Trauma



If it wasn’t for the trauma center at ORMC, I wouldn’t have my leg,” says Eddie Hamilton, 37, of Ocala. He may have numbness in his foot and walk with a limp, but he can get around and play with his two young sons. For that, he is eternally grateful.


Early on the morning of December 9, 2013, Hamilton was on his way to his job as a machine operator at Townley Manufacturing. He’d decided to ride his motorcycle that day, and fortunately, he was wearing his helmet, jacket and gloves.


At 6:40am, he was stopped at a red light when suddenly his motorcycle was violently struck from behind by a drunk driver. The impact hurled Hamilton and his bike through the intersection and into an SUV that was turning. Hamilton’s guardian angel was working over time that day, as he missed being run over by mere inches by another vehicle that was trying to avoid the accident.


“I remember being pushed from behind, and the next thing I knew I was lying on my back looking up at the sky and trying to take off my helmet,” Hamilton recalls. “I asked someone to help me get my cell phone so I could call my wife. I remember being in the ambulance with the paramedics and then Dr. Garcia standing over me when we got to the hospital. I asked him if I was going to lose my leg, and he told me they would do everything they could to save it.”


Save it they did, but that was no easy task.


When paramedics arrived on the scene, Hamilton’s right foot was pointing to the right, but his knee was facing left. Both the tibia and fibula in his right leg were broken in two places with one bone completely shattered. Despite the horrific condition, he couldn’t feel his leg at all. That’s because he was suffering from “compartment syndrome,” a life-threatening condition in which swelling from the injury cut off the blood supply to his leg from the knee down. Unless rapidly relieved, acute compartment syndrome usually requires amputation of the affected limb.


Hamilton underwent emergency surgery, in which incisions were made to relieve the pressure in his leg and restore blood flow.


“When I woke up, my leg was encased in a wound vac to keep fluid from building up,” he recalls. “My leg was in external fixation, and I was in the trauma center for almost two weeks.”


Since that December day, Hamilton has had six surgeries on his leg. He’s still seeing Dr. Riley, the trauma center orthopedic surgeon, who was one of four doctors who operated on him.


“The police report said that I was hit at 45 to 50 mph,” Hamilton says. “If the ORMC Trauma Center wasn’t here, I’d have been flown to Shands. If I’d had another 20 minutes for that flight and for them to assess the damages before surgery, I don’t think I would have my leg.


“My wife Meghann and I have two sons—Xizavier, 4, and Xizander, 3—and if I wasn’t able to walk, I couldn’t do the things most dads do,” he adds. “I’m no longer able to ride a motorcycle; I can only bend my right knee about 70 percent and only have about 30 percent range of motion in my ankle. But I’m very grateful to ORMC and credit Drs. Garcia, Ang, Riley and Farrah for me being able to walk and work again.”

June Wells had different expectations for last Christmas. The Hernando resident never expected to spend the holiday as a trauma center patient, but considering the alternative, she’s grateful.


On December 23, 2013, a routine afternoon drive to the neighborhood pharmacy ended up in a serious accident. Wells, 69 at the time, was in the left turn lane at the Citrus County intersection of Kensington and Route 44.


“I’ve been going this way for 20 years and never had a problem,” recalls Wells. “I stopped, looked left, then right and left again before pulling into the intersection. I never saw the truck that hit me. The next thing I knew, I was being put into an ambulance.”


The truck collided with the driver’s side of Wells’ Buick Century, which was totaled in the accident. The impact damaged the vehicle so badly that emergency personnel responding to the scene had to cut her out of the car.


Rushed to Citrus Memorial Hospital, Wells was then transferred to ORMC’s Trauma Center, which was better equipped to deal with her extensive injuries. She suffered a broken left clavicle, nine broken ribs, a punctured lung, head laceration and concussion.


“I was one big bruise on my left side from the tip of my toes to my head,” says Wells, who admits the concussion left her with limited memories of her time in the hospital where she stayed until December 30.


“All the doctors who took care of me were very dedicated, professional and helped get me back on my feet. They were there when I needed them. I felt like they never slept, because someone was always checking on me,” notes Wells.


“I had to have physical therapy after my release and follow-up visits with some of the doctors from the hospital, but I have no lingering effects from the accident,” says a relieved Wells.

Hamilton and Wells are just two of the nearly 3,000 trauma patients who have been treated at the new trauma center at Ocala Regional Medical Center since it opened December 8, 2012.


Prior to that, patients requiring trauma medical care were transferred by ambulance or helicopter to Shands Hospital in Gainesville or to Orlando or Tampa. As Eddie Hamilton noted, the extra time necessary for such transport could have serious consequences. Getting critical care as rapidly as possible can reduce mortality, as well as the patient’s overall injury and financial cost.


“Ocala Regional Medical Center made its intention in December 2011. A year’s time to build a trauma center is pretty fast, but we wanted to be up and running, and we met the deadline,” says Trauma Medical Director Darwin Ang, M.D., Ph.D., FACS, who specializes in life-threatening injuries and has extensive experience with critical care and trauma surgery.


Establishing trauma services at ORMC came with a hefty price tag. It took more than $6.5 million to build the center, including adding a rooftop helipad, resuscitation rooms in the emergency department, radiology and ICU upgrades, establishment of an in-house blood bank and providing critical care training for staff at all levels of patient care. In addition, Ocala Health, which includes Ocala Regional and West Marion Community Hospital, has added 90 new staff members and committed $22 million annually for specialty on-call and other clinical support required to operate a trauma center.


For the patients benefiting from that care, it’s worth every penny.


