Issue One 2011

On the night of June 10, 2007, Buffalo Firefighter Mark Reed was severely injured while responding to a fire with his unit.  Mark was crushed by the weight of a falling chimney and was immediately rushed to Erie County Medical Center.
    Mark came in with a severe head injury and a mangled leg.  He was critically ill and his life was in danger because of blood loss from the leg injury.  A tourniquet was applied to the leg to temporarily stop the bleeding.  He was rapidly transferred to the operating room to control the bleeding and evaluate the extent of damage to the leg.(1)

     In Western New York, whenever calamity strikes throughout the city or across the countryside, in domestic battles or thruway pileups, in sudden explosions or howling storms, the victims are almost always rushed to one destination–Erie County Medical Center.  And once inside the towering medical complex just off Buffalo’s Kensington Expressway, the severely injured come under the care of the remarkable team of trauma doctors, nurses, surgeons, and other experts who comprise ECMC’s Adult Trauma Center.  Because ECMC has been the destination for trauma victims for many years, it may be surprising to learn that this nexus of hope for victims and their families was established only a few decades ago. 
    Examination of the damaged blood vessels, broken bones, crushed muscles and torn nerves demonstrated that the leg was injured beyond repair.  Rather than risk Mark’s life in an effort to save the leg, an amputation above the injury was performed.  His blood pressure stabilized after the amputation and he was transferred to the Trauma Intensive Care Unit for management of his head injury.(1)
    The first hospital built on Grider Street was known as Buffalo City Hospital and renamed in 1939 for one of its founders, Dr.  Edward J.  Meyer.  In 1978, the present hospital was built on the same site and renamed the Erie County Medical Center to reflect its importance to the larger community and its growing national reputation as a center of clinical expertise and professional training.  That same year, Dr.  John Border founded the Trauma Center at ECMC, eventually working out of just one room with two trauma surgeons, Dr.  Roger Seibel and Dr.  John LaDuca.
    “Trauma is different from other surgery,” says Dr.  LaDuca.  “It’s a catastrophic event that occurs suddenly.  It affects mostly people under the age of 40.  In fact, it’s the biggest killer of people under 40.  Typically, they are strong and vital people.  This life changing event occurs and the life of the family is now in a crisis which has to be dealt with on many levels.  And it takes a whole team of dedicated people who are really versed in what they do and who work together to resolve the issues.”
    Dr.  Border, who graduated from Harvard Medical School in 1956, introduced many innovative methods in trauma care, particularly in orthopaedic trauma, that later became accepted practices throughout the nation.  While traveling in Europe, Dr.  Border had observed the success of aggressive resuscitation and the immediate setting of fractures in trauma patients, methods of care that were virtually unknown in the U.S.  He also recognized the danger inherent in the physical stress suffered from severe multiple trauma and led a University at Buffalo research team that discovered the benefits of  treating patients with a protein and glucose therapy.  The treatment enables injured bodies to repair damaged tissue and prevents post-traumatic shutdown of vital organs. 
    “Dr.  Border, Dr.  Seibel, and I comprised the entire trauma department for the first fifteen years of its existence,” recalls Dr.  LaDuca, who retired in 2008.  “We did general and orthopaedic surgery every other night.  We did vascular, hand, and facial surgery before surgery evolved into its current subspecialties.  We saw all the patients who came into the emergency room, prioritized their injuries, and followed up on their care with our team of residents.  Now we have a specialized team that takes care of all of those patients.”
    He was heavily sedated and remained on a breathing machine while treatments were directed at decreasing pressure on his brain.  These efforts were successful and he made a gradual recovery toward independent living after a period of recovery on the Rehabilitation Unit at ECMC.(1)
    According to Peggy Cramer, Vice President of Trauma and Emergency Services, ECMC cared for more than 55,000 emergency patients in 2008 and is also the designated emergency preparedness site for Erie County.  Trauma patients are prioritized based on the severity of their injuries and oftentimes that priority is determined by reports from the ambulance.  If the patient is reported as very unstable in the field, a Priority 1 is assigned and the trauma team meets the stretcher at the Emergency Room door.  The charge nurse in Trauma gets a heads-up on the nature and extent of the injuries and alerts the rest of the team.  The medical center is designed so that both the Trauma Operating Room and the Trauma Intensive Care Unit are just steps away from the Emergency Department.  The TICU cares for patients in grave danger during the most critical phase of their injury or illness.  It is now officially known as the John R.  Border, M.D., Trauma Intensive Care Unit. 
    “The most common injury is falls, then motor vehicle accidents, then penetrating wounds from a stabbing or a gunshot,” says Melinda Lawley, TICU Unit Manager.  “Males are definitely more frequent than females and we’re seeing a lot of younger males–the daredevils who are testing the limits.  Then we also see the older male who shouldn’t be on the roof, up in the tree, or behind the wheel anymore.  And that patient tends to stay longer than the younger male, who is completely healthy other than his immediate injuries.”
