||Trooper First Class Jimmie Meurrens
The specifics of what happens in a traumatic
injury—from the scene of an accident
to treatment in a trauma unit—is not something many of us may want to think about outside of, say, an episode of ER. But, as the audience of a STEP forum on this topic learned recently, emergency medicine is a constantly evolving field that deserves our attention not just because of its connection to medical research, but because of the frequency at which these injuries happen and how often trauma specialists save lives.
At the forum, “Surviving Traumatic Injury: Improving the Odds,” paramedics, researchers and trauma surgeons provided real-life examples
to demonstrate exactly what happens from the first 911 call throughout hospital care. Specialists
also provided updates on diagnosis and treatment for problems such as blunt aortic injury and burns.
While many of the examples—which often included film footage—were not for the weak of stomach, it quickly became clear just how complicated and important this high-pressure work can be.
In an overview of current trauma management,
Dr. Rao Ivatury, professor of surgery and emergency medicine and physiology at Virginia Commonwealth University, stressed this point with statistics. The leading cause of death in the first four decades of life in the U.S. is unintentional
injury, he reported. This death rate has been increasing; the 2006 estimate is 38 percent greater than the rate in 1992. Part of the issue is that patients who in the past would not have made it to the hospital are now able to get there, thanks to efficiencies in paramedic treatment. Trauma surgeons are doing their best to keep up with the increasing numbers by re-evaluating old methods, utilizing current research and looking for ways to bring new concepts into practice.
Dr. Rao Ivatury of Virginia Commonwealth University provided an overview of current trauma management.
“We have made a lot of accomplishments,” Ivatury said, “but we still have a lot of things to learn because modern treatment of trauma is pushing the boundaries of survival.”
In a talk that made all of this even more immediate,
Trooper First Class Jimmie Meurrens, a flight paramedic and instructor for the Maryland
State Police Aviation Command, played a series of calls to 911 and between dispatchers
and paramedics after a traffic accident. A man had been hit by a car and lay in the middle of the street. One caller assumed the man was already dead.
Though Meurrens showed slides during the recordings, no photo was needed to capture the urgency of the calls. “This is EMS,” or emergency
medical services, he said. “This is what we have to do out there on a daily basis.”
Involved in the STEP forum presentation were (from l) co-chairperson Dr. Prabha Atreya of NIBIB, Ivatury, co-organizer Dr. Laura Moen of NIDDK, Dr. Guy Clifton of the University of Texas Medical School, Dr. Ronald Tompkins of Harvard Medical School, Dr. Aurelio Rodriguez of Drexel University College of Medicine, co-chairperson Dr. Christopher Hatch of NCI, Trooper Meurrens and First Sergeant Tobin Triebel of the Maryland State Police, and co-organizer Dr. Michael Small of NCI.
Modern EMS services are a relatively recent phenomenon, he explained. Though credit for the first “pre-hospital” system is often given to Napoleon’s army in the late 18th century, it wasn’t until 1966, when the National Academy of Sciences put out a white paper on accidental
death and disability, that people really began paying attention. The authors found that ambulances
were ill-equipped and inappropriately designed and that personnel were inadequately
trained: at the time, 12,000 morticians were providing 50 percent of the nation’s ambulance services. The American Ambulance Association then reported that as many as 25,000 people a year may have been permanently disabled due to mishandling by poorly trained ambulance
personnel. In the wake of this news, “we began to first see commonly recognized training throughout the country,” Meurrens said.
He provided background on the guiding principles
of EMS: the familiar, six-pronged Star of Life for on-scene care; the “ABCs,” focusing on the key issues of airway, breathing and circulation;
and the concept of the “Golden Hour,” the principle that if someone’s injured, he or she needs to be in definitive surgical care within an hour or will likely die. This concept
was developed by Dr. R. Adams Cowley, known as the “father of trauma care.” The idea was so pioneering that the Shock Trauma Center
at the University of Maryland, where he did this work, is now named for him.
In many ways, Maryland is a leader in emergency
services. It had the first statewide EMS system, which has been used as a model around the country and the world, and the Maryland State Police was the first to perform
a civilian medevac—using a helicopter to transfer patients from the scene of an accident to a trauma center.
Meurrens, who, as a flight paramedic, knows all about this form of transport, returned to the story of the man hit by a car to demonstrate
the potential power of using helicopters,
as well as other advanced methods of emergency treatment. It seems the “man” was actually a 14-year-old boy who snuck out of his house to see his girlfriend and was struck by a car while crossing a road.
“When I got there he was unconscious, unresponsive,
he was breathing poorly…he had abrasions on his chest and abdomen, he had a broken leg, he was just in a horrible state of disrepair,” Meurrens said. They were about an hour and a half away by car from the local trauma center, but by air, only 26 minutes. Meurrens administered necessary procedures and transferred him immediately to Baltimore’s
Shock Trauma Center. “Within minutes
there he was taken to the operating room to relieve the blood and swelling that started to develop.”
Today, the boy has made a full recovery. “He’s on the track team, running a 6-minute mile,” Meurrens said, adding that he tries to imagine how he would feel about this boy if he was a son or brother. “How would he have fared if he had to take an hour and half trip up the street? I fully believe that this case clearly demonstrates how the partnership between field EMS, helicopter EMS and trauma
centers saves lives.”