When an Injury Is a Trauma Case

“After a two-vehicle crash early this morning, two people were taken to Salem Hospital, one with life-threatening injuries.”

“A woman who had to be extricated from her car by fire personnel was transported to Salem Hospital in critical condition.”

You hear the stories. You hope it’s no one you know. And you hope it’s never you. But what if it is?

What is a medical trauma?
Oregon hospitals participate in a statewide trauma system, using a standard definition of trauma. “People with potentially life-threatening injuries, or whose injuries require treatment within a few hours, are entered into the state trauma system,” says Nicole VanDerHeyden, M.D., Ph.D., medical director of Salem Hospital’s trauma center, the third largest in the state.

“A trauma designation makes sure a patient gets rapid assessment and care,” explains Dr. VanDerHeyden.

Medical trauma is based on these factors:

• Type of injury. In our area, the most common trauma patient is one injured in a motor vehicle crash or in a fall from a ladder, another high place or stairs.
• Energy of the injury; for instance, a crash at highway speed or a vehicle rolling over multiple times.
• A person’s general appearance at the scene of the injury, which provides emergency personnel with indicators about the severity of the person’s injuries.
• A person’s vitals, such as blood pressure and heart rate, which provide critical information about how stable the person is medically.

Activating the trauma system
If paramedics determine an injury is a trauma, they activate the trauma system by calling the emergency department at the trauma hospital. According to Michael Heffner, emergency medical services coordinator with the city of Salem, the standard of care is to remove traumatically injured people from the scene and begin ambulance transport within 10 minutes from the time paramedics arrive.

Care must be delivered in a rapid, organized manner to stop bleeding or prevent the injury from further disabling the patient.

“We follow the state’s trauma rules, which require us to take patients to the closest highest level of care, which is typically Salem Hospital,” says Heffner.

Once the trauma system has been activated, a team of nurses, technicians, respiratory therapists, X-ray technicians, an emergency room physician and a trauma surgeon is brought together. The operating room is prepped if needed and other specialists, such as neurosurgeons, orthopedic surgeons and anesthesiologists, may be called. Additional hospital staff, such as chaplains and security, also may assist the team.

By the Numbers
More than 100,000 people a year are treated at Salem Hospital’s Emergency Department and Urgent Care Center, making them the busiest in the state.

In 2006, Salem Hospital’s trauma team treated 731 patients in the emergency department. The most common causes of trauma injuries were motor vehicle crashes (219) and falls from ladders, stairs and high places (158).

Last year, 69 people were seriously injured after falling on the ground. Most of these were elderly people who tripped or lost their balance and suffered head injuries or fractures.

Every year a few trauma patients, mostly children, are transferred to Portland because they need highly specialized care not available at Salem Hospital.

Trauma injuries seen at Salem Hospital 581 115 15 7 3 3 7

County in which injury occurred Marion Polk Yamhill Linn Lincoln Tillamook Other