Archive for January, 2011

Trauma Nurse and Surgeon Are Guests at State of the Union

Friday, January 28th, 2011

Two of Congresswoman Gabrielle Giffords’ care providers, Tracy Culbert, a trauma nurse, and Randall Friese, a trauma surgeon at University Medical Center in Tuscon sat in the gallery to watch President Obama’s State of the Union speech on Tuesday evening. The following day, in an interview on Good Morning America, the two said it was a great honor to be invited to hear the speech, and they were moved by the gesture of the empty seat left for Giffords. Having cared for her in the first minutes and hours after the rampage that left the Congresswoman with a bullet wound through her brain, the two had become very close to her.

Much Made of Military Medicine as Giffords Moves to Houston Under Holcomb’s Care

Monday, January 24th, 2011

With Congresswoman Gabrielle Giffords’ transfer to Houston’s Hermann Memorial Hospital Institute for Rehabilitation and Research, the Arizona lawmaker comes under the care of retired Army Col. John Holcomb. Dr. Holcomb is a former consultant to the Army Surgeon General and a past commander of the U.S. Army Institute of Surgical Research at Fort Sam Houston. He is also on the board of the National Trauma Institute.

In a San Antonio News-Express article published Jan. 22, the journalist rightly highlights how advances in military medicine have translated into civilian hospitals. It was very fortunate for the Congresswoman and other victims of the rampage on Jan. 8 that a former Navy surgeon, Dr. Peter Rhee, is head of the trauma team at University Medical Center in Tuscon where they were first brought for treatment. Military doctors are far more accustomed to treating the kind of gunshot wounds sustained by Giffords and others that day, and much has been learned in the past nine years as the wars in Afghanistan and Iraq have taken a horrible toll on our servicemen and women.

What is missing from the article, however, is acknowledgement of the fact that the type of research that can keep emergency medicine and trauma care advancing as it needs to is embarrasingly underfunded. Unfortunately, trauma research is cobbled together out of multiple programs and agencies, and has long lacked adequate support. The Department of Defense receives much of its research dollars through the congressional earmark process, and thus, even that funding is in danger of being lost.

NTI hopes that the recent attention paid to the importance of superb trauma care will also lead to a better understanding of what the field needs in order to reduce death and disability from traumatic injury, the number one killer of Americans to age 44.

Access to Trauma Care Limited in the U.S.

Friday, January 21st, 2011

A study published in the Archives of Surgery finds that 31 percent of Americans living in rural areas do not have access to trauma care within an hour’s drive. Another 12 percent in urban areas have difficulty accessing trauma care as well.

Even though access to trauma centers results in death and disability for patients of all ages, say the study’s authors, underfunding results in the closure of many such facilities, exacerbating a national crisis in emergency care.

Trauma Research Responsible for Giffords’ Improved Chances

Tuesday, January 11th, 2011

It is because of brain trauma research conducted over the past few decades that Gabrielle Giffords even has a chance of recovery from a gunshot wound to the head, says Dr. Peter Nakaji, a neurological surgeon at the renowned Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix. Advances in treating brain trauma have come a long way since the early 1960s.

Today, Nakaji says, one of the most important aspects of treating brain trauma is reducing swelling and pressure inside the skull. “We know the secondary injury is sometimes the most important part. We want to keep the brain around the damaged area intact,” Nakaji says. “It’s pretty standard today to remove part of the bone to keep the swelling down. Taking out that bone [skull] is like popping a cork of champagne — it relieves the pressure. It seems like an extreme thing to do, but it allows the parts of the brain around the damaged area to heal.”

Trauma Surgeon in Spotlight Following Rampage That Kills Six and Injures Arizona Congresswoman Gabrielle Giffords

Monday, January 10th, 2011

Gabrielle Giffords (D-AZ) could not be in better hands following the senseless rampage that left her with a bullet wound in the head on Saturday. Peter Rhee, Chief of Trauma at the University Medical Center in Tucson, is a former military trauma surgeon who dealt with similar wounds and more during multiple deployments to the Middle East.

