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| Hospital Affiliations -- Newspaper
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The Business of Saving Lives
Teamwork vital element in treating trauma victims
By Maria Elena Fernandez
It's been almost four years since Gwinnett Medical Center
became a trauma/triage center - a hospital that can accept
victims of car accidents, shootings, stabbings and other
life-threatening injuries.
There were bumps along the way, but officials say the
county's only such center has come a long way in the delivery
of urgent care.
For starters, the biggest job was just coordinating the
system's many components. A trauma patient winds up in
a hospital. But before the patient arrives there, paramedics
on the scene administer care and make crucial decisions.
Then the patient is transported to an emergency room where
doctors, nurses and radiology and laboratory technicians
begin the next stage of the life-saving process. The next
step could be surgery or intensive care.
By the time a patient is stabilized, about 50 people have
played a role, said Debbie Kozeny, Gwinnett Medical Center's
trauma coordinator.
"A patient does not make it [only] because of a physician,"
Kozeny said. "From the paramedics on the field to the
physical therapist helping the person rehabilitate, every
member is a crucial part of the system. There was a time
when the individual parts of the system did not communicate
that well and the system suffered, but we are working
on the now and we can see the changes."
Gwinnett Medical Center handles about 36,000 emergencies
every year. About 400 or 500 are considered trauma cases
- and that figure is on the rise, officials say.
"Our pace is up considerably," said Steve Rolader, a Gwinnett
County police information officer. Gwinnett isn't that
suburban anymore."
At least two neurosurgeons are needed to make the system
work, Konzeny said. For almost two years, Gwinnett Medical
had one neurosurgeon because the other served in the Persian
Gulf War and didn't return to the hospital when his tour
of duty ended.
Finding neurosurgeons who want to take trauma cases has
been a chronic problem in metro Atlanta for years. A 1989
survey by the region's emergency medical council showed
only 12 of 45 neurosurgeons would work trauma cases.
Last summer, Gwinnett medical recruited Dr. Don Penney,
a neurosurgeon at Chicago's Cook County Hospital, one
of the nation's largest and most respected trauma centers.
Penney and his associate, Dr. Randal Rudderman, a plastic
surgeon, are working with Kozeny to improve the system.
Their biggest accomplishment, they say, is that "trauma
bypass" - which occurs when patients are taken to another
center because the one closest to them cannot treat them
immediately - has been virtually eliminated.
"Even though bypassing was done for legitimate reasons
- either our neurosurgeon was already busy or our scanners
were occupied - it was still frustrating to the paramedics
who are trying to make crucial decisions in seconds and
must travel from one trauma center to another," Kozeny
said. "It became very difficult for them treat the patient
on the field."
Maj. Lee Mitchell of the Gwinnett County Fire Department
said he has seen a dramatic change in the system in the
last year.
"There was a lot of frustration that stemmed from not
being educated to everybody's jobs and roles in the whole
system," Mitchell said. "We were frustrated because they
couldn't take the patients and they were frustrated that
we didn't understand. But now, we are communicating more
and patients don't feel the detrimental effects."
Penney has taken an active role by helping people serving
in the different parts of the system understand the whole
process, Mitchell and Kozeny said.
"If we can get people to stop thinking about their niche
and think about the whole system and how we can work together,
then the patients will win," Rudderman said. "The system
is not broke; but it could run better."
Penney and Rudderman visit fire stations and go out with
paramedics to the scenes of emergencies. They also are
holding educational sessions for anyone involved in the
trauma system every two months in casual settings outside
of the hospital.
"The more information we can disseminate to each other,
the better it is for the patients and the more cost-effective
it is to the hospital system," Penney said. "In a trauma
case, a lot of it depends on what happens in the first
24 hours. It does not serve the patients to have a couple
of high-powered surgeons in a hospital when there are
things going wrong in the field or in the intensive care,
for instance."
Last September, Chris Hayes tested the system for himself.
He was driving on Killian Hill Road when he lost control
of his car. The car flipped and Hayes, 32, was ejected
50 feet. He broke his neck in two places, suffered brain
damage and broke his shoulder.
Today, Hayes is out of the hospital and finished with
therapy. He practices karate three nights a week and can
bench press 190 pounds - just like he did before the accident.
Hayes exemplifies a trauma case that is handled well from
beginning to end, Penney said.
"First, I give it all to God, but I know that Dr. Penney
and all of the nurses and therapists who watched over
me helped save me," Hayes said. "I have never been treated
that well in my life and it's changed my whole attitude.
I am amazed. Everything's working."
The Atlanta Journal, January 10, 1994
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