    Mark’s head injury was significant but only part of the picture.  His overall injuries were very extensive.  Fragmented bi-frontal skull fracture with some depression.  The bone was pushed in towards the brain.  Penetration of the brain didn’t occur and there was no excessive brain bleeding, just a little superficial bleeding.  The bone was slightly depressed so we re-aligned the skull fracture and then he had some cranial-facial surgery.(2)
    ECMC is the region’s adult trauma center, distinguishing it from the pediatric trauma center at Women & Children’s Hospital.  In 1989, it was also designated a regional burn center where burn victims are treated by a specialized burn healthcare team.  The team was originally established by the late Dr.  Seibel, the medical center’s former Clinical Chief of Surgery and Clinical Director of Trauma and Burn Services, who was also recognized by his national colleagues as a leader in trauma care and education.  ECMC recently dedicated its Burn Treatment Center to the memory of Dr.  Seibel.
    I worked with the neurosurgeons on Mark.  He had high level facial fractures that we essentially temporized at the bedside until he was out of the woods.  Once he was stable, our job was to reconstruct his upper face.  For Mr.  Reed, going into a situation hoping to save a life and then to be injured like that and having such a life altering experience and injury is devastating.  But the most remarkable thing about Mark and his family is that they’re not angry over the circumstances that led to his injuries and have been able to turn all of the negatives into some very positive energy.(3)
    “Trauma is very difficult and it requires a dedicated team of people who understand what to look for and what to deal with immediately,” says Dr.  LaDuca.  “And if you don’t do it routinely, you don’t have that awareness.   Time is very important in the survival of the trauma patient.  You only have so many hours to really clarify all of the issues, identify every single injury and treat it.  If you don’t do that, the patient is likely to die.  So our team is very aware of what to look for and is always observing the changes in a patient that are important.  It’s an awesome responsibility to take care of people who are severely injured but the rewards are great.  It’s the simple thanks or a smile that you get from families or the relief that you see on the face of a parent or spouse.”
    The surgical trauma intensive critical care unit is very good.  This crew pulls off some remarkable things.  Doing facial work, I’ve seen some amazing recoveries come out of TICU.  Some that were so bad you thought there was no possible way out of this.(3)
    The heart of the TICU is its nurses, an elite group of professionals with a remarkable record of nearly 20 years as a trauma team and esprit de corps to spare.  “I’ve been here 26 years and I’ve been in the unit for 22 and I don’t know where the time has gone,” says Madonna Lakso, TICU Charge Nurse.  “It’s amazing.  Every day is different.  There is not one day that you come in where there isn’t something unexpected.  It’s never routine.  It’s always exciting and fast paced.  The adrenaline’s running and that’s what keeps you going to the next station.”
    “Long before we were officially designated a NYS Adult Regional Trauma Center in 1994, this hospital had a trauma program and a trauma registry,” adds Linda Schwab, Trauma Coordinator for ECMC and outlying hospitals in Western New York.  “The system of trauma is very much ingrained in the culture of this whole building.  It’s who we are; it’s what we do.  We were the first trauma center in New York State to be reviewed by the Department of Health.”
    `I’m a rehab doctor and the first day I saw Mark he was very confused, agitated, and in need of almost total care.  He had no memory, which is very common in a post brain injury.  We gave him neurostimulators to help his brain function as well as a mood stabilizer.  One to two weeks later he began to improve dramatically.  The agitation stopped and he continued to improve until discharged three weeks later.(4)
    In addition to the physicians, nurses, and techs that make up ECMC’s trauma team, there are also experts on hand to tend to the spiritual wounds and other non-medical concerns of both patients and families.  Fr.  Francis X.  Mazur, known throughout the hospital as Father Butch, is the head of a community interfaith organization and one of the trauma team’s spiritual counselors.  Father Butch is an open, affable man with a gift for laughter and storytelling who is also profoundly serious about his work and his responsibility ministering to critically injured patients and their families.
    “My work with different religions is extremely valuable here in the hospital–knowing the different religions and their cultural aspects, especially regarding end-of-life decision making,” says Father Butch.   “The nurses and physicians explain the medical procedures and then I come in and the family might say, ‘what do you think?’ and I try to help them make a decision.  A lot of times we’re talking about withdrawal of treatment and sometimes we may have two family members who are at odds with each other and I’ll try to help them come to a decision.”
    At this hospital, we have a very hardworking staff.  You can still find physicians here in the hospital after 8 PM.  In most other hospitals, you can’t find anyone after 5 PM.  It is very common for me to start work at 6:30 in the morning and go home at 9:30 at night.  Because our patients are so sick and have so many complications, we can’t leave them.  And that’s why we have a very good nursing team to keep a close watch and report to us.(4)
    Social workers also provide emotional, non-medical support to families in the trauma unit.  It may be simply writing a letter for a family member or perhaps offering counsel to a family upon the death of a patient.  Neville Francis is a tall and serious man with a calm demeanor whose thoughtful words bear the lilting accent of his West Indian heritage.  He has served the trauma team as a social worker for the past 12 years. 
