May 17, 2016

Dr. Miller: What happens in a level 1 trauma center? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. David Rothberg. He's an orthopedic surgeon specializing in trauma surgery. He's also a professor of orthopedic surgery.

David, tell us a little bit about what it means to work in a level 1 trauma center as an orthopedic surgeon.

Dr. Rothberg: Well, we're a member of the team that takes care of patients on their worst day generally. A lot of the patients that come to a Level 1 trauma center are patients who have been in a car accident or have fallen from an extreme height or some sort of accident along these lines. And we're a member of the team along with the general surgeons and neurosurgeons that take care of all sorts of trauma. Anything you can think of, from head trauma, spine trauma, belly trauma and extremity trauma.

Dr. Miller: So these could include industrial accidents. It could include automotive accidents. Just about any type of traumatic injury that would involve, what, multiple organs or just orthopedic injuries?

Dr. Rothberg: Really multiple organs. Orthopedics tends to take a lead role, often times in the operative care of these patients. But we're a member of a huge team and what it means to be a level 1 trauma center is that we can take care of anything.

Dr. Miller: Give me some examples of the types of injuries you particularly take care of.

Dr. Rothberg: In orthopedic trauma, we take care of just about any broken bone or soft tissue injury, but our specialty has evolved around the care of pelvic and acetabular fractures and fractures into people's joints.

Dr. Miller: Do you see these types of injuries mostly in automobile accidents?

Dr. Rothberg: They can be in automobile accidents but we see them ranging from recreational activities, like rock climbing to industrial accidents like you mentioned.

Dr. Miller: Now in a patient who's being sent to a level 1 trauma center, how far away are they coming to our center from? What is our outreach or ability to take care of these patients in terms of geography and distance?

Dr. Rothberg: Well, we're fortunate to have an incredibly large geographic catchment that involves Idaho, Montana, Nevada, parts of Northern Arizona, Wyoming and occasionally people from all around the United States who may be here.

Dr. Miller: Would the patients who are injured then be sent directly to us by helicopter or fixed wing or would they come from another hospital usually?

Dr. Rothberg: It's really variable. We have an incredible active helicopter service because of how large the geography is. But we also consult with physicians and outside hospitals who have patients that are above and beyond what they can take care of. And so we are commonly talking with them on the phone, brining patients here to help with their definitive care.

Dr. Miller: Tell me a little bit about the families of these patients. How are they directed to our hospital to follow up on their loved ones and be sure they're being taken care of?

Dr. Rothberg: That's an incredible process. So in the very beginning it's really patient-focused but as soon as that level 1 trauma activation, which can vary in time but usually is quite quick, somewhere in the ballpark of 15 to 30 minutes, we're already involving the patients. They've been in the ER talking with our social workers and then our surgeons and other providers are already talking to them as soon as possible.

Dr. Miller: Now you work with other types of specialists outside of orthopedics. Could you talk a little bit about that team approach? I mean, what happens when a patient hits the emergency department and they come in with a trauma? How do you begin to take care of them in conjunction with other specialists?

Dr. Rothberg: What happens is the general surgeons are usually kind of the quarterback of the football team. They're really in charge of what's going on in the trauma bay, along with the ER doctors and the anesthesiologists.

But when they come in, it's an incredible amount of people that are there on the spot, so orthopedics and neurosurgery and EMT and plastics. They're all there so that all injuries can be identified and taken care of in a timely manner. But we end up being involved with the vast majority of these because of the amount of extremity injuries that are involved in these traumas.

Dr. Miller: Sounds like chaos.

Dr. Rothberg: It can be but it's a pretty incredible process that we review and have almost a script that we follow each time so that nothing is missed.

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