Split-second decisions in trauma care

Grady Thrive

Trauma surgeon Grace Rozycki knows almost nothing—name, medical history, or current medications—about many of the patients arriving in the ER in need of immediate surgery. But her team’s extraordinary expertise and judgment often combine to save these patients’ lives against the most desperate odds.

Did we know whether the young woman had insurance or money to pay?

Grace Rozycki, chief of trauma and surgical critical care at Grady Hospital, laughs at the question. “When many patients arrive, we don’t know their names, anything about their lives, their medical history, or what medications they may be taking.

“When this woman was brought into the trauma bay, we knew only that she had been shot in the hip and that she was in shock, complaining deliriously of abdominal pain, and appeared to be nine months pregnant. We also knew she was dying and every second counted.” The reason that this patient had been brought to Grady is that this facility is a level 1 trauma unit (one of only two in Atlanta), with a trauma surgeon and operating room available 24/7.

In the operating room, Rozycki and the trauma team began an exploratory laparotomy and clamped the woman’s abdominal aorta to control bleeding while anesthesiologists started the first of 12 units of blood to restore her plummeting blood pressure. Working side by side with a team of Emory obstetricians, they performed an emergency cesarean section, opening the uterus to retrieve a baby boy, already blue from lack of oxygen.

Because of the ricochet of the bullet, the woman’s bowel was severely damaged, but she was too weak to withstand definitive repair. The team removed the most damaged parts and then packed gauze pads and a sterile plastic bag over the open abdomen to control further damage. The woman was moved to the intensive care unit, placed on a ventilator, and further resuscitated until her condition could improve.

The following day, Amy—by then her identity was known and her family had arrived—was returned to the operating room for complete bowel repair. Two days later, the surgeons closed her abdomen. On day eight, she and her healthy son left the hospital.

The doctors don’t know, and never thought about, how much the hospital or physician services cost or if they were reimbursed. What they do know is that they made the right split-second decisions that saved two lives.


   
   
 
 

Emory provides 85% of physician care at the publicly funded Grady Memorial Hospital, which serves a large indigent patient population. Last year, Emory physicians provided $24 million in uncompensated care for these patients. When Grady patients do have coverage, all payments for Emory services go to the Emory Medical Care Foundation, which provided $34.9 million in fiscal year 2010-2011 to support Emory’s mission at Grady, including support for salaries and other operating expenses.

 


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