Evo Terra (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Evo Terra and today with me is Dr. Christopher Michetti, Chief of Trauma and Trauma Medical Director at UM Capital Region Medical Center. Our topic, demystifying and demythifying trauma care.Thanks for joining me, Dr. Michetti.

Christopher Michetti, MD: It's pleasure to be here. Thank you.

Host: Now, I know there have been numerous medical dramas since I was born that talk about ERs and shows what takes place in emergency rooms, but I have a funny feeling there's a massive difference between what takes place in an ER and trauma center versus those other televised programs.

So can you talk to me a little bit about the differences there?

Christopher Michetti, MD: Yeah, well, you know, first I'll say I'm a big fan of those shows. I watch a lot of medical dramas, have since I was a resident and ER was on TV. They're very entertaining, but, yeah, they're not real life. There's a lot of differences, for dramatic effect. They have to make everything seem super exciting and fast paced and dramatic and make the doctors and nurses have a lot of complicated decision making.

And, in reality, things sometimes do happen very quickly in the trauma world, but not everything happens all at once, in the same scene, so to speak.

Host: On those medical dramas, everybody's rushed to the ER. But wait a minute, we actually have ERs and we have trauma centers, and then we also have urgent care. So maybe you could break down that for us.

Christopher Michetti, MD: Yeah. Most hospitals have some emergency care available and, most larger hospitals have an emergency department. And, 6,000 something hospitals in the United States will have most of those having emergency departments where people can go for any number of emergencies in any body system.

It's kind of a comprehensive care center. Trauma centers, there's maybe about 2000 or so in the United States, are specialized hospitals that tend to injured patients and more severely injured patients. So when we think of trauma, I'm thinking of people that are very hurt that might need surgery, that are bleeding, that need urgent attention for life-threatening reasons.

So, if you're walking down the street or you're playing basketball and you sprain your ankle, you're going to go to an urgent care center or an emergency department. If you're having a heart attack or a stroke, you're going to an emergency department. If you are severely injured. You're going to hopefully be taken to a trauma center.

 That's not always the case, but, that's where you would go if you need complicated care.

Host: Yeah. That all makes sense. These TV dramas, once again, I know everything's all fast and flashy and probably wrong, but let's talk about those first critical minutes because I know that's very important when it comes to saving a life, especially in a trauma center. So what happens right after a trauma center patient arrives?

Christopher Michetti, MD: So at a trauma center, when a patient arrives, typically the trauma team is alerted, and that's either their overhead page or on your phone or whatnot. But the team is alerted ahead of that patient's arrival so that they can be there to greet the patient. So seconds count in trauma, because a lot of these are life-threatening injuries.

The patient is descended upon by a group of people, doctors, nurses, residents, physician assistants, nurse practitioners, putting in IVs, taking clothes off, assessing for wounds and injuries, and it looks chaotic. So when you see it on TV, you know, it just looks like, chaos and noise and drama. We're actually doing it in a very methodical fashion.

We're going by a systematic evaluation that starts with things that are highest threat to life first. And going through those, and once we kind of assess that a threat to life is being addressed or maybe is not there, then we can have a more kind of a calm evaluation, head to toe to find everything we can on the patient.

Host: You mentioned some of the people that are involved with the trauma team. I wonder if we could run through that once again and, and with some ideas of what the responsibilities are.

Christopher Michetti, MD: Sure. So trauma teams are mostly led by trauma surgeons, so we're general surgeons that get specialty training in trauma care and critical care. And so the trauma surgeon is kind of the captain of the ship there in the room, not necessarily in there getting their hands dirty all the time, but standing back, getting the big picture, leading the crew.

There's someone specifically assigned to do the surveys we call them, of the trauma patient, to check them for all the injuries and do a complete exam and talk to them and see what's going on if the patient's able to communicate. So that's usually a surgery resident, an emergency department resident, a PA, a Nurse Practitioner.

There are also nurses, trauma nurses that are attending to the patient, putting them on the monitor, inserting IVs. There are medical students involved a lot of times helping out. And then we have a lot of other consultants that we might call in also to assess the patient at various times during their evaluation.

Host: I've heard of something called a trauma resuscitation unit. What is that?

Christopher Michetti, MD: Trauma resuscitation units, we have one at Capital Region Medical Center. It's a specialized unit that is distinct geographically, from the rest of the emergency department. So, at most trauma centers, you'll have trauma bays designated for trauma patients to come in and they'll have special equipment and monitors and things like that.

They're usually interspersed with the rest of the emergency department and part of their rooms. The TRU or the TRU that we call it is, geographically separate. Some trauma centers have that. We have a separate unit that has five beds. University of Maryland downtown, the Shock Trauma Center has a whole building devoted to it, so they have a very large, TRU, but, that's, probably more the exception rather than the rule among trauma centers.

