On March 20, Baptist Memorial Hospital-Golden Triangle trauma personnel treated four gunshot victims for what was described as “non-life-threatening” injuries.
News media and police departments often use that term: “Non-life-threatening” injuries. And general surgeon Jan McClanahan said it was accurate in the case of the Sim Scott Park shooting. But he said that simple term lacked context and did not cover half of what EMTs and hospital staff went through to keep the victims’ injuries “non-life-threatening.”
McClanahan, who chairs the Columbus hospital’s trauma committee, said treating those four gunshot victims took 21 operating hours and during much of that span, three surgeons were operating simultaneously. One victim, he said, arrived with no pulse and had to be resuscitated, while two suffered shots to the abdomen and the forth underwent surgery to save a limb. Authorities have declined to identify the victims, three of whom have been released from the hospital.
One of the victims, McClanahan said, needed a substantial amount of blood from the hospital’s blood bank.
“That was a mini-mass casualty,” McClanahan said. “It basically interrupted the whole afternoon of surgery because of one trauma. Elective surgeries that had been scheduled had to be moved to the next day.”
1,000+ trauma cases in ’14
McClanahan said that in 2014, Baptist Memorial treated 1,049 trauma cases, including 89 cases of penetrating trauma, from which only 12 fatalities resulted. During that year, he said 396 came from vehicle wreck victims that made it to the hospital. On-scene fatalities are not reflected in that number.
“What we always say is that if you arrive at the emergency room alive, you ought to be able to leave the hospital alive,” he said. “Obviously, that’s not always true because some injuries just aren’t survivable.
“In trauma, we talk about the ‘Magic Hour,'” McClanahan added. “If you can get to a trauma patient within the first hour, that’s your best opportunity to save the patient. After that, survival rates begin to drop.”
Baptist Memorial also treated 200 broken hips in 2014, something McClanahan said fell under the trauma umbrella.
“Probably one of the most common trauma cases we have is people who have fallen and broken their hips,” he said. “You don’t think about that as a trauma, but it is.”
Classified as a Level 3 trauma center in Mississippi’s state-funded trauma system, Baptist Memorial has four general surgeons and four orthopedic surgeons it can call on within a 30-mile radius. North Mississippi Medical Center in Tupelo is the nearest Level 2 center — earning that distinction because of its proximity to neurosurgeons. University of Mississippi Medical Center in Jackson is the only Level 1 trauma center in the system, meaning it has access to the tools and surgeons to handle virtually any manner of trauma on-site, McClanahan said.
Everything stops for trauma
In cases of trauma, emergency responders identify the severity of the trauma and communicate with a state-operated dispatch center to determine where to take a patient. If a patient is brought to Baptist, the hospital’s trauma program manager and registered nurse Deborah Bouleware said emergency services notify ER staff of the number of casualties and the severity of the injuries.
From there, Bouleware said ER personnel notifies everyone on the hospital’s trauma team, which ranges from ER doctors, surgeons on call, nurses, orderlies and others. Once the patient arrives she said the ER doctors work to stabilize the patient and nurses set up equipment in one of Baptist’s four trauma bays while they wait on surgeons to arrive.
At any point, McClanahan said, the ER doctors on duty can upgrade or downgrade a trauma case. In instances of a severe or mass trauma, McClanahan said it can become organized chaos.
“It’s chaotic, but it does work,” he said. “I think (at Baptist) we’re comfortable in that we can mobilize our resources and get the job done. And we’ve demonstrated we can rise to perform in a mass casualty.
“The problem with trauma is you don’t know what you’re going to find when you walk in the door,” he added. “Trauma requires everything you know. Everything else stops, and you just have to do that.”
When a trauma comes in the door at Baptist, even a mini-mass casualty like on March 20, marketing manager Megan Pratt said the hospital has plenty of resources to maintain a high level of care for its non-trauma patients. While she said elective surgeries may be delayed during mass casualty traumas, the hospital did not compromise care for its regular patients.
Importance of trauma care
Unfortunately, Pratt knows how critical trauma care can be. In 2009, her 18-year-old daughter, Madison, died on the operating table at DCH in Tuscaloosa, Alabama, of complications from a car wreck.
Pratt said emergency responders airlifted Madison to DCH from the wreck scene — only about 2.5 miles from the Pratts’ home — and Pratt said her family watched as that hospital’s trauma unit worked diligently to save her daughter’s life.
“I know that surgeon did everything he could to save her,” she said. “He just couldn’t. You never realize how important a good trauma team is until you deal with it personally. You learn to appreciate what these guys do.”
Failure, or the potential thereof, in a trauma situation is something that weighs heavily on McClanahan’s mind when he walks into those situations. The greatest stresses of the job, he said, are when a surgeon doesn’t know what to do or when his or her abilities are overburdened.
Still, he said he remains focused on what it’s for – saving someone’s life — and he continues to try to rise to the occasion.
“You enjoy doing anything well that you’ve been trained to do, and I think that’s true of any profession,” McClanahan said. “Not wanting to make a mistake is a great motivator. I’m deathly afraid of standing there and not knowing an answer I need to know.”
State trauma system regulations require all trauma surgeons and ER doctors to complete advanced trauma life support training, while nurses must complete the trauma nursing core curriculum. Trauma doctors, surgeons and nurses must re-certify every four years.
McClanahan said Medicaid, Medicare and private insurance cover some trauma costs, while 15 percent of the state’s trauma system funding is used to reimburse hospital for trauma care.
That still left nearly half of Baptist’s trauma care unfunded, though, McClanahan said.
Zack Plair is the managing editor for The Dispatch.
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