trauma patient with an array of Medical Center employees playing critical roles. But this is no television show.

A typical scenario goes like this: A car overturns, causing severe injuries. Paramedics keep the patient stable during transport to the hospital. Emergency room physicians and nurses evaluate the patient upon arrival.

The pace quickens.

Clockwise from center, Dr. Heather Evans; Jamie Johnson, RN; and Stacy Hart, RN
Clockwise from center, Dr. Heather Evans; Jamie Johnson, RN; and Stacy Hart, RN

A trauma attending physician, who's in the hospital 24 hours a day, is contacted. The blood bank is called. Surgery subspecialists, such as neurosurgery or orthopedics, are paged as needed. Campus police officers maintain order in the midst of chaos dealing with distraught family members and friends waiting for news.

During the patient's stay, trauma and critical care nurses work with the attending physician to return patients to health. Physical therapists, respiratory therapists and social workers all blend into the patient's care, proving the emergency room is one part of the continuum of care.

"Trauma is not the ED. It's the entry point," said Amber Kyle, manager of the trauma program. Trauma patients spend most of their time recuperating in the Surgical Intensive Care Unit or on 3North, the trauma recovery floor.

Kyle's eight employees make sure the Medical Center complies with the state's requirements for maintaining level one trauma status. They also collect data from every trauma patient daily and report information to Porter.

"The benefit is, if I find the problem right as it's happening, I can fix it," Porter said.

Kyle and her team offer trauma education programs and coordinate injury prevention. They presented an outreach program on gun-injury prevention at the Boys and Girls' Club of Jackson, nine months before an 8-year-old child was shot while sitting at a table doing homework.

The Medical Center's trauma team cared for the child and she recently was able to return to school.

"We're not just here for people who did something stupid and were shot," Porter said. "Sometimes people are shot through no fault of their own."

Still, gun or knife wounds comprise only 18 percent of trauma cases.

"Sixty-seven percent of patients we see are from car crashes, and everybody drives," Porter said.

Add injuries from other motorized vehicle accidents and falls and the percentage increases to 83 percent in 2009. Another lesser-known source of traumatic injuries is falls.

Several weeks ago, a man fell and suffered an injury that required him to be airlifted to the Medical Center. Since a former requirement for a patient to receive a CT scan before transfer had been lifted, the patient arrived here quickly. Within 15 minutes, he was headed to X-ray; but on the way, the patient went into cardiac arrest and had to be taken immediately to the operating room.

"We had to remove his spleen. If we had waited for the smaller hospital to do a scan before transfer, that patient would have died," Porter said.

The trauma case load has increased over the last year because of newly enacted state legislation. Effective Jan. 1, 2009, the state began a "play or pay" system, requiring hospitals to pay into a trauma fund if they didn't want to treat certain trauma patients. The money is used to reimburse hospitals that cared for those patients. Because of the Medical Center's status, many of them came here.

Porter works with four other trauma surgeons in the division and he wants to hire another one. They generally work long shifts, as much as 36 hours, sleeping in the hospital.

Why does he do it?

"We save people's lives," Porter said. "If you come in to see me and I don't do what I'm supposed to do or if the trauma center wasn't here, people would die."