Editor's Note
The Tempest of Trauma
Illness intrudes on lives. Sometimes it is a casual knock on the door, the URI that leaves in days. Sometimes it is a cat burglar, atherosclerosis that steals away health gradually over years. And sometimes it is a tempest, rushing in with devastating suddenness, overturning victim and family. Trauma, our topic this month, can be such a storm.
Suddenness defines trauma. The fall from the ladder, the automobile crash, or the gunshot instantly propel the victim from health to disease. A 911 call starts a cataract of urgency, where speed rules and seconds can determine survival. The frenetic pace is tailor-made for Hollywood with M.A.S.H. nurses sprinting to tented operating rooms or ER stars barking orders, intubating tracheae, and starting IVs while still looking glamorous. Even a “real” ER can be controlled pandemonium if too much trauma hits the door. Young ER docs describe an adrenaline rush; the graying veterans look haggard from the pace.
Yet such suddenness, such drama needs a stable delivery system to take care of the victims. It’s not enough that the paramedic adeptly administers advanced life support or that the emergency room physician quickly finds the pneumothorax. If the patient doesn’t get to the right facility with the right equipment and the right crew with the right skills to treat their injuries, the game is lost. To do that takes an undramatic web of coordination, communication, and cooperation such as that proposed in the Minnesota Statewide Trauma System plan (see “Raising the Bar for Trauma Care in Minnesota,” p. 36). With everybody on the same page in the future, an accident victim with multiple fractures in Small Town, Minnesota, will be routed after initial triage to the hospital best equipped to treat their injuries.
Since 9/11, our government, hospitals, and first responders have had to think about the unthinkable and to prepare for the unimaginable. On Sept. 11, 2001, our TV screens showed jumbo jets flying into skyscrapers and reducing them to rubble. Suddenly, terrorism wasn’t something that happened a long way away to somebody else. No longer are terrorists with nuclear devices considered only fodder for Tom Clancy novels. Preparing our medical system to respond to Armageddon scenarios is work that should be and is being done (see “If Disaster Strikes,” p. 24).
Trauma will always be with us. It will always be sudden and, for victims and their families, it will always change their lives instantly and probably forever. Medicine can never totally buffer the shock imposed by trauma on patient and family, but with adroit clinical skills and an efficient trauma network it can make the journey smoother and safer.