    “What I do is help the family through the crisis mode,” says Mr.  Francis.  “As soon as the patient is taken to the trauma unit, the social worker gets involved.  Initially, the family is not concerned about themselves because they’re focused on the patient.  Later, other family problems may arise.  When the patient recovers, we may get into post-hospitalization care at home.  We assist with financial and insurance problems and help fill out forms and proxies or help a family find a place to stay if they’re from out of town.  We’re responsive to all the needs of the family and we take our cues from them.”
    Listening to the TICU team recount their experiences and talk about their work, it’s impossible not to be both awestruck by their dedication and a little envious of the passion they feel and the rewards they receive from their work.  The inherent pressure of the lifesaving work and the skill and teamwork necessary to execute it seem akin to those of a firefighting company or a M.A.S.H.  unit in a combat zone.  The split-second medical coordination and almost intuitive communication also engender a profound sense of loyalty and mutual respect among team members. 
    “I really appreciate how well this unit works as a team,” says TICU Nurse Susan Kiener.  We don’t even have to talk.  The patient is rolled in and his blood pressure has crashed.  Not too much is said.  Everybody just goes to work.  They don’t have a specific job but you know what needs to be done and it’s pretty impressive to watch what’s done.  Suddenly the pressure looks good.  We’ve run some fluids.  We’ve got blood going.  We’ve sent off labs.  We’ve changed dressings.  We’re done.  It’s a good feeling to work as a team like this.”
    `ECMC was amazing.  I’m a nurse at another hospital and generally I would be a little overbearing but at ECMC I was quiet because I felt the doctors and nurses taking care of my husband knew exactly what they were doing.  I felt that when I left him in Trauma at night to go home, he was well cared for.  I had a sense of relief knowing he was getting the best care and I didn’t feel the need to question anything.  I was allowed to just be my husband’s wife and nothing else.  Looking back, I wouldn’t have done anything different.(5)
    In 2006, ECMC ranked first among 50 New York trauma hospitals for trauma survival rates.  The hospitals were evaluated and graded in a report released by the New York State Department of Health.  What accounts for the remarkable success of  this Level 1 trauma center in the heart of one of the nation’s poorest cities? Certainly the vision of its founders–Drs.  Border, Seibel, and LaDuca–set the tone and the bar for the highest level of trauma care. 
    The ongoing research in trauma and other clinical areas in collaboration with the University at Buffalo has brought national recognition to the medical center, which in turn attracted more talented and dedicated physicians and nurses to Grider Street.  One of them was Dr.  William J.  Flynn, Jr., who is now clinical director of the trauma unit and the director of the TICU.  “The survival and recovery of our most critically injured patients reflect the efforts of many individuals and the expertise of multiple disciplines,” says Dr.  Flynn.  “These include  general surgery, vascular surgery, orthopedics, neurosurgery, infectious disease, occupational and physical therapy, nutritional support, respiratory therapy and rehabilitation medicine.  The availability of this expertise is a community resource that serves its members well in time of need.”
    Above all, the trauma team has enormous professional pride in their work and the determination to do everything within their power to guarantee the best possible outcome for each patient in their care.  “You never give up,” says Susan Kiener.  “If you saw the miracles that we see.  We see people coming in that seem to have no possible chance to survive and they go back to college.”
    “When you’re caring for a patient you’re thinking of what you’re doing now and you’re also grieving for the family,” says Madonna Lakso.  “As a mom, I can totally feel it.  You’re thinking of the people you’re going to help and what a great thing it is to do this for people.  You’re pushing so hard.”
    “This is harder, more stressful work than other medical specialties,” says Dr.  LaDuca.  “Especially the emotional part.  We need to bounce things off each other all the time.  We give each other hugs.  We take care of each other.  Because you can’t help but get emotionally involved in your patients’ lives.  It takes a tremendous amount out of you.”
    “But you don’t have any business in this profession if you don’t have that,” adds Susan Kiener.  “You’ve got to have a big heart and you’ve got to be willing to share it.”
    I was told 17 doctors were on my case.  Every single one had a hand in saving my life.  What stands out in my experience at ECMC is the care received by my family, my wife, and myself.  They definitely went above and beyond.  Seeing how injured I was, they just took great, great care of me.  I’m so grateful for everyone at that hospital and how well they’ve taken care of me.  And they continue to check on me.  I love it.  (6)

1 William Flynn, M.D., Surgeon, Director, TICU, ECMC
2 Gregory Bennett, MD, Neurosurgeon, ECMC
3 Barry Boyd, DMD, MD, Surgeon, ECMC
4 Gary Wang, MD, PhD, Rehabilitation Physician, ECMC
5 Nancy Reed, Registered Nurse, Wife of Patient
6 Mark Reed, Patient, Firefighter