Spring 2013
Trauma center: Partnering for success in a common vision

synapse: University of Nevada, Reno School of Medicine

Trauma surgeons in front of helicopter

From left to right, University of Nevada School of Medicine trauma surgeons Dr. Jay Coates and Dr. John Fildes and Gregg Fusto, director of trauma and burn services, help lead the fifth busiest trauma center in the US. Photo by Dave Smith.

Of the many aspects to the partnership between University Medical Center of Southern Nevada and the University of Nevada School of Medicine, one element shines as a testimony to cooperation for the mutual benefit of each, as well as the community at large.

By Anne McMillin, APR

For nearly 25 years, the UMC trauma and burn center, staffed by School of Medicine faculty surgeons, has been the shining beacon in a relationship that benefits all of southern Nevada and extends its reach into California, Utah and Arizona.

"The trauma center demonstrates how far we can go when we work together," said William A. Zamboni, M.D., chair of the School of Medicine's surgery department.

"It is an example of having a hospital partner working closely with School of Medicine surgeons to achieve success within a common vision."

Benefiting the community

John Fildes, M.D., medical director of the trauma and burn unit and vice chair of the school's surgery department since 1996, said the partnership between UMC and the School of Medicine is well-known as one of the most successful in the country.

"Those outside the medical community in Las Vegas know of the UMC trauma and burn center and its successes. The old saying goes that we are the best-kept secret in Nevada," he said.

That success may be attributed to several factors.

First, the successful collaboration between community surgeons, many of whom are adjunct faculty and School of Medicine surgical residency graduates, faculty surgeons and UMC employees working together to operate all aspects of the trauma and burn center as a well-oiled machine.

According to the UMC web site, the trauma and burn center's dedicated staff includes seven trauma surgeons, one pediatric surgeon, four pediatric intensivists, 23 emergency physicians, 18 pediatric emergency physicians, 10 neurosurgeons, one pediatric neurosurgeon, 23 orthopaedic surgeons, 13 anesthesiologists, three surgical critical care fellows, a board certified nurse practitioner and highly trained, knowledgeable and dedicated intensive care unit, trauma resuscitation, surgical residents, medical residents and other health care professionals.

Second, the trauma and burn center is well-equipped with technology capable of treating most any kind of injury known to humans. From hyperbaric oxygen chambers to treat burn victims and diabetes patients to its limb replantation center, the trauma unit provides 24-hour care to receive, stabilize and treat patients whose lives are threatened by multi-system injuries, brain injuries, spinal cord injuries, orthopaedic injuries, burns and those at risk for multi-systems organ failure.

Third, the School of Medicine's surgery department, through the trauma center, has reached out to the U.S. Air Force at Nellis Air Force Base in Las Vegas, to extend its expertise and train military surgeons and emergency medicine physicians in trauma.

"In 2008, the general surgery and emergency medicine residency programs expanded to accept active-duty residents. In addition, the trauma unit is now staffed with Air Force surgeons," said Fildes.

"Through the Sustainment of Trauma and Resuscitation Skills program, we are providing hands-on experience to military surgeons in a civilian setting."

The benefit of this arrangement is that military surgeons maintain current competency in advanced techniques in the fast-paced trauma center that they may then take to the battlefield and perform under austere and dangerous conditions.

"This program with the military allows those surgeons to maintain wartime readiness because the skills they learn with us are the most advanced in the state," said Gregg Fusto, director of trauma and burn services at UMC.

"Military nurses, surgeons and respiratory therapists all are in rotation to get tuned up for battle."

The medical school and UMC have been very successful in recruiting and retaining those surgical residents and fellows that come to southern Nevada to train. Several former trainees are now on faculty and see patients in the trauma center.

"More than 50 percent of the surgical residents that come through our unit stay in the local community to set down roots and care for our citizens," Fusto said.

