Trauma service turns 30

The doctors and nurses with Stanford’s Level 1 trauma service treat the Peninsula’s most gravely injured residents and conduct research on how to improve care.

Trauma nurse coordinator Jo Ann Schumaker-Watt and trauma service director David Spain. 
Norbert von der Groeben Here

Jerry Hynes had just left his favorite Santa Cruz bookstore on Dec. 23, 2013, when he was run over by the bus he was rushing to catch.

The driver stopped the bus, but until he understood what the vehicle had hit, its full weight remained on the legs of the 76-year-old retiree. The injuries list that later documented Hynes’ damaged body parts was four pages long. Almost 2½ years and many arduous hours of rehabilitation later, “I go for a walk outside each day, I go to the gym, I go to the library,” Hynes said. “Considering how what I call my new life began, it’s all been grace.”

Hynes credits the Stanford Health Care Trauma Service for saving his life and preserving his leg function. “I could have ended up as a permanent invalid,” he said. “Thanks to the amazing work of the Stanford trauma team, I came through intact.”

The story of Hynes’ against-the-odds recovery is one of many in the 30-year history of the Stanford Trauma Service. On May 14, as part of Stanford Medicine’s Health Matters community education event, the service will celebrate three decades of providing this special form of medical care that depends on a precisely practiced choreography to urgently treat severe injuries.

Trauma care is taken for granted these days, but this wasn’t always so, according to trauma surgeon David Gregg, MD, clinical associate professor of surgery, who led the service from 1986 to 2001. Until the late 1960s, when trauma care began to be organized around special skills and personnel, “the way trauma care had been managed in most local hospitals was in an emergency room that would also be open to take trauma patients,” Gregg said. The lack of training, national standards and verification processes, he said, was failing patients.

Ranked by level of services

Using national standards now determined by the American College of Surgeons, trauma programs are ranked by their level of services and available medical expertise. Since 1998, SHC’s trauma service has been verified as a Level 1 provider, the highest level of trauma care recognized by the American College of Surgeons. It’s one of just 12 Level 1 adult trauma programs in the state and the only one between San Francisco and San Jose. It also serves as one of just three Level 1 pediatric trauma services in Northern California. Last year, SHC’s trauma team treated more than 2,600 patients from its coverage area of the Peninsula’s 2.6 million residents, as well as patients flown in from elsewhere in Northern and Central California.

Trauma care is part of emergency medicine, but traumatic injuries are distinctive in their severity. They may include penetrating and blunt force injuries, airway obstruction, fractures, paralysis — or all of the above. A trauma team’s paramount goal, said trauma nurse coordinator Denise Greci Robinson, is to keep bleeding under control and airways clear for breathing. 

Rapid identification and treatment of injuries is accomplished through the collaboration of emergency medicine doctors, trauma surgeons, specialized nurses, advanced practice providers, imaging technicians and care coordinators, Greci Robinson said. When needed, specialists in orthopaedics, neurosurgery and other areas will come quickly to assist.

“We have a standardized approach to identify injuries quickly and get those treated in a timely manner. Sometimes people will go immediately to the OR, sometimes to the ICU,” said Shelly Woodfall, SHC’s trauma program manager.

David Gregg led the trauma service from 1986 to 2001.
Norbert von der Groeben

How the team operates

Each trauma team member has a clear role. One doctor acts as the captain of the team, directing the specifics of care; a nurse does the same for the nursing team — but neither one will touch the patient. Another doctor is in charge of calling out all the injuries observed in the patient, a third is expert in clearing a patient’s airways to insert a breathing tube. Technicians also have designated jobs — to operate equipment or monitor it. Trauma specialists like orthopaedic surgeons and general surgeons assess and repair damage.

In the limited space of a treatment room, where more than a dozen people might be coming in and out, preparing to manage stress is critical, said Greci Robinson. “When you’re in the middle of it, so focused on doing your job, emotions don’t surface.” If the noise level rises too high, the doctor in charge will call out, “One voice!”

As a level-1 trauma center, SHC provides a complete package of services, from community education on injury prevention to rehabilitation to research that advances trauma care. “We pride ourselves on trying to figure out better ways to take care of our patients,” said David Spain, the Carol and Ned Spieker Professor and professor of surgery, who has been director of the trauma service since 2001. He has guided many improvements, including new technologies for imaging and information sharing, ways for SHC to be a resource for trauma patients throughout the state and novel approaches to care based on outcomes analysis.

Asiana Airlines crash

“We are constantly reviewing data about our performance,” Spain said, “and we’ve been recruiting people who are committed to doing trauma care.”

The program’s greatest test was the 2013 Asiana Airlines crash at San Francisco International Airport. There were 307 people aboard the flight, and SHC was the only nearby Level 1 trauma center with a helipad. Within 30 minutes of the crash, SHC’s trauma service had paged the staff: More than 150 trauma and emergency medicine specialists would be engaged in treating 55 patients.

The team aimed to treat as many people as possible within the “golden hour,” said Patrice Callagy, director of emergency nursing services. She has been at SHC for nearly 25 years and well knows that starting treatment within the first hour after injury boosts the odds of survival. “We also know that if you are treated at a Level 1 trauma center, you have a 25 percent greater chance of survival,” Callagy said.

The trauma team’s research on care improvement continues, said team surgeon Thomas Weiser, MD, assistant professor of surgery. “We have to be prepared for what happens not just today, but five or 10 years from now.” 

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