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November 25, 2009

Texas trauma center looks toward expansion

By Erica Molina Johnson
The El Paso Times

EL PASO, Texas — The frenzy usually starts with a call from the paramedics.

With sirens blaring, they speed toward El Paso's only Level 1 trauma center to get help for the bloody or battered person strapped to a gurney in the back of their rigs.

Other times, there is no warning at all. The emergency department staff can do nothing more than watch as a car slows near the ambulance bay and the body of an overdosing heroin user is shoved out.

No matter how it starts, the response is always the same.

The crowd of 17 doctors, nurses, technicians and staff swarms around the patient and begins a carefully orchestrated performance with a singular mission: saving a life.

Natalie Quintana has been a nurse at University Medical Center's emergency department for four years -- long enough to show her the best and worst of humanity.

"There are some things that really affect us a lot, especially some of the child-abuse cases and some of the things like that," said Quintana, 27.

She recalled one recent night that brought several victims from shootings in Ju?rez to her emergency department.

"They were children, all of them, and that was really difficult for us, especially because a couple of them passed away."

But those cases are the exception among the approximately 175 patients seen each day and the more than 60,000 patients seen each year.

The bulk of cases are abdominal pains, coughs, colds, minor accidents and other ailments traditionally handled by family physicians. High rates of poverty and no insurance drive some people to wait until they can no longer tolerate their condition before finally turning to the county hospital's emergency room, said Blas Meza, director of the emergency department at UMC.

Psychiatric patients also often wait for a spot in a mental unit only a few feet from someone awaiting stitches.

But when a trauma patient hits the doors, the buzz of these other cases fades into the background.

The trauma cases arriving at UMC are the worst injuries -- gunshot wounds, people in car wrecks, homeowners falling off their roofs while maintaining swamp coolers.

The moment the department knows a trauma case is on the way, the medical center team gets ready for action.

Adrenaline starts pumping even before the patient is pulled from the ambulance or helicopter, or, occasionally, dragged in from the front of the building.

"There's never a dull moment," Meza said. "You either love this place or you hate this place. I love it."

Meza said that, for the person unfamiliar with how an emergency department works, what happens next can look like chaos.

"It just looks like people are running around in circles, but the reality is everyone does have a specific function," he said. "They're doing their jobs and it all comes together."

When a patient arrives by ambulance, paramedics will have bypassed other hospitals en route to UMC. There is method to the madness, as the operating rooms at UMC are better-equipped to handle difficult cases, Meza said.

The patient is met by two emergency room physicians -- a faculty member and a resident -- and two surgeons. In addition, there are at least two nurses, X-ray technicians, blood bank personnel and others.

Meza said the emergency physicians take care of the patient's airway first. Surgeons work on identifying damage.

The main goal in the ER is to stabilize the patient to allow surgery as quickly as possible, Meza said. He said while the doctors are working on the airway and injuries, one of the nurses' first goals is to keep up the patient's blood supply.

They often use rapid infuser machines to force blood into a patient who is bleeding heavily. The machine can push in a unit of blood in about four minutes. The traditional transfusion process takes an hour or more.

"When we're talking trauma, we're not talking about putting blood into a container with no leaks. We're talking about a container that has leaks, holes, stabbing or bullet holes," Meza said. "When we're using the rapid infuser, we're pushing in blood hopefully faster than it's leaking out and we're refilling the container."

Meanwhile, surgeons are clamping anything that is bleeding.

Meza's emergency department has three trauma bays, though it recently handled as many as five traumas at once.

One case that tested the trauma team's strength was a September 2008 shooting at an East Side nightclub. UMC took care of seven of the 11 people who were shot.

Hospital personnel were called at home shortly after 2 a.m. to head back to work. The shooting was declared a disaster at the hospital.

The teams rushed into action and had three patients in emergency surgery as some of those called in to help were still arriving.

Handling multiple traumas often requires shifting staff from elsewhere in the emergency department, as well as from elsewhere in the hospital.

Not all bullet wounds are Level 1 traumas. Shots to the lower arms and legs do not have the same risk of severe bleeding.

Though those who work in the emergency might do their best work under pressure, they rely on one another to deal with what they have seen once the crisis has passed.

"Nurses, they take a beating," Meza said.

Quintana sees life in the trauma center the same way.

"Sometimes I love my job, and sometimes I don't know how I'm going to get through the day," the nurse said.

Meza said the emergency department at UMC will be better prepared to serve its patients as it expands in 2011.

It will grow from 38 beds and seven hallway beds to a larger space with 57 beds in hospital rooms. He said this will help accommodate the more than 60,000 patients who annually visit a department that was originally intended to serve about 40,000 patients a year.

Copyright 2009 El Paso Times, a MediaNews Group Newspaper

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