In addition to the immediate life-saving services provided within the trauma center, the unit actively participates in outreach and prevention programs. Those include "Encare and Learning to Care," a slide presentation created by the Emergency Nurse Association to teach the risks associated with drunken/drugged driving and non-seatbelt usage; "You Drink, You Drive, You Lose" and "Every 15 Minutes," programs conducted in conjunction with local high schools, law enforcement and other community groups teaching the consequences of drinking and driving; and "Taking It to the Streets," an educational program designed for emergency medical service providers and focused on improving patient outcomes and survival.

Symbiosis between institutions

The partnership between UMC and the School of Medicine benefits both institutions in addition to the community it serves.

"An academic medical center such as UMC needs the medical school and the medical school needs UMC to provide the hands-on experience in trauma. As a big, urban hospital serving a large population, we provide a place to treat the medically underserved, those who often have the highest need for health care services," said Brian Brannman, chief executive officer at UMC.

He went on to say that medical students and residents see a variety of disease processes at UMC, which provides them the facility they need to train and learn.

For their part, surgical faculty praise the administration at UMC for providing the equipment upgrades needed to operate and sustain a Level One trauma center.

"I credit UMC with providing the necessary resources to allow our faculty and the center to flourish. This is an example of how far we can go when we work together," Zamboni said.

Trauma surgeon Jay Coates, D.O., says the relationship between the hospital and the medical school is nearly seamless, which allows him and his colleagues the ability to teach within the patient care setting.

"They've been supportive of our establishing training fellowships. In turn, medical school faculty serve in administrative roles within the hospital," said Coates, who was the first trauma fellow at UMC in 2000. Following additional training in Pennsylvania, he returned to Las Vegas in 2002 and set up the School of Medicine's surgical critical care fellowship at UMC with Fildes.

Grateful patients

Brannman said the hospital and its trauma unit does the "heavy lifting" of the community in terms of saving lives and providing a concentration of services in one location. Taking care of the bulk of trauma cases in the region is what makes the trauma and burn center and its staff so accomplished, he said.

According to Fusto, the trauma and burn center treated 12,800 patients in 2012 of which 2,400 were admitted and of those, 96.4 percent were saved.

Michael Casey, M.D., the school's first accredited critical care fellow, remained on staff at UMC following training and is an assistant professor and trauma surgeon at the school.

He has seen and treated some of the most severely injured patients coming through the trauma and burn center, but does so with compassion for both the patient and his or her family.

Some time ago, Casey treated a 19-year-old who went through the windshield of a car, was partially decapitated and spent four weeks in ICU.

"The family was astonished at how well the UMC trauma system worked for their loved one," Casey said.

There was also the young, healthy athlete brought into the trauma unit after nearly being cut in half by a motorcycle. He was unconscious for two weeks.

Casey recalls the first thing said when he awoke: "Thank you for saving me, so I can see my wife and kids again."

Sometimes, the injury is so severe that all the efforts of the trauma and burn center's staff cannot save the patient. In those cases, the surgeon's role changes to helping the patient pass on and comforting their family through the process.

"We help families understand what is going on with their loved one and what their options are. We comfort them, help them grieve and get them in touch with those who can get them the best information possible for those end-of-life decisions," Casey says, adding that families appreciate the frank discussions around medical options and death.

Casey said this comforting role is taught to medical students and residents, who see it regularly practiced in the trauma unit.

Bright future for trauma center

As successful as the partnership between UMC and the School of Medicine has been, leaders at both organizations are looking to the future with an eye toward further improvement.

Zamboni said there is always room to improve survival rates through clinical and basic science research, an effort the medical school is supporting through developing infrastructure to carry trauma research to the next level.

Fildes notes that the trend across the U.S. is for trauma centers to broaden patients seen to include other kinds of surgical emergencies, something he hopes to develop at UMC.

"And there are always improvements to be made in violence intervention, vehicle safety and workplace safety that will gradually lead to a decline in patients seen at trauma centers," he said.

Brannman said the strength of the relationship between UMC and the School of Medicine can only grow as he and Dean Thomas L. Schwenk, M.D., work together.

"We are just getting started and our futures are linked together as we strive to strengthen the clinical presence on our campus at UMC," he said.

"I see an exciting future ahead because we are making good use of the taxpayers' money with life-long benefits to every Nevada citizen."