Editor's Note: This is part one of a two-part series behind-the-scenes of Atrium Health's trauma and surgery departments.
“When the trauma pager starts going off, the team heads to the trauma bay,” says Susan Evans, MD, chief of Surgical Critical Care. “If it’s a code one, every member of the team is there, working together to stabilize a patient, monitor their heart rate, deliver an IV, stop bleeding. It all happens quickly, and each member of the team has a very specific role that they must perform in sync with sometimes more than a dozen people in a small space.”
Atrium Health’s Carolinas Medical Center houses the area’s only Level I trauma center, the F.H. "Sammy" Ross Jr. Trauma Center. There, teams care for the sickest patients, offering the highest level of comprehensive care for any type of trauma injury, whether it’s a traumatic brain injury or an emergency surgery.
When a trauma patient is transported by air or by ambulance, the 24/7 team, comprised of nurses, Emergency Department physicians, residents, surgeons and more, evaluates patients in a systemic pattern. Consistency is key, but at the same time, the team knows when to change course.
“We start with the airway. Is their airway clear, can they breathe? Do they have enough blood flow? Then, we look at the other injuries that are not necessarily life-threatening but important to how a person functions,” says Evans.
10 p.m.
Dr. Evans is six hours into the night shift at CMC’s Level I Trauma Center.
At any moment, her pager could go off for an emergency surgery or trauma patient. As chief of critical care surgery, there’s no waiting around, with a number of her overnight patients in need of follow-up care or emergency care in CMC’S Surgical Intensive Care Unit.
Cases range from a person recovering from gunshot wounds to unscheduled surgeries that pop up when a patient’s condition changes in a matter of moments. For some, life has changed in a matter of hours, after a crash or accident.
11 p.m.
A patient needs emergency surgery and moving them down to the operating room could harm them. Residents, nurses, physician assistants and surgeons all put on gloves and sterile gear. More than 15 people descend upon a room, working for over an hour. Staff from other floors move additional supplies outside the room, connecting extra IVs and working together, despite not having met or interacted before.
Midnight
Family members come in and out of patient rooms, smiling, crying and asking questions. Dr. Evans, nurses and physician assistants move to the side to console families or discuss next steps in a complex case.
“We talk to the families and support them, because often families are very nervous about what’s happening with their loved ones,” Evans says. “Providing emotional support to families and their patients is important. There are times when we can heal people medically, but if we can’t also heal them emotionally and they don’t feel like someone cares about them, it’s harder for them to recover.”
In another instance, nurses have started a phone chain to try and locate family members to stand by a patient’s side for the last moments. The patient didn’t come in with any identification, and you can tell by the look on the nurses’ faces that they want a family member to provide comfort, to be there.
“If someone comes in and they have a high risk of dying or they begin to have complications, our surgeons look them in the eye and say, ‘You’re going to be okay. We will take care of you.’ That emotional support is important, because our job is so much more than just surgery,” says Evans.
1 a.m.
A new mom who experienced low oxygen levels, leading to a stay in the ICU, receives news that she’ll be able to meet her twins for the first time in Levine Children’s NICU. The smile on her face reveals excitement, and her care team works to coordinate the after-hours meeting for nearly an hour.
“We see patients at the end of their life and the beginning of their life. It’s hard to watch people die, but it’s also exciting to see new life come as well,” says Evans.
Part two of this series will take a broad look at the team’s history and the development of trauma care regionally.
