“Melissa Smith is the heart and soul of the trauma program and is involved in every aspect of the oversight and functioning of the trauma service.”
These words would be extraordinary praise from a supervisor, but they are remarks by an American College of Surgeons (ACS) peer reviewer following their site visit in late 2024.
The ACS has just awarded Vanderbilt University Hospital (VUH) its fourth consecutive national verification as an adult Level 1 trauma center.
As VUMC’s trauma program manager, Smith was a driving force behind VUH’s first national ACS verification in 2014, working alongside then chief of the Division of Trauma and Surgical Critical Care Richard Miller, MD, and others to achieve this status. She has been spearheading this effort ever since.
“Melissa sets the standard for trauma program managers,” said Trauma Medical Director Bradley Dennis, MD, associate professor of Surgery in the Division of Acute Care Surgery. “She is a leader, not just at VUMC, but at the state and national levels. Her commitment and dedication to Vanderbilt’s trauma program is second to none.”
The ACS Level 1 trauma center verification process closely examines the entire spectrum of trauma care, including outreach and prevention, as well as efforts to improve performance and conduct outcomes-based research. An exacting 122 standards must be met.
Patients with traumatic injuries come to VUH from an 80,000-square-mile region, and approximately 9,400 acute trauma patients are treated at the hospital annually.
Smith was drawn to a nursing career because of her grandfather’s stories of his experiences as an Army medic during World War II. Her grandfather was later diagnosed with Parkinson’s disease and came to live with her family. He eventually suffered a traumatic brain injury after a fall.
“I was 13, and I remember going into the ICU to visit,” Smith said. “He had an ICP (intracranial pressure) monitor — all the technology. That really impacted me. I remember thinking, ‘I need to do this.’”
Smith began her nursing career in cardiology but quickly realized she wanted a faster pace. She transferred to VUH’s Trauma Intensive Care Unit where she provided bedside care for eight years.
“I’ve always had a deep desire to make a significant impact,” she said. “Being in the high-stakes environment of trauma care, where every second counts, is challenging and rewarding at the same time.”
Smith earned her MSN and worked for three years as a nurse educator before she was approached by Miller to lead the efforts for the national Level 1 trauma center verification.
Smith’s dedication to ensuring the best possible care for critically injured patients is one of the many reasons her colleagues nominated her for the Five Pillar Leader Award, which she received at the January 2025 VUMC Leadership Assembly. The award recognizes leaders who consistently model leadership across the five pillars of excellence — people, service, quality, innovation, growth and finance — and the Credo.
Those nominating Smith noted that “Her fingerprints on the VUMC trauma program are indelible,” and that she “has innovated all along the way.”
Smith is credited with creating a world-class performance improvement program for VUH’s trauma center. Her system of evaluating overtriage and undertriage of patients has been replicated nationally, and her work to house VUH’s evidence-based patient management guidelines on an open-access web-based platform has allowed their use by trauma care providers across the globe.
“We frequently hear from providers at other institutions who note that Vanderbilt protocols are posted in their ICU provider workrooms, complete with Vanderbilt letterhead,” noted Dennis, who holds the Carol Ann Gavin Directorship in Acute Care Surgery.
Smith focuses on improving patient outcomes on a large scale, driving systemic changes and continually enhancing the trauma center’s robust practice management guidelines to guide delivery of the best evidence-based care.
For example, during her review of all VUH trauma admissions, Smith noticed a pattern of patients transported by EMS agencies coming in after receiving large doses of the anesthetic ketamine. These patients often became overmedicated, leading to adverse clinical events such as intubation. Concerned, Smith contacted other trauma centers; they were seeing the same troubling trend.
Smith worked with VUMC’s EMS Center of Excellence, which in turn worked with the state EMS medical director to establish ketamine use and dosing guidelines, as well as a recommendation for additional education. Since that time, adverse events related to prehospital ketamine administration have decreased greatly.
Smith’s life away from VUMC is a bit less fast paced. She and her husband, Lacy Smith, have three sons, one in high school and two in college, both of whom are preparing for careers in medicine. They’re all huge sports fans, and their 2024 family Christmas present was a trip to watch the Los Angeles Lakers play.
If she hadn’t become a nurse, Smith said she’d likely have become a pastry chef.
“I actually received a ton of scholarships to go to culinary arts school,” she added.
Her specialty is strawberry cake, concocted with fresh, pureed berries and covered in decadent icing. Smith’s colleagues, who often request this delicacy, willingly share their trauma protocols, but not the cake.
View Melissa Smith’s video from Leadership Assembly.
If you are a VUMC employee, you can nominate a colleague for an Elevate Credo Award, Five Pillar Leader Award, or Team Award. Visit the Elevate website to fill out a nomination form. Employees demonstrate credo behaviors when: they make those they serve the highest priority; respect privacy and confidentiality; communicate effectively; conduct themselves professionally; have a sense of ownership; and are committed to their colleagues. Elevate award nominations are accepted year-round. If a nomination is received after the cutoff for an award selection period, the nomination will be considered for the next period. VUMC VOICE will post stories on each of the award winners in the weeks following their announcement.
