Dr. Jim Aiken always prepares for the worst. As director of the trauma stabilization unit at the newly opened Louisiana State University/Elmwood Trauma Hospital (1221 S. Clearview Pkwy., Jefferson), Aiken oversees a medical team that deals only with the most critical injuries such as gunshot wounds, stabbings, high falls and severe car accidents. Aiken, who heads Homeland Defense at LSU Health Sciences Center, also serves as medical advisor for the New Orleans Office of Emergency Preparedness. Prior to Hurricane Katrina, Aiken headed up Charity's Level One Trauma Center, which had 550 staffed beds and saw 3,800 patients per year. Although the Elmwood Center is a considerable improvement over the emergency room tents at the Convention Center, it is not rated a Level One trauma center and has fewer beds, only 20 presently. Aiken talks about what this new center can and cannot do.
Q: What is the role of this unit if it's not a Level One trauma center?
A: We're here strictly as a holding area to stabilize and to make immediate decisions about the care of the severely injured patients. In a nutshell, our capabilities are to take a severely injured patient and get him to the operating room within what we call the golden hour, or 60 minutes from the time the patient was injured. If you can do that, your survival rate hovers around 80 percent. Once you get beyond the 60 minutes, and this is one of the few consistent things you see in medicine, the survival rate tumbles down to 40 percent very quickly. The one service that we don't offer is obstetrics, so for the few incidences -- this only happens a couple times a year -- where there is a patient with a fetus over 24 weeks old, the time we could expect to be able to save a fetus, that patient should go to a hospital that offers those services. Otherwise, we can take care of pretty much any kind of trauma.
Q: Then why isn't it considered Level One?
A: There's some semantics involved, and also a Level One is a designation by the American College of Surgeons. For you to get that designation, it's not something that happens on opening day, or even by stated capabilities. You have to show outcomes, you have to show numbers. Essentially, you have to demonstrate a successful track record. It's not that we're not capable of providing Level One service, but we are not going to take on that moniker until we have gotten it from the American College of Surgeons. There's another important piece: We used to take everything. If you scraped your knee, we would take care of you. We can't do those kinds of numbers anymore. We're an 11 bed holding area, and right now we're only staffed for 20 beds upstairs, so we're quite concerned if we get inundated with sprained ankles or people who aren't really hurt, that it will take away from our ability to immediately respond to a seriously injured patient.
Q: What constitutes a seriously injured patient?
A: That's a patient from the wounds, or from how they look, we know the patient will probably need an operation or at least very close observation by people who are prepared to operate. For example, if someone is shot in the chest, we know they may require an operation or interventional maneuvers to keep him alive. A patient in a serious car wreck, and we've had several already, may show signs of shock, blood pressure low, pulse rate high, or diminished mental status. These are people whose presentation is such that their chances of needing an operation become very high.
Q: Who determines whether or not a patient comes to your trauma center?
A: It starts with the medical society approving the protocols, the instructions, for bringing them to us. In Jefferson Parish, St. Bernard and in Plaquemines, that has taken place. In Orleans, they're still signing off on it. So, as of today, we're not taking any patients from Orleans until that happens. We hope to have it in the next couple of days. Then the decision gets to the paramedics; they're at the scene, and they make a determination. In Jefferson Parish, they still call their own medical control, discuss the case with the physician on the radio, and between them, they make the decision whether to bring the patient here or not. In Orleans, we here at Elmwood are the medical control for everything, so they would call us directly.
Q: Currently, what is the average amount of time elapsed from an injury to when a patient begins receiving care at Elmwood?
A: We've only received six patients so far. One transport may have exceeded the 60 minutes, but all of the other ones, as far as I know, have come well within the 60 minutes.
Q: Prior to Elmwood opening, patients came from the eight-parish metro area (EMA), but now it's only for four parishes: Orleans, Jefferson, Plaquemines, and St. Bernard. What about the other four parishes?
A: We thought it was important to understand what our true capabilities were and how much we could expand by hiring other staff. Right now, we don't even have the bed staff we want. Hopefully, some day soon we will be able to serve the other parishes.
Q: Since Charity and University hospitals are still closed and the poor were a large percentage of the patients there, usually not Level One trauma cases, where are these people supposed to go?
A: Certainly the people can go anywhere they want for emergency services; the law forbids any health-care facility from denying services that are urgent. LSU still operates a facility, in tents, at the Lord and Taylor Department store (at New Orleans Centre), and we're seeing in excess of 100 people a day there. Beyond that, it's been a matter of local hospitals and clinics taking on that load. A lot of people are not getting care, and we are seeing people who are a lot sicker than they should be. It's because they're not getting the primary care they need like medication refills.
Q: What about catastrophic events like a terrorist attack, large bus crashes, or infectious-disease outbreaks? Is Elmwood prepared to handle such emergencies?
A: For a terrorist attack, if it involves serious trauma, and we will have decontamination capabilities soon, we would play a part in that. I don't see us as the hub; we would get saturated very quickly. We're still working these plans out. We're not an infectious-disease center; we don't have that capability unless it's on a consulting level. Any role we would play in a disaster would have to be confined to serious trauma.