For trauma medical director, trauma care starts when first responders arrive on the scene

by Dr. Jeffrey Skubic - Trauma Medical Director, DHR Health

“I never have to worry about not being able to get information from the pre-hospital provider, which for us in trauma is everything.”

Trauma care doesn’t really start when the patient hits the door here at DHR Health. It starts when emergency medical services – the pre-hospital providers like EMTs, paramedics, fire departments, police officers –arrive at the scene.

That’s when trauma care starts. And their communication with each other and with us is incredibly important so that we know what's coming in before they get here.

That’s why we’re on FirstNet®.

DHR Health is the largest health system in south Texas. We are a full tertiary, academic, level one trauma center, the only level one trauma center south of San Antonio – for about 250 miles.

Many times, EMS chiefs will call me right from the scene. “Hey, we got this bad car wreck. The patient looks like they have a broken leg. They can't breathe. They're going to need to be intubated."

They tell me while they're on the way here and we have time to prepare. Care really starts from the time of the accident and the first arrival of pre-hospital providers. Their communication with us is so important. And it's important that we have strong communication that doesn’t go down; communication that works in rural areas because we're covering such a large part of south Texas.
 

A typical day

A typical day for me as a trauma surgeon starts about 7 in the morning – 6:30 on Mondays. We get sign-out from the overnight surgeon, who sleeps in the hospital with the rest of the team. Then we start ICU rounds in the intensive care unit on the sickest trauma patients.

As traumas come in, we have to stop what we're doing, report to the emergency department immediately and evaluate the trauma patients. Then we have to determine whether to send them to the operating room, the ICU or to the floor. Or we have to decide if we can discharge them.

As soon as we take care of that patient, we go back to whatever we were doing. It's basically a day of constant interruptions as traumas come in.
 

Communication is critical

The kind of traumas we see at a level one trauma center are anything from elderly falls to motor vehicle accidents, to ATV rollovers, all the way up to stab wounds and gunshot wounds.

So the kind of communication needs we have as a trauma team are huge.

Many times I’ll get a call directly from the local EMS chiefs – or the highest-ranking person on scene. They’ll call and tell me, "We’ve got a house fire here. We’ve got five people. They're really burned. We're going to be bringing them into you soon." So we can be ready and be able to absorb a large number of patients at one time.

In a mass casualty event like that, communication becomes so important because you're not just getting one patient. You may get eight or nine. For instance, last August we had a mass casualty event in Encino, Texas, about 50 miles north of here. A large van carrying about 30 people flipped over. Ten people died on the scene and 20 patients needed to go to trauma centers.

The paramedics and EMTs were calling the trauma directors at all the different hospitals to get ready. We got about 8 patients at once from that event.

I had to call in some trauma surgeons because we have a mass casualty protocol here. We had multiple trauma surgeons arrive for that event. And we had eight or nine of our surgical residents all in the trauma bay before those patients started to arrive. The second they arrived, we had the room fully staffed.
 

A picture worth a thousand words

But I don’t just get phone calls. Sometimes I’ll get videos and pictures from the scene.

EMS providers may send me pictures of a car wreck where a telephone pole has crashed on top of the car. They send that to me to emphasize how much energy the patient may have absorbed and how much damage their vehicle took.

As a trauma surgeon I'm always trying to evaluate how much energy the patient absorbed.  And getting pictures or video from the scene is very helpful. They’ll bring a patient in who was in a high-speed motor vehicle collision. And they’ll send me pictures of the vehicle and it's barely damaged. Airbags didn’t deploy. It didn’t flip over. So when I'm evaluating that patient, that tells me this is probably more of a low energy mechanism.

On the flip side, paramedics sent me a picture of a head on collision that crunched in the entire front end of the car. I'm already thinking, ”Prepare for this patient.” This was a high energy mechanism. And the video or pictures of the vehicle clue me into what kind of injury they could have.

