Calif. trauma systems helping to save lives

By Kathleen Wilson
Ventura County Star  Promising results so far for new county program

VENTURA, Calif. — Vanessa Maynard was so severely injured in an automobile accident a little over six months ago that doctors were surprised she had lived long enough to get into surgery.

Maynard, 51, of Camarillo suffered massive internal injuries in March when the sports car she was riding in was broadsided and the wreckage went two feet into the passenger side. Her aorta split. Both lungs collapsed. And those were only the most imminent life-threatening problems. She also lacerated her liver, broke her ribs and pelvis, and sustained brain injuries.

'She needed for everything to go right to survive,' said Dr. Laurence Weekes, the Los Robles Hospital & Medical Center trauma surgeon who supervised her care. 'I think it did.' Maynard's case and that of a 25-year-old Navy sailor, whose carotid artery was severed when a drill bit punctured his neck, were presented this month to the Ventura County Board of Supervisors. They are the human proof that the county's year-old trauma system is saving lives, officials said. Since its inception in July 2010, about 2,300 patients have been treated in the system that routes the most critically injured people to Los Robles and Ventura County Medical Center.

Ventura County lagged the rest of the state in instituting a trauma system, a coordinated method of care for patients with major injuries. But mortality data show promising results for the fledgling program in comparison with similar-size hospitals offering the same types of trauma care.

VCMC reported a mortality rate of 2.72 percent, slightly under the national average of 3.03 percent for hospitals of up to 200 beds. Los Robles officials calculate their mortality rate at 1.21 percent against a national average of 3.04 percent for hospitals of up to 400 beds.

Officials speculate that the VCMC rate is higher because of the larger numbers of stabbings and shootings in its service area.

Steve Carroll, director of the county emergency medical system, said the goal is zero. That may never occur given the nature of trauma injuries, which run the gamut from shootings and major motor vehicle accidents to falls exceeding 10 feet.

But Carroll said the new system boosts the chance of survival.

"What we were trying to do was elevate the bar," Carroll said.

Doctors at VCMC performed surgery on Shawn Gilroy, a 25-year-old Seabee who has since left the Navy. His right carotid artery was severed and his internal right jugular vein torn when a drill bit penetrated his neck in June.

Gilroy was treated at St. John's Regional Medical Center in Oxnard, where doctors inserted a breathing tube, and then underwent surgery at VCMC. He said he expects to make a full recovery.

Physicians say trauma systems are particularly suited to treat these major - and sometimes bizarre - injuries.

The idea is to immediately deliver specialized care instead of having to wait for an operating room, imaging equipment, doctors and nurses to be available. More than a dozen people may mobilize to handle a case, and they follow a carefully orchestrated plan. The work starts inthefieldwhenrescue workers assess who needs to go to one of the trauma centers instead of the nearest hospital.

For Maynard, the system went into gear at the scene of her accident shortly after 4 p.m. March 7 at the corner of Woodcreek and Santa Rosa roads in eastern Camarillo. She and her 21-year-old son had just gone out to celebrate the A he scored on a college math test. They picked up a sandwich for him and a lemonade for her, then began driving home in their small BMW.

Her son turned left from Santa Rosa onto Woodcreek in front of a Suburban that couldn't stop in time. Sheriff's Senior Deputy John Popp said the driver was going under the speed limit of 50 mph, but that the small car was no match for the Suburban. The vehicle struck the front of the small car, then ran into the side, a particularly vulnerable spot to be hit.

In a sense, Maynard got lucky because a fire station sits at the corner of the intersection. Fire officials were not able to confirm the account last week and she has no memory of what happened. But Maynard's son, who was less seriously injured, told her firefighters heardthe crash and rushed outside to help. The rescue was prolonged because Maynard had to be extricated from the car, but hospital records showed she arrived at the hospital at 4:45 p.m. By then, paramedics had alerted a specially trained nurse that a serious trauma case was on the way.

The nurse then activated a "Code Green," an internal system for calling and paging the nurses, doctors and technicians on the trauma team to be ready. Weekes, then 10 hours into his 24-hour shift at the hospital, was waiting for Maynard when she arrived.

What he calls the ABC's were thefirst priority: airway, breathing and circulation. Maynard had a clear airway, but was having difficulty breathing so doctors inserted a breathing tube and put her on a venti lator.

After a chest X-ray showed her lungs had collapsed, the staff inserted chest tubes to allow the lungs to expand. It's a procedure that Weekes said has to be done within minutes.

Then doctors found a tear in her aorta. More than 90 percent of accident victims with the injury die at the scene, said Dr. G.R. Mohammadzadeh, the cardiothoracic surgeon who operated.

He was amazed to find her thoracic aorta cut in two, leaving only a thin transparent outer layer of the aorta to carry blood. That tiny layer could have burst at any moment, he said.

"It's all that kept the blood from flowing into the chest and killing her," he said.

"I was just amazed she was still alive. I think it just wasn't her time."

The surgeon repaired the tear by inserting a cylindrical piece of fabric that mimics the aorta during an operation lasting four to five hours.

Afterward, the immediate dangers that she could die in surgery or be paralyzed had passed. But she still had a long recovery ahead. She was hospitalized for two weeks at Los Robles, then went to a rehabilitation program at St. John's Regional Medical Center.

She had to learn to talk again because her speech was garbled, and couldn't walk for two months until her pelvis healed. She developed blood clots in her legs for which she takes a blood thinner.

One of her vocal cords is paralyzed, either from the trauma or the time she spent on the ventilator. She hopes her full speaking voice will return, but she may need an implant or other procedure to ease the problem. Her vision was compromised in the accident, but 90 percent of it has returned, she said.

Still, she's happy to be alive and credits the trauma care for that.

Coming that close to death has made her much calmer, she said, and more appreciative of her family.

"Really nothing else matters," she said.

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