Host: Got it. Earlier you mentioned that, we have ERs, we have trauma centers, we have urgent cares, and I think oftentimes patients don't get to choose where they wind up oftentimes. So talk to me about that decision process. Who figures out where we send a patient, especially when there's multiple hospitals, like we have in Maryland?

Christopher Michetti, MD: Yeah, for trauma, usually, the trauma center is choosing you. You're not choosing the center because in a life-threatening situation, the EMS providers are going to route the patient to whatever hospital can take care of their needs. So, while most hospitals can take care of the basics of broken foot and chest pain, things like that.

The EMS providers will have guidelines as to where they should take a patient based on their severity of injury. So they will bypass a lower level trauma center or a non-trauma center and go farther to get to a trauma center that can actually provide the care they need, because, again, seconds and minutes counts.

So if somebody's bleeding, you would rather not stop at the hospital around the corner if they don't have a surgeon that can operate on you and stop your bleeding. So it's worth it to take the extra time to go to the trauma center, and we call that triage and EMS, are the ones that will make that decision.

So if you decide to go to a hospital for whatever reason, yes, you can choose your hospital if you are incapacitated and calling 911, which you should be calling 911, then they will take care of that decision making process for you.

Host: And that's important that we have that because we need to get the care we need when we need it so, desperately. TV dramas, going back to the beginning, most of them are things like gunshot wounds, stabbing, or the random weird dog bite. What kind of injuries are most common in trauma care?

Christopher Michetti, MD: Well, if we're thinking nationwide, it is blunt trauma, things like falls and motor vehicle crashes. So definitely car crashes are very prevalent and, falls not only from, you know, falling off a roof or falling from a height, but falling from ground level, which a lot of our older citizens can get very hurt by just falling from ground level with head injuries, hip fractures and things.

So the majority of trauma centers have a blunt trauma population. In cities and urban areas, you'll have more of the gunshots and stabbings. And so for example, in Prince George's County, at Capital Region Medical Center, about one out of five of our patients has a penetrating injury, which means gunshots, stabbing, things like that.And that's variable depending on what trauma center you're looking at.

Host: On TV shows, you've mentioned this previously, you know, there's oftentimes there's one spot. I mean, the TV show might even be centered around a hospital, and that is the one place things happen. But I know that, UM Capital Region is part of a much larger medical system. So talk to me about how the University of Maryland Medical System hospitals all collaborate with one another when they're caring for patients.

Christopher Michetti, MD: Yeah. Well when you have a hospital system, then you sometimes specialized care to certain hospitals so that the expertise can be concentrated in certain areas. So I mentioned before the levels of trauma centers. So level one is the highest level, and the Shock Trauma Center, University of Maryland is actually a little beyond that.

They're a regional resource. And so Capital Region Medical Center, being a level two, we can take care of almost everything trauma related. But there are some very specific high level interventions that we would need to rely on our partners in Baltimore for us. So having a system we can send a patient initially after stabilizing them, to Baltimore, to the main campus for other specialized care, for things that we can't provide.

Host: Sounds like a lot of teamwork is, is taking place there. I'll wrap up with this question. What's the one thing that you wish people would understand about trauma care that they never show us on the TV drama shows?

Christopher Michetti, MD: There's a long list. If I have to pick one, well, you know, a TV show, it's going to be a half hour or an hour, and you have to have a resolution, right? Trauma recovery takes a long time. And so what you don't see is the weeks and months and sometimes years of recovery that has to happen for trauma survivors after their initial injury.

So there's a lot of intense action early on. You might have lifesaving surgery and the patient gets out of the hospital or a week and on the TV show you think, okay, well there, you're done. The patient's saved and everything's good. That patient, that person has a life to get back to and the trauma event affects them emotionally, psychologically, as well as physically. So we often say, after the scar is healed, there's still a lot of healing to be done. And, there's a lot of patients that have significant injuries that don't get back to work, they don't get back to their normal lives.

They're affected in their relationships and financially as well. We don't see that year of recovery that it takes a lot of patients to endure. And, in the past decade or so, we're trying to really draw attention to that because we don't have resources to help these patients a lot of times after they leave the hospital.

So I do really want people to know that it's not all done when you check out of the hospital.

Host: Well, Dr. Michetti, thank you very much for all the information you've shared with us today.

Christopher Michetti, MD: Thank you, really excited to be here and, glad you had me on the show.

Host: And thank you for listening to Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media. I'm Evo Terra, and you can find more episodes just like this one at umms.org/podcast or on our YouTube channel, and also on your favorite podcast listening platform.

Thanks for listening.