I’ve been bringing quite a number of patients to the trauma room lately. You get hurt in a routine motor vehicle accident, you end up in a regular room in the ED or probably even more likely, a bed in the hallway until they can clear your c-spine, get you off the backboard and send you home with a script for a muscle relaxer. You get hurt in a big crash, you will likely get the trauma room. There, you will get all your clothes cut off and likely get fingers or tubes in all of your orifices, including orifices you didn’t know you had.
The rules for who gets the trauma room are constantly changing. They seem to go from permissive to restrictive and back depending on who knows what. There was a time when the biggest complaint paramedics had was “I asked for the trauma room and they didn’t give it to me.” Now I can’t tell you the number of times I have brought in a patient non lights and sirens, wheeled him down the hall, past the open trauma room door where I have seen a fully gowned trauma team, awaiting a patient and I have wondered what they were waiting for, what was coming in? a shooting to the head? a horrific MVA? a high fall with loss of consciousness and multiple fractures? Only to discover they were awaiting my patient — a woman who had fallen down five stairs and had a headache or a man in a rollover who was ambulatory on scene with no complaint other than a laceration on his arm.
All I ask for is consistency. Depending on the day don’t put one patient in the trauma room and his identical brother from an identical accident with an identical complaint in the waiting room after tearing off his c-collar in triage.
Most of my trips lately to the trauma room have fallen into two categories. A) I didn’t call for the trauma room, but they decided the patient belonged in the trauma room(usually due to mechanism, in some cases self-reported — human radar gun patient says the other car was going fifty-sixty miles an hour when it struck his car) and B) Calls where I asked for the trauma room on mechanism only with the patient not showing much in the way of injury.
* There were times in the past (depending on the pendulum) where mechanism really didn’t matter, you had to be banged up to get in the trauma room. Nowadays mechanism alone buys you the trauma room most every time.
In each of these categories, I would see disappointment in the trauma team members’ eyes as they saw that the trauma really wasn’t very interesting — they had been paged for this? — much like we sometimes can think we got called for this? when we show up on the site of a supposed bad car wreck to find really no injuries at all.
I feel like the director of a boring movie, the author of a boring book, a boring college professor. I want to say either “I didn’t call for the trauma room” or “Hey, I’m just following your protocol.”
Then the other day we get called to a motor vehicle accident. I know the location and I say to my partners “this is going to be a real wreck.”
We arrive to find a car into a tree with no skid marks. The tree is embedded in the engine. The man sits in the front seat of the car, in which the air bag has deployed. He looks dazed. When I ask how he is, he says, “Anyone else hurt?”
“I think just you,” I say.
“Anyone else hurt?” he says again.
“I think only you.”
“Anyone else hurt?” he says.
The steering wheel is crumbled. Then I look down at his legs. I see jagged bone ends. His right foot is upside down next to his considerably shortened right leg, hanging by a thin margin of skin and muscle.
“Are you in any pain?” I ask
“Anyone else hurt?” he says.
We rapidly extricate him. He also has bruising on his chest and abdomen. I have to use four trauma dressings just to wrap his legs which in addition to the open fractures have deep lacerations to the subcutaneous layer. His heart rate is in the 120’s and I am worried he may soon go into shock.
“Anyone else hurt?” he asks.
Not to mention the question of a brain injury.
I give my report in the trauma room. I feel bad to say so but I feel almost like a celebrity chef unveiling a master dish when I finally unveil the man’s grotesquely deformed limb. “Open tib-fib fracture,” I say with a flourish.
Their heads nod, their eyes alive with interest.