“We can now provide residents of Marion and surrounding counties with trauma care in their own community and ensure that critically injured patients have access to treatment faster, which could mean the difference between life and death,” said Randy McVay, chief executive officer of Ocala Health. “We are proud to be able to meet a true community need for easier access to comprehensive trauma care when minutes matter.”


The Florida Department of Health approved the Level II trauma center designation. This is the first and only trauma center in the area comprised of Marion, Citrus and Hernando Counties. It is also accessed by Emergency Medical Service providers from Lake, Sumter and Levy Counties.

“Trauma is the No. 1 cause of death for anyone under the age of 45. In 2010, the Florida Department of Health put out a graph showing that this was the most underserved area for trauma in the state. We had the most patients transferred out of the area for trauma care,” observes Ang.


“We have I-75 running through Ocala, so we have traffic accidents. We have a lot of animal-related injuries because of the horse industry and also a fair amount of penetrating trauma due to gunshots and stabbings. Our area includes The Villages, and with the geriatric population there, we see a lot of falls and some significant injuries from golf cart accidents.”


Ang notes that many of the patients come in with traumatic brain injuries, spinal cord and orthopedic injuries, but, interestingly, he says that falls are the most common cause of injuries. Complications can arise in geriatric patients especially, as they often have complex fracture patterns due to more brittle bones and being on blood thinners.


Although Level I trauma centers also offer specialized care for pediatric trauma patients and have a burn unit, a Level II center is still able to stabilize such patients before sending them on for specialized treatment.


“In the state of Florida, there’s not much difference for adult patients between Level I and Level II,” explains Ang. “The main difference is that, as a Level II, we only see children if their lives are in imminent danger. For example, if a child has lost vital signs, they might be brought here so we can try to resuscitate and stabilize them before sending them to a Level I trauma center.”

So, what’s the difference between a trauma center and “regular” hospital? Trauma usually refers to an acute injury that threatens limb and/or life. Of course, a patient doesn’t have to be at risk of losing a limb or dying in order to benefit from the services of a trauma center. A trauma center is also capable of taking care of critically ill patients, and not all hospitals can do this.


There are five main trauma surgeons and multiple specialists who rotate through the center, providing 24/7 coverage, 365 days a year. Ocala Regional’s trauma services are also led by program director, Donna Nayduch, R.N., M.S.N., ACNP, who previously served the same role at Duke University.


The high level of skill doesn’t end with the surgeons. Every individual who is involved with the trauma center—every nurse, tech, respiratory therapist, pharmacist, radiologist, even security personnel—has received specialized training about how trauma affects the human body.


Upgrades were made to the ORMC campus in order to provide trauma care, including the addition of a helipad atop the facility, which allows for incredibly fast arrival and send off of critically injured patients.


The resuscitation room alone is state of the art and can handle up to four patients at a time. Complete with its own laboratory and radiological suite, it can also double as an operating room.


“We also built a blood bank in the hospital before opening the trauma center. That’s of huge importance for all patients,” says Ang. “Now we have hundreds of units of blood available in house. If someone is bleeding to death, they can get emergency blood here and a lot of it.”


Continuous renal replacement therapy (CRRT) is also new to ORMC since the trauma center opened. In addition, they now have the ability to monitor intercranial pressures and can completely handle neurological injuries, such as a large subdural hematoma, or “brain bleed.”


“Our mortality rate is 3.1 percent, and the state’s rate is 4.95, so we are far below that,” notes Ang. “Every case that comes through is an opportunity for improvement. Every week we have morbidity and mortality conferences, as well as bi-weekly, multi-discipline conferences, where we review and ask ourselves, ‘How can we do a better job of saving the next patient who comes in?’”


Those conferences include not only hospital staff but representatives from rehab facilities, skilled nursing facilities, long-term acute care facilities, assisted living facilities, hospice, neuro-rehab facilities and psychiatric facilities. Each offers valuable input on how patients fared after leaving the trauma center.

“A lot of people don’t realize that they didn’t have local access to a trauma center before this,” says Ang. “I think our community has more peace of mind just knowing if they are ever in a life or death situation with severe injuries, we could be able to provide them with top-quality care.


“Being local is also important for families. They can spend more time with patients without having to travel far,” he adds. “It’s not just about serving the patients but also their families. A trauma center is like a fire department in that once you have it, you can’t imagine not having it around.”


*name has been changed for privacy reasons


 


Research and Quality are Vital


Serving as the director of research and quality of the USF/HCA trauma network, Dr. Darwin Ang recently led an effort to beat out 30 applicants to win the largest grant studying the surgical fixation of rib fractures, which is highly relevant, as respiratory failure is a common problem with trauma patients. The study is a research collaboration among several hospitals in the USF/HCA trauma network.


“Lung collapse can lead to low oxygen saturation and pneumonia,” says Ang. “Pneumonia is the No. 1 cause of death in hospital patients, especially those over the age of 65, so this is an important medical question we are trying to address. We were awarded the grant earlier this year, and this fall, we will get started on the study, which is slated to run for three years. This will be one of the largest multi-center trials in the state of Florida. We are excited that Florida has an opportunity to lead the country in studying this disease process.”


To ensure quality is a priority, the trauma center at Ocala Regional is part of a network of several hospitals, which meet on a regular basis.


“The trauma network meets bi-weekly to standardize our patient care based on evidence-based science and to compare our clinical outcomes with each other and with the rest of the trauma centers in the state,” says Ang.


Ang states that later this year this group will have a peer-reviewed journal article showing that trauma centers, such as Ocala’s, have had a positive impact on geriatric patients in areas they serve and the state of Florida.


“It’s really rewarding to be an integral part of a community,” he adds, “and to know that your service improves the lives of those around you and makes this area a safer place to live.”

Posted in Marion Features

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