Inside the trauma unit at Gary Methodist - August 9, 2015

Courtesy of NWI Times

August 09, 2015 7:00 am • Giles Bruce giles.bruce@nwi.com, (219) 853-2584

GARY | A message went out over the loudspeakers in the emergency room at Methodist Hospitals Northlake Campus: “Trauma standby, adult times one. Trauma standby, adult times one.” It was the hospital’s second trauma patient in less than an hour.

Doctors and nurses gathered in the trauma bay and put on gowns impervious to blood, having just cleaned up after the first trauma case that night, a motorcycle-accident victim with a possibly fractured skull. Staff got IVs and other supplies ready. Someone brought in a portable X-ray machine.

A few minutes later, the patient arrived, crying out in pain as she was moved from the ambulance cart to the hospital bed. The woman had been struck by a vehicle. “She doesn’t remember the circumstances,” one of the paramedics said.

“Can you give something for the pain — 50 (milligrams) of fentanyl?” an ER doctor called out.

The woman let out a phlegmy scream, as about a dozen people surrounded and cared for her. “Let’s get some blood in here!” a physician said.

A chaplain walked around with an iPad, trying to find contact information for the patient’s family. “I think I’ve got a son,” she said.

“Relax your arm, dear,” a doc said to the woman in a calm, reassuring tone.

Ultimately, a decision was made to transfer the patient, who would need a specialized surgical procedure, to a higher level trauma center in the south suburbs of Chicago. A helicopter showed up several minutes later.

Trauma volume increases

Neither of the trauma cases on this recent night would have ended up at Gary Methodist if it hadn’t been designated by the state as a Level III trauma center last August. A state rule advises emergency responders to take a traumatically injured patient — a person who’s in danger of losing either life or limb — to the nearest trauma department if it’s less than 45 minutes away. The hospital is the first and only trauma center in Northwest Indiana.

While trauma is the leading cause of death for Hoosiers younger than 45, according to the Indiana State Department of Health, the preventive-death rate drops by 25 percent when a patient is taken to a trauma center.

It’s been a busy summer at Gary Methodist. The facility is not only getting its regular dose of gang violence and motor-vehicle crashes the warm-weather months bring out, but also trauma cases from around the region. Because of the transport rule, Methodist Northlake’s trauma-service area has expanded from Gary to all of Lake, much of Porter and parts of Jasper and Newton counties. In turn, the hospital’s trauma volume has more than doubled in the past year, with about half the patients coming from outside Gary. At 98 trauma cases, July was its busiest month yet.

“It’s gotten busier, but my job has gotten easier at the same time,” said Dr. Nick Johnson, an emergency-medicine physician at Methodist who keeps the mood in the ER light with his easygoing manner and sense of humor. “Before the trauma center started, I was expected to keep anyone alive overnight kind of on my own. Now we get a lot more backup.”

Johnson still remembers the night, years ago, when the ER got six gunshot victims within 25 minutes. Now, with the state designation, trauma surgeons are always 30 or fewer minutes away. Another change has been the types of cases that end up at Methodist.

“I had my first tractor accident the other day,” he said.

About a fifth of Methodist’s trauma patients are still being transferred to higher-level trauma centers in Illinois or Indianapolis. A state-funded report on Northwest Indiana trauma care published last summer recommended the creation of a Level I or Level II facility in the region by 2018.

It suggested Methodist, Munster’s Community Hospital and Valparaiso’s Porter Regional Hospital as the likeliest locales because of their proximity to highway systems and population centers and capacity of acute beds with the potential to expand.

The path to becoming a trauma unit

Dr. Michael McGee, a Gary native and medical director of emergency services for Methodist Hospitals, said that when he moved back to Northwest Indiana in the mid-2000s, he noticed the need for more trauma care right away. The big difference from his youth? The increase in gun violence.

“At that time, we were not a designated trauma center,” he said of the Gary hospital. “We were a de-facto trauma center.”

But many patients were being taken directly to certified trauma centers in Illinois, Indianapolis or South Bend. This would often interfere with the “golden hour” of trauma: that if someone with a traumatic injury doesn’t get into the operating room within 60 minutes, the person’s risk of death increases significantly. It’s also an inconvenience for a patient’s family to have to travel hours to visit their loved one in a hospital.

So McGee joined a statewide task force to expand the trauma system in Indiana. Out of that group came a plan for the state to start offering its own designation. The “in-process” classification, which is what Gary Methodist has, means a given hospital has to be certified by the national trauma-accreditation organization, the American College of Surgeons, within two years.

More than a year before applying for the state designation, Methodist Northlake brought on trauma coordinator Jennifer Mullen, a longtime ER nurse. She made sure the facility had the proper staffing, facilities and protocols in place.

“I think it really is altruistic to be a hospital that does trauma,” Mullen said, noting that many trauma patients have little to no health insurance and the state of Indiana doesn’t provide any funding for trauma centers. “You’re doing a huge service to the community.”

McGee, however, believes that for Northwest Indiana to provide its residents with the best health care possible, it needs a Level I trauma center. Such facilities have general surgeons on site 24-7, staff specialty surgeons and act as teaching hospitals. But he said what Methodist has done is a good first step.

“People who come in with severe injuries are now being treated appropriately, are being treated more timely. They’re getting to the operating room quicker,” McGee said.

“We’ve pretty much fast-tracked everything, from labs to X-rays to cat scans to surgery.” Where it takes a typical hospital four hours to get an emergency patient into surgery, Methodist is now doing it in around an hour, Mullen said.

Another requirement of trauma centers is community outreach — in other words, trauma prevention. Mullen, for instance, talks to kids about the dangers of distracted driving; McGee gives presentations in schools about avoiding violence.

“Trauma care doesn’t just happen in the trauma bay,” Mullen added, saying it extends from the paramedics in the field to the entire hospital to the community at large. “It’s bigger than this room.”

Preventing loss of life or limb

On another recent night, the trauma unit got a call that a gunshot victim was being transported from Merrillville.

“Make sure everyone has eye protection,” said Dr. Reuben Rutland, a trauma surgeon and trauma medical director for Methodist, as the staff scrubbed up in blue smocks. The room had the sanitized smell of chemically cleaned-up bodily fluids.

The paramedics wheeled the patient in. “Friend, can you wiggle your toes?” “Can you feel me touching?” Johnson said. “My man.”

Medics took an X-ray of the injury. The doctors quickly determined it wasn’t life-threatening.

But it could have been worse. And that’s the point of the trauma unit: to quickly respond to and streamline any cases that place life or limb in jeopardy. This is especially important in a city like Gary, with its high incidence of gun violence and location amid major highways and heavy industry.

“This is going to sting,” Rutland said, preparing to clean out the patient’s wound. “It’s not as bad as what you’ve been through, but I’m not going to lie, it’s going to sting.”

“Aww s—, f—, man,” the gunshot victim cried out.

Still, the trauma bay was oddly quiet, mostly the sounds of machines beeping and phones ringing and medical professionals talking quieter than you’d imagine. “It’s not like TV or anything,” Rutland said. “Everybody tries to remain calm.”

The controlled chaos gradually died down as staff members put a splint on the patient and wheeled him to an operating suite down the hall.

A few minutes later the only person in the room was a janitor, humming to herself and mopping blood off the floor.

For part two of this series, click here.