August 29, 2013

Trauma Center celebrates 25 years

A 19-year-old student was leaving her church’s revival on a rainy night in a small Kentucky town, when her life was forever changed by a horrific car accident.

Teamwork and an integrated approach to caring for each patient are among the driving forces behind the success of Vanderbilt’s Trauma Center. (photo by Daniel Dubois)

A 19-year-old student was leaving her church’s revival on a rainy night in a small Kentucky town, when her life was forever changed by a horrific car accident.

Pinned in her car, first responders worked more than three hours to extract her from the vehicle before transporting her to a nearby hospital, where doctors said only a miracle could save her. Fighting for her life, she was eventually airlifted to Vanderbilt via LifeFlight and taken immediately into surgery, the trauma team working tirelessly to save her life.

Thirty-four days at Vanderbilt, a leg amputation, four surgeries and 94 units of blood later, Rachel Pentecost and her family say she would not be here today if it weren’t for God and for the doctors, nurses and staff at Vanderbilt.

Pentecost is one of nearly 60,000 of the area’s most critically injured patients to pass through the doors of the Vanderbilt Trauma Center, which today celebrates a quarter-century as the region’s only provider of level-1 trauma care.

On Aug. 30, 1988, Vanderbilt became the first hospital in Middle Tennessee designated as a Level 1 Trauma Center, and to this day remains the area’s only hospital that meets the rigorous standards required to care for the most acute patients.

Covering a 65,000-square-mile territory, 58,000 patients have been admitted to the Trauma Center over its 25-year lifespan, including more than 25,000 motor vehicle accident victims, nearly 4,500 gunshot victims, 1,700 stabbing victims and more than 7,000 fall victims, along with a high volume of other injuries ranging from construction accidents to pedestrians hit by cars to recreational accidents.

A ubiquitous disease that can affect anyone, trauma is the leading cause of death in persons under the age of 44, but receiving care at a Level 1 Trauma Center can lower risk of death by 25 percent, according to the Centers for Disease Control and Prevention.

Patients who survive their injuries and arrive at Vanderbilt alive have a 95 percent chance of survival.

These patients are cared for by one of nine board-certified trauma surgeons and eight trauma fellows, along with Emergency Medicine physicians and nurses who are trained extensively to care for the most critically injured patients. This team also works closely with orthopaedic trauma surgeons and subspecialists in neurosurgery, facial trauma, radiology and vascular and spine surgery. Vanderbilt also operates the region’s only burn center, with 20 beds dedicated to burn care.

“We’ve developed a regionalized system that rapidly transports, resuscitates and manages critically injured patients, with the best overall results of saving lives in our region. We are the experts, and we’ve learned how to do this really well,” said Richard Miller, M.D., chief of the Division of Trauma and Surgical Critical Care and professor of Surgery. “It’s a real collaborative effort, from the time LifeFlight lands on the helipad and continuing between the Emergency Department and our Trauma team; everyone has a specific role, and it’s like a symphony.”

This “symphony” of Vanderbilt’s trauma care includes a fleet of five LifeFlight helicopters and a world-class Emergency Department that sees more than 60,000 patients annually, providing an integrated approach to care that has been emulated in hospitals nationwide.

“There is a reason why Vanderbilt stands out as one of the most exemplary trauma centers in the world — teamwork and expertise when treating every patient, every time,” said Corey Slovis, M.D., professor and chair of the Department of Emergency Medicine. “When I arrived here more than 20 years ago, I was taken aback by how standardized our trauma care was, with every patient treated exactly the same in the initial resuscitation. But over time, I saw the greatness of the Vanderbilt trauma care system. Injuries were not missed, expert care was the rule and was never compromised and younger physicians learned as they worked their way up the system and became exemplary team leaders. Today, doctors, nurses, paramedics, radiology, respiratory, social work, housekeeping and registration all work as a team, every patient, every time.”

Covering a 65,000-square-mile territory, Vanderbilt LifeFlight’s fleet of five helicopters rapidly transports many of the region’s most critically injured patients, providing these individuals the care only a Level I Trauma Center can provide. (photo by Warne Riker)

This integrated approach to trauma care that today is standard practice at Vanderbilt was pioneered with John Morris, M.D., at the helm.

“We started from ground zero,” said Morris, associate chief of staff of the Vanderbilt Health System, chief medical officer of the Vanderbilt Health Affiliated Network and Vanderbilt’s first director of the Division of Trauma and Surgical Critical Care. “And now, over the last 25 years, we’ve treated over 50,000 trauma patients, and we’ve done it in a fashion that I think all of us are proud of clinically, and all of us are proud of our contributions to research and education. We’ve made a significant difference in the community’s care of the injured patient.”

Morris began his tenure at Vanderbilt fresh out of his fellowship in 1984, at a time when the institution had no helicopter, no trauma service, no trauma doctors and no Department of Emergency Medicine.

Within six years of his arrival, Vanderbilt was one of only a handful of medical centers in the country to offer a trauma fellowship program. Vanderbilt now has the largest trauma and acute care surgery fellowship in the nation that meets the American Association for the Surgery of Trauma’s rigorous standards to be a certified American College of Surgeons fellowship, and has trained more than 50 surgeons since 1990, including current Trauma Chief Miller as the program’s first fellow.

Meanwhile, Vanderbilt’s Department of Emergency Medicine was born in 1992, followed by its residency program in 1993, and Vanderbilt’s LifeFlight fleet grew to five helicopters plus a fixed-wing aircraft and ground ambulances.

In the early 1990s, critically injured patients were grouped with other surgical intensive care patients, and Vanderbilt’s ICU was becoming inundated with trauma patients. It became evident that the hospital needed dedicated trauma space.

On Aug. 13, 1998, the acute care unit known as the Vanderbilt Trauma Center, located on 10 North in Vanderbilt University Hospital, officially opened its doors.

The 31-bed acute and sub-acute unit has treated a diverse patient population from all walks of life, from country music superstars to farming accident victims, from professional football players to high school athletes.

Among the more visible patients in recent years: a well-known singer-songwriter gravely injured in a scooter accident; a country music star and a professional football player, who were both critically injured in automobile accidents; members of Middle Tennessee’s law enforcement community injured in the line of duty; a rodeo cowboy gored by a bull; a teenager who nearly had his head severed as he was garroted by a wire fence while riding an all-terrain vehicle; an elderly man who suffered a traumatic brain injury after falling from a horse and then having the horse, in turn, fall on his head; and a teenager who had both feet severed by an amusement park ride.

But Vanderbilt’s trauma service to Middle Tennessee and the surrounding area doesn’t stop within its walls, as doctors and nurses regularly conduct prevention and education programs free of charge in area businesses and schools.

A Level 1 facility must be able to provide leadership and total care for every aspect of injury, from prevention to rehabilitation, which means Vanderbilt’s trauma program is continuously learning and looking at ways to improve performance across disciplines and enhance communication between specialties.

“Our ongoing mission is to provide optimal care for our community, leading the way in medical education, research and high-quality patient care,” Miller said. “Our patients are regular people, who one minute were going to work or having dinner, and the next minute they are in critical condition from a car wreck.”

These regular people include Rachel Pentecost, who could have never imagined how her life would change on that rainy evening after church, and whose family feels eternally grateful for the care their daughter received.

“The staff in the trauma unit became like family to us,” said Pentecost’s parents, the Rev. Darren and Kathy Pentecost. “The doctors and nurses took remarkable care of Rachel, and their thoughtfulness and kindness made the journey so much easier.”