Fall 2011
Trauma: Hospital within a hospital

synapse: University of Nevada, Reno School of Medicine

Coates and Kuhls in trauma center

School of Medicine trauma surgeons Coates and Kuhls treat patients at the UMC trauma bay.

Set on fire. Shot. Stabbed. Mauled by animals. Impaled in traffic accidents.

By Anne McMillin, APR

The trauma unit at University Medical Center in Las Vegas works as a well-oiled machine to treat all manner of human mishap with the singular goal of patient survivability.

Trauma surgeons, the majority of whom are School of Medicine faculty, work side-by-side with community physicians and surgeons, nurses, psychologists, therapists, social workers and other health care professionals, to ensure a nearly 96 percent survivability rate for their patients coming into the only Level One trauma center in Nevada.

The Level One trauma center designation indicates the center has capacity in all surgical specialties, including replantation. Faculty also train students, residents and fellows, conduct research and are engaged in community outreach and education efforts. At UMC and the School of Medicine, those outreach efforts include programs such as a two-day advanced trauma life support class, the "Every 15 Minutes" teen drinking and driving prevention program and proper car seat installation and bike helmet education courses for the community.

"By combining world-renowned trauma surgeons, with the best and brightest School of Medicine residents, we have created a trauma center that can take care of any life-threatening injury imaginable, and that's critically important to the folks in our community," according to Brian Brannman, UMC's chief executive officer.

John Fildes, M.D., chief of the trauma division at the medical school and UMC, said the unit is always waiting, prepared to perform life-saving intervention.

"The trauma unit at UMC is part of the public safety net that includes law enforcement, fire departments and emergency medical services, treating life-threatening injuries in a time sensitive manner," he said.

The trauma unit oversees critical care, surgery critical care, burns, trauma and emergency general surgery in the only stand-alone trauma unit west of the Mississippi and one of only a handful in the entire U.S. The unit is separate and independent of the UMC's emergency room department, although both departments work closely together.

Together we've grown into nationally recognized programs in trauma, burns and acute care surgery, inclusive of community surgeons and clinical faculty. -John Fildes

"The trauma unit has its own operating rooms, by-pass capabilities, CAT scan, intensive care unit and transplant capabilities," said Jay Coates, D.O., one of seven faculty trauma surgeons working at UMC.

Coates adds that many people don't recognize, even though they may benefit from, the outstanding trauma facility they have in their midst.

"Trauma is the highest cause of death in people from birth to age 45 and trumps the next three causes, HIV, cancer and cardiovascular disease, combined," he said.

"To have a unit like ours dedicated to that level of care is truly significant for our population because our patients survive under our care, whereas they might die elsewhere."

Building a trauma unit of this stature for the region took several elements within the medical community coming together.

"Back in the 1980s, the southern Nevada medical community and UMC recognized the need to treat the injured and burn patients," Fildes said.

"At the same time, the School of Medicine saw the need to treat patients with time sensitive injuries and committed staff to develop these programs. Together we've grown into nationally recognized programs in trauma, burns and acute care surgery, inclusive of community surgeons and clinical faculty."

William A. Zamboni, M.D., the school's surgery chair, said one of his most important initiatives has been to have faculty surgeons lead the way in providing key services for UMC and the trauma unit has been a very successful example of that.

"The trauma faculty have built an internationally recognized division within the surgery department and are a symbol of academic excellence for the School of Medicine," he said.

Not only are trauma surgeons and staff charged with saving patient lives, they must also be sensitive to patient family needs during adverse times when emotions run high and lives hang in the balance.

"This specialty teaches us as surgeons how to approach difficult topics in an empathetic manner when giving bad news to families," said faculty trauma surgeon Deborah Kuhls, M.D., who is also section chief for critical care.

She said trauma surgeons also have the opportunity to speak with their patients after the initial medical crisis has passed.

"After their brush with death, patients are often more open and emotionally vulnerable. They are able to discuss the risk-taking behavior that landed them in the trauma unit and consider changing that behavior."

Kuhls has had success communicating with patients who are in the trauma unit as a result of alcohol-related injury.

"Many of our patients have social issues, but all of us working trauma buy into our patients' issues and accept them," she said.

In her role as assistant dean for medical education, Kuhls said another benefit to the community, beyond immediate patient care, is that trauma providers have a strong role in the education and training of the next generation of health care providers.

"To save lives, we have to be at the top of our game by staying up-to-date and applying critical judgment quickly and accurately. We teach thorough evaluation of our patients and good technical skills delivered in a precise manner. We have to be systematic with complex assessments and decision-making within a tight timeframe and we teach this to our students and residents," she said.

When not in the trauma unit, faculty surgeons are often at the Clinical Simulation Center to introduce students to basic critical care concepts such as administration of central lines and chest intubation.

School of Medicine surgery residents practice their skills using task trainers and technology before moving into the surgical suites at UMC.

New ultrasound machines at the simulation center are used to teach medical students to detect fluid around the heart muscle and in the abdomen, a frequent occurrence in trauma patients.