Monday Medical: Important aspects of trauma care
For Steamboat Pilot & Today
While a visit to the emergency department is a trip most want to avoid, comfort can be found in knowing and understanding the trauma level of the department.
According to the American Trauma Society, the different levels – Level I, Level II, Level III, Level IV and Level V – refer to the kinds of resources available in a trauma center and the number of patients admitted yearly. As a Level III trauma center, UCHealth Yampa Valley Medical Center can handle the vast majority of serious injury scenarios when they arise.
“Most of the emergency situations we encounter can be managed here,” said Dr. Brian Jekich, an emergency medicine physician at Yampa Valley Medical Center. “The patient is treated, their illness or injury is managed at our facility, and they may be discharged from the emergency department or admitted to our hospital. Only the most severely injured patients need to be transported for a higher level of care.”
As a Level III trauma center, YVMC can provide prompt evaluation and stabilization of injured patients through care delivered by emergency medicine physicians, trauma and orthopedic surgeons, and many other medical specialists. This includes treating a variety of traumatic injuries from head injuries to broken bones, and any other type of medical emergency that may need surgery or immediate intervention and stabilization.
Staying local vs. transferring
Jekich said that a patient with severe brain injuries who requires neurosurgery is one example of a patient who would be transported to a Level I trauma center after being evaluated and stabilized first in Steamboat.
“If a patient was in a car accident with multiple system injuries to the brain, spinal cord and perhaps internal organs, then that patient may need multiple types of specialists to address the various injuries,” he said. “These patients are often critically ill and will require intense ICU care. In that situation, we would perform diagnostic testing including imaging and blood work, treat life-threatening conditions to stabilize the patient and then arrange for transfer to a higher level facility.”
Another example would be serious burn or frost-bite patients who would be transported to a center specializing in those injuries.
Patients, families have a voice in decisions
While every patient’s unique circumstances are taken into consideration, a decision to transport is ultimately up to patients and their families. According to Jekich, most tend to agree with the providers’ recommendation in hopes of the best possible outcome for the individual patient. Under the Emergency Medical Treatment And Labor Act, patients or their family members must be informed and consent to having care transferred to another facility.
“It’s generally a conversation with patients and their families regarding how to best to care for the patient,” said Jekich. “We can do a lot here, but sometimes we do recommend a transfer.”
If transfer is necessary, the severity of the patient’s illness or injury as well as transport method – meaning by ambulance, helicopter or fixed-wing aircraft, and weather conditions are evaluated to determine the most appropriate of transportation.
Talk with loved ones about medical wishes
Jekich stressed the importance of discussing important medical questions with family members before a serious accident or injury might occur that could prevent a person from making their own decisions.
“All patients should have a medical power of attorney who knows their wishes,” he said. “Have these conversations with your spouse, parents and children about topics such as life-saving measures, resuscitation and end-of-life care.”
For example, an advance directive is a legal document that explains how you want medical decisions about you to be made if you cannot make the decisions yourself. The MOST form, or Medical Orders for Scope of Treatment, delineates preferences for life-saving treatments such as CPR and medical intervention. Ideally, those forms should be part of a patient’s medical record or be on file with a patient’s primary care physician.
“We’re generally going to err on providing more care, not less, in terms of life-saving measures, so these documents are very helpful to us, the patient and the family,” said Jekich.
In any emergent situation, Jekich said patients are best served going to the nearest hospital emergency department as opposed to delaying care.
“If an injury occurs, don’t try to triage it yourself,” he said. “Get quick attention, stabilization and treatment.”
Mary Gay Broderick writes for UCHealth. She can be reached at firstname.lastname@example.org.
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