Summer is trauma season and so far it has been an exceptionally busy season.
I was watching 30 or so people suit up in the ER the other day for back-to-back major traumas. Suiting up for a major trauma involves putting on multiple layers of protection.
The first layer of the uniform is a green shoulder-to-knee length wrap-around cape made of flexible lead sheets. This is so the team members can stay at the patient’s bedside completing time sensitive procedures even while active X-ray scans are going on. X-rays can’t penetrate lead.
Next a green lead choker collar goes on. The thyroid gland in the neck is the most X-ray sensitive tissue in the body and so gets extra protection. A blue impermeable fabric gown follows, covering all the lead, to keep the blood off. Masks and goggles, surgical caps, booties and gloves complete the stifling 15-pound ensemble. The team members now look like a cross between medieval knights and monks.
xWhen we call a major trauma alert, teams from general surgery, anesthesia, neurosurgery, orthopedic surgery, pharmacy, social work, and chaplaincy all descend upon the ER to join the ER team of nurses, techs, and ER residents already assembled. Each team answers to a different leader and the possibility of conflict between services always lurks.
Watching these 30 people milling about yesterday waiting for the patients to arrive led me to reflect on how remarkable it was that such a disparate group could come together so quickly and become an effective team with so little friction.
It helps that the mission is so clear. A human life is at stake and most people can put their egos aside and work together. That is the motivation but the mechanism is the rigid hierarchy of responsibility in a teaching hospital. The chain of decision-making is strictly by seniority. Every learner is ordered and identified by the number of years of training, from first year medical students (MS1) through fourth year students (MS4). Residents are annotated by the number of years they are out of medical school, called Post Graduate years (PGY1-PGY7). Everyone knows who to turn to for a decision.
Well, the first two patients arrived, then more arrived, and then even more arrived. They weren’t all from the same trauma, it was just a busy day. Through it all, the residents and students kept up their camaraderie and morale. The system was working at peak efficiency. It was gratifying to be a part of such an effort.
Of course in two weeks all of my PGY-3’s will graduate and leave and the hospital will welcome all new PGY-1’s, fresh faced, enthusiastic, and utterly inexperienced. Seems like a good time for a vacation. I’m trading in my lead-lined cloak and blood-soaked boot covers for shorts and flip flops. Be careful this summer!