It was Rhee who delivered the news Sunday that Giffords, heavily sedated, on a ventilator, and in critical condition, had been responding to commands, and that was about as positive an outcome as anyone could imagine under the conditions. The bullet entered and exited the left side of her brain. “When you get shot in the head and a bullet goes through your brain, the chances of you living is very small and the chances of you waking up and actually following commands is even much smaller than that,” Rhee said.

Giffords arrived at the Tuscon hospital 38 minutes after the incident and doctors immediately removed bone fragments and relieved pressure on the brain.

Rhee spent 24 years in the Navy, retiring as a Captain. He is a strong basic science and clinical researcher with more than 160 publications in peer-reviewed journals and 11 book chapters, including participation in writing the Guidelines for the Field Management of Combat-related Head Trauma (published by the Defense and Veterans Brain Injury Center). He has been a speaker at NTI’s Annual Trauma Symposium.

Read an L.A. Times Story about Rhee’s training.

Helicopter Transport Positively Impacts Trauma Patient Survival

Wednesday, January 5th, 2011

A study published in the Journal of Trauma that is the first to explore emergency helicopter transport at the national level finds that patients tranported by helicopter are more likely to survive traumatic injury than those transported via ambulance.

The data show that even though the patients transported by helicopter are more severely injured, require more hospital resources, and come from greater distances, they are still more likely to survive than ground transported patients.

“On the national level, it appears as though helicopters are being used appropriately to transport injured patients to trauma centers,” said Mark Gestring, M.D., lead study author and director of the Kessler Trauma Center at the University of Rochester Medical Center in a press release. “Air medical transport is a valuable resource which can make trauma center care more accessible to patients who would not otherwise be able to reach such centers.”

Since the 1970s, helicopter transport has been an integral component of trauma care in the United States, due in large part to the military’s experience transporting sick or injured soldiers during war time. The availability of helicopters in the civilian setting has been credited with improving trauma center access for a significant percentage of the population.

IVs Given to Trauma Patients May Be a Waste of Time

Wednesday, January 5th, 2011

An article published in the Annals of Surgery this month reports that giving IV fluids to trauma patients before they are transported to the hospital may waste precious time and delay transportation to a hospital. Elliot Haut, an associate professor at Johns Hopkins University and the study’s lead author, says the findings indicate it may be better to get the patient to the hospital quicker.

Intravenous fluids are often given to severely injured patients to raise dangerously low blood pressure due to blood loss. Many states often require emergency medical personnel to perform a variety of interventions before transportation. But in Haut’s study, patients who were given pre-hospital IV fluids wee 11% more likely to die than those who did not receive them.

Haut emphasized that IV fluids may be beneficial in some cases and that more research is needed to determine their value in patients with traumatic brain injury, for example. Read more of the story.

Medical Research a Priority in Combat Zone

Monday, January 3rd, 2011

A story in the Washington Post on December 30 highlights how seriously the American military has been taking medical research as the conflicts in the Middle East wage on. “The armed services are dedicated to saving every life, limb and eye of battle-wounded service members in Afghanistan and Iraq,” says journalist David Brown. “The task requires not only skill and energy, but also the capacity to learn from failure and broadcast success.”

Deployed trauma surgeons take precious time off from tending wounds to present medical papers to their colleagues and to submit findings to peer-reviewed journals. And some believe that military doctors are better than their civilian counterparts at letting go of things that don’t work and taking up protocols that do. “In the armed services, new approaches are viewed with more urgency,” suggests Brown after interviewing several doctors and other healthcare professionals in theater.

Quoted in the story, Andrew N. Pollack, a surgeon at the University of Maryland’s Shock Trauma Center and an NTI board member, points out that they see about 30 limb-threatening leg injuries a year, while doctors at the Walter Reed Army Medical Center get about 30 a month. “Insights at the military hospital are causing orthopedists everywhere to question how they treat violent leg fractures.” Data collection has also gotten much better, allowing military doctors to mine the Joint Theater Trauma Registry for insight and leading to changes in how fluid resuscitation and blood transfusions are conducted, among others.

Other NTI board members quoted in the story are Col. Brian Eastridge and John B. Holcomb.

Brown’s story is an insightful look at how military medicine is advancing practice quickly. Read the article.