2/21/08
CMH emergency staff ready to handle even most severe traumas
By Cathy Gilbert

JERRIOD GRIZZLE/Manning Times

Members of the Life Net South Carolina Transport team prepare the helicopter to take a patient to a Level 1 trauma center. Clarendon Memorial Hospital is host to the chopper for a 12-hour shift every other day and can summon it to the hospital or an acident scene in minutes.

Just over 30 years ago, orthopedic surgeon Dr. James K. Styner was piloting a light aircraft when it crashed into a field in Nebraska. His wife was killed instantly and three of his four children received critical injuries. He carried out the initial assessment (or triage) of his children at the crash site. Dr. Styner had to flag down a car to transport him to the nearest hospital; upon arrival, he found it closed. Even once the hospital was opened and a doctor called in, he found that the emergency care provided at the small regional hospital where they were treated was inadequate and inappropriate.

Styner soon realized that with the proper protocol, he could have done a lot more to treat his children in the field and developed a system of simultaneous assessment and treatment now known as Advanced Trauma Life Support or ATLS.

As a rural hospital, Clarendon Memorial Hospital is extremely well equipped and well staffed. But there are cases, just like Dr. Styner’s, that are known to be too critical and too complicated to be handled here at home. With nearly 35 miles of Interstate 95 traversing our county, high-speed motor vehicle accidents are all too common.

To address the type of trauma that is associated with such accidents, as well as other incidents such as gunshot wounds, traumatic falls and drug overdoses, the emergency department at Clarendon Memorial is well trained in assessing these types of cases and moving them on to a Level 1 trauma center, such as Palmetto Richland in Columbia or the Medical University of South Carolina in Charleston.

Clarendon Memorial currently contracts with Life Net South Carolina to provide emergency helicopter transportation from with the hospital or the accident scene to a Level 1 trauma center.

In May of last year, Life Net was formed by the merger of two air medical helicopter transport services, Life Reach and CareForce (which had previously served CMH). The goal of this new program is to get definitive care to the patient faster by being based in the surrounding communities rather than the traditional hospital based system.

Clarendon Memorial houses the Life Net staff in a space provided by the hospital and the chopper is at the hospital for 12-hour shifts every other day. At other times, it is available within minutes from one of its other bases in Camden, Columbia, Orangeburg or Augusta. The total transport time from CMH to Palmetto Richland is just 19 minutes.

According to Dr. Ken Johnson, director of the CMH Emergency Department, all emergency room doctors and paramedics are certified in ATLS.

“Dr. Styner realized that there are actually three levels of traumatic injury,” Johnson explained. “First there are those who die at the scene usually from massive head injuries. Then there are those who will die within the first hour and if they are to survive, stabilization needs to occur within that first hour, known as “the golden hour.” The third level is those who may die days or weeks later from complications that arise after care begins.”

Johnson explained that all victims of trauma are susceptible to shock, loss of airway and massive bleeding.

To that end, Styner developed a protocol that is easily remembered by a simple catch phrase, ABCDE.

A is for airway. Responders, whether in the field or in the emergency room, must first assess a victim’s airway to make sure that they are moving air and if they are not stable, intubate them.

B is for breathing and if a patient is not breathing on his or her own, measures are taken to breathe for them.

C is for circulation or hemorrhage. Compression bandaging may be used to stop bleeding and to keep blood pressure stable.

D is for disability. All victims, especially of motor vehicle accidents are placed on a backboard and their head is stabilized to prevent additional injury that could lead to paralysis.

And lastly, E is for environment and exposure. The patient will have his clothing cut away and will be covered with warm blankets to prevent hypothermia.

“With the ATLS protocol, every physician and emergency department staff member are speaking the same language and operating under the same guidelines,” Johnson explained. “While all of these assessments are going on, we are summoning the helicopter and talking to the receiving trauma center. No time is wasted with long tests or x-rays. We are racing to get that patient stabilized within that golden hour.”

Lin Rainey is the director of Emergency Medical Services at CMH and oversees both the ground and air transport services for the hospital.

“We have a very effective trauma system in place, especially to be so rural,” Rainey said. “Because of our relationship with Life Net, we can be much better than the trauma services of many larger cities.”

Directing the traffic in the emergency department at CMH is nurse manager Marsha Nelson.

“Because we don’t have all the high level specialists like neurosurgeons and cardiac surgeons, we can’t be a Level 1 trauma center,” she explained. “But, we do have a very intricate, well-defined set of procedures that have been developed to ensure maximum patient care.”

Nelson estimates that trauma patients are transported from CMH between 10 to 20 times a months and at least 75 percent of those will be transported by air.

“We see more trauma in the summer than the winter due to increased traffic on the interstate. We transport out all penetrating injuries due to gunshot wounds or motor vehicle accidents, run overs, drownings or multiple system injuries,” she said.

Rainey said that accidents involving penetrating injuries, second or third degree burns, paralysis, amputation or ejections from vehicle all require transport to a trauma center due to the possible severity of injury.

Rainey’s staff includes 13 fulltime paramedics, five EMT-Intermediates and three basic EMTs with two currently in paramedic training. The EMS answers approximately 5,900 calls per year and with about 120 trauma flights per year and 550 transfers per year.

With 600 square miles of Clarendon County, nearly 35 miles of Interstate and a growing population, the importance of high-level trauma care is not to be underestimated.

But thanks to a dedicated and highly trained local staff, that high level of care is just around the corner.