They did enough damage to completely crumple the front of the car. That can create what's called a deceleration injury. That’s when a human body is moving at a speed and comes to a sudden stop. And that can cause organ damage internally. The big thing I'm looking for in a deceleration injury is a great vessel injury – an aortic injury.

That’s something we may not look for because we may not see that on our x-rays and our ultrasound. Having that image and knowing what happened, I can send the patient for a CT scan so I can see the aorta.
 

Why FirstNet

FirstNet is important because it allows EMS providers, hospital personnel – all of that network – to stay connected, no matter what happens. In a hurricane storm or in a mass casualty event, when a lot of people are using their cell phones, you may not be able to get a signal or call out.

Having a separate network allows us to maintain open communications no matter what happens . If we don’t have communication with each other, we're going to have a real big problem.

For me, it's more about when we have those bad events: the bad car wreck, the shooting, the house fires, the mass casualty events. That’s where FirstNet is so important. When you have terrible events or events that may light up the cell phone network and you can't call out – just like 9/11. I'm from the New York area, so I was there when that happened. I couldn’t get signal, couldn’t do anything. It was hard to call anybody.

FirstNet is here so that, no matter what, the first responders, the EMS pre-hospital providers, the hospitals, can still communicate. For me, that’s what it's all about.

If you show up with 10 severe burn patients right now without calling me ahead of time – or sending me videos or footage of what they look like before they get here – it's going to be hard to prepare. No matter how good of a hospital you are, it's going to be hard to be ready for that. Communication is so important to be able to take care of patients in emergency situations, which is what I deal with all day.
 

Timing is everything

The golden hour of trauma is so important because we estimate it's about an hour from when the incident happens to be able to get hemorrhage control. Meaning if a patient is bleeding, you have about an hour to get in there and stop the bleeding.

FirstNet provides rapid communication, stable communication that I know is going to work. That allows us to get that information. So, if I know they're coming and they're able to communicate with me that the patient's bleeding badly, we already have the whole blood hanging in the room. I have all the equipment out next to the bed before they arrive. We can open the patient, give them blood, whatever they need, but that’s all time dependent.

Not having that good pre-hospital communication that FirstNet provides would be catastrophic to taking care of patients. We have to have information.
 

Connectivity where you need it

Finally, as a trauma medical director, I have to be reachable 24/7/365. And FirstNet provides that strong connection. We're in an urban area. But just 20 miles north of here, it becomes very rural. FirstNet gives us the freedom as physicians to leave that area and still have a strong connection.

The trauma surgeon on call may need to get a hold of me at 3 in the morning. And I’m going to have to connect and look at x-rays or whatever it is – wherever I am.

Having FirstNet has allowed us to have the stronger connection to all our pre-hospital providers. For me, that’s such a big part of my job. If you work in trauma or emergency surgery or emergency medicine, I recommend they look into it and see if they can get it at their hospital system.

People think physicians are only in the hospital. They don’t realize that I probably know every police chief, EMS provider in all of south Texas here. We go to meetings together. We constantly try to improve our pre-hospital care. And most of our meetings focus on communication.
 

Dr. Jeffrey Skubic is the Trauma Medical Director at DHR Health in Edinburg, Texas, the largest health system in south Texas – and the only level one trauma center south of San Antonio. He is board certified by the American Board of Surgery in both surgical critical Care and general surgery, and specializes in trauma surgery, emergency general surgery and surgical critical care. Dr. Skubic is part of the Rio Grande Valley’s largest and most comprehensive surgical team, offering patients the latest in trauma surgical treatment and technology. He earned his Doctor of Osteopathic Medicine and Master of Science in Musculoskeletal Medicine at New York College of Osteopathic Medicine of New York Institute of Technology,  Old Westbury, New York. He completed his general surgery residency at the University of Arizona College of Medicine in Phoenix, Arizona. That’s where he found a passion in trauma surgery and decided to attend Harvard University (The Brigham and Women’s Hospital) to pursue a fellowship in acute care surgery/critical care.