Inside the trauma center

Sunday, May 24, 2015 | 2 a.m.

A trauma center is a place no one hopes to visit.

When it is necessary, however, we’re thankful for the staff, technology and education available there to meet our needs. Medical trauma occurs when a patient is injured seriously and suddenly by an external force. That can include severe, blunt or penetrating wounds; burns; electrical shocks; and near-drownings. Such acute injuries also can be accompanied by behavioral, psychiatric or social factors, or a combination of all three.

“The spectrum of traumatic injuries is wide, and trauma centers treat it all,” said Dr. Chris Fisher, medical director of trauma services at Sunrise Hospital and Medical Center. Trauma treatment requires immediate, swift and coordinated action to ensure the best possible outcome for the patient.

Trauma care in Clark County operates as a coordinated system between three different hospitals, which include a Level I facility, a Level II facility, and a Level III facility. The distinguishing difference between Level I and Level II is that Level I publishes research and has residents, but both facilities are equipped to handle the same severity of trauma. Cases handled by Level III are not as critical as those handled by the other levels. All three levels work together to make up the Southern Nevada Trauma System.

Trauma center staffers undergo extensive training that can take multiple years, depending on the discipline. Trauma surgeons, for instance, must complete a two-year fellowship on trauma and critical care after their general surgery residency. Nurses must have emergency room experience and complete Trauma Nursing Certification Courses (TNCC), as well as eight hours of trauma-specific courses each year. Ongoing continuing-education classes also are required for other staff. The success of a trauma center hinges on its staff’s ability to assess, diagnose and treat each injury or wound in and of itself, and in combination with other injuries and wounds. As such, effective trauma treatment requires a complex, multidisciplinary effort.

How do they treat so many types of injuries?

Trauma centers need to be able to treat a wide range of patients, which means every trauma center is equipped to handle myriad medical subspecialties. To receive trauma center certification, every trauma center is required to provide 24/7 coverage for medical subspecialties including neurosurgery, eye surgery, orthopedics, spine, plastic surgery, neurology, thoracic surgery, interventional radiology and urology. Surgeons, anesthesiologists and nurses — all dedicated solely to trauma — also are available 24/7, along with access to operating rooms. “To treat acutely injured patients, we have the added designation of specially trained doctors and staff,” Fisher said. “We also have dedicated services that can be used only for trauma, such as a specific operating room, intensive care unit and emergency room beds reserved for trauma patients.”

What’s the difference between trauma centers and emergency rooms?

Like trauma centers, emergency rooms are equipped to handle nearly any medical situation imaginable, including life-threatening injuries. However, emergency rooms also handle disease symptoms (such as high fevers or severe stomach cramps), medical events (such as heart attacks or strokes) and less critical medical emergencies (such as broken bones or mild lacerations). Trauma centers often are located within the emergency room of the hospital, but they are required to adhere to stricter guidelines established by the American College of Surgeons.

Traumatic injuries in Las Vegas:

• Motor vehicle crashes

• Falls

• Pedestrians being hit by cars

• Physical abuse or assaults

• Gunshots

• Stabbings

• Contact sports

• Animal attacks

“We see a lot of motor vehicle-related trauma in Las Vegas, because our roads are very wide and the speed limits are high,” Fisher said. “It’s also a tourist destination, and many tourists may be inebriated and crossing the street in areas where they’re not supposed to cross or not following the lights. Sometimes, both the driver and the person they hit are inebriated.”