Treating Trauma | Behind the curtain look inside Arkansas's only Level 1 Trauma Center
Author: Laura Monteverdi, Longform by Lara Woloszyn
Published: 8:49 AM CST February 14, 2018
Updated: 8:49 AM CST February 14, 2018
HEALTH 3 Articles

Treating Trauma | Behind the curtain look inside Arkansas's only Level 1 Trauma Center

Chapter 1

UAMS Trauma Center

It's a place you never want to end up but every year more than 2,500 people come through the doors of the UAMS trauma center. UAMS is the only adult Level 1 Trauma Unit in the state of Arkansas.

Photojournalist Bre Conyers and Laura Monteverdi spent more than 20 hours inside the trauma unit to get a behind the scenes look at saving lives. We worked with the hospital to get permission from every patient to be able to show you what its really like.

As the sun sets on the city of Little Rock, the night is just beginning inside the trauma unit at UAMS. Just after 9:30 p.m. the first call of the night comes in. It was a woman badly injured in a car accident in El Dorado. Her injuries were severe so she had been flown into the state’s only level 1 trauma center.

Two hours later the patient arrived and trauma teams moved quickly as they worked against the clock to stabilize the patient and make sure she had no internal bleeding. In total, about a dozen people surrounded the patient, each with a specific job.

To THV11, it was a chaotic scene. But to the men and women behind the curtain, it was “organized chaos.”

“My job in those moments is to make sure the team knows what their roles are. Everybody in that room even though it looks like chaos has a task they are trying to accomplish,” said Dr. Ron Robertson. “What I have learned a long time ago is if I go in and I’m really wound up it makes everyone else in the room really wound up. And so, if I can keep a low-key demeanor and go about my business and approach things in a systematic fashion, I think it makes everyone else at ease.”

Dr. Robertson, the medical director of trauma, is at the helm. He's the medical director of trauma at UAMS which is one of 9 trauma surgeons that make up the team.

“You can have nights where it is quiet. You don't have anything. And then you can have nights where it is one after the other,” he added.

For the past 21 years, this has been his second home. From falls to car crashes to gunshot wounds, he's seen it all.

“You never know what you are going to deal with,” said Dr. Robertson.

With three trauma bays, the trauma unit can handle just about everything including two patients back to back. As the team continues to stabilize the first patient, another patient arrives via medflight from Texarkana. This time it was a 75-year-old man with a massive head injury from a car accident. The clock starts and work to stabilize the patient began.

“The team can get so focused on what is going on that they lose time. And so, that is a hallmark that they can go to they can look at the clock and see ok we’ve been in 5 minutes. What have we gotten accomplished? Has our lab work been sent to the lab? Do we have blood work coming from the blood bank? With goals set for the team so at 15 min we have to make a decision,” said nurse Terry Collins.

On this night it was a double success. Both patients in critical condition but stable and sent to the ICU to spend the night. This was a quieter night than most Dr. Robinson said but a night that has only just begun.

“I’ve got several hours to go so that may change,” said Dr. Robertson.

Chapter 2

Level 1 Trauma Center in Action

In 2005, Arkansas ranked the worst in the nation for timely trauma center accessibility. In fact, before it was established by the state legislature in 2009, Arkansas was one of only three states without a fully functioning trauma system.

But fast forward to 2018 and that has changed dramatically. Patients are surviving injuries they never would have before and receiving care faster than ever before.

It's a Tuesday evening in January inside the trauma unit of UAMS Medical Center. Just after 5 p.m., the call comes in. A Little Rock police officer was injured in a multi-car pileup while on his motorcycle. A possible head injury sent him straight to the state's only adult level 1 trauma center. It's these types of scenarios that the trauma team at UAMS is prepared for. Since it is the only adult trauma center in the state, it is able to provide the highest level of trauma care.

“It’s such a gift. It’s such a blessing. I mean we wake up every day and our legacy is saving lives and not many people can say that,” said nurse Terry Collins.

Terry Collins, nurse
Terry Collins, nurse

According to the U.S. Centers for Disease Control and Prevention, getting to a Level 1 Trauma Center can lower the risk of death by 25 percent for patients with severe injuries.

“I think most people think they live close to Level 1. Within 5 to 6 minutes to a Level 1 Trauma Center. And I think they would be surprised to know that they are really not,” said Collins.

With specialized surgeons on duty at all times, they can treat the most serious and urgent cases.

“For us, that means we keep someone here 24 hours a day, 7 days a week, 365 days a year. The other hospitals they don't have to stay in house. They have typically a 30-minute response time. So, it gives us a little different perspective for patients we can take care of,” said Dr. Ron Roberston. He is the medical director of trauma at UAMS and he said having a Level 1 designation in the state can mean the difference between life and death in the event of a tragedy like a mass shooting.

Dr. Ron Robertson
Dr. Ron Robertson

“I have an operating room that sits open 24 hours a day, 365 days a year that sits open waiting for those patients to come in. This is the one place we can get a patient to the operating room within 10 minutes or so. If they do need our services,” said Dr. Robertson.

Or tragedies like a plane crash. Terry Collins was on duty in June of 1999 when American Airlines Flight 1420 crashed at the Bill and Hillary Clinton National Airport. “What went through my mind on that night was how can we handle this many patients? It was over 100 patients. Where should we get them all? We are the closest hospital to the airport. And how can we be the most effective and efficient and make a difference in their lives?” said Collins.

This is exactly what UAMS is doing every day. The hospital took a lead role in 2011 when the statewide trauma system began operation.

“Before the trauma system, it took a long time for patients to get accepted at a trauma center. Sometimes several hours before they could find an accepting hospital,” said Dr. Robertson. “What would often happen is they would land at a hospital, they'd identify an injury they couldn't take care of they would end up transferring to another hospital. They would find something they couldn't manage and so patients would go to 2-3 hospitals before they got definitive care. And the problem with that is that impacts mortality.”

In the past, there could be a six to eight hour delay in getting a trauma patient to the appropriate hospital. But thanks to the trauma system made up of nearly 70 hospitals in Arkansas and the surrounding states that time is down to just 7 minutes.

“When we talk about trauma care we talk about the right patient right place and the right time and sometimes that means flying over a trauma center or driving past a trauma center to a place where their injuries can be managed from the beginning,” said Dr. Robertson.

“Patients are living that never would have lived before we had these resources and this capability,” said Collins. “We know that we can save lives. And we know if the patient makes it to us most likely they are going to make it home."

And it's these resources and a team of dedicated doctors that allow patients like Officer David Phillips to make a full recovery.

Chapter 3

Surgeon saved

When trauma surgeon Doctor Todd Maxson worked to create a trauma system in Arkansas in 2009 he had no idea that less than ten years later his life would one of those saved by it. This next chapter of this series is a miraculous story.

It was the night of September 1, 2017, Dr. Maxson was taking a break after a long day of surgery at Arkansas Children’s Hospital.

“I was coming home for a bit, and I was on a motorcycle. I was helmeted with my protective gear on and was struck by a car really about halfway between children’s and the university’s hospital,” said Maxson.

Maxson was thrown from his bike, breaking his helmet. The car dragged his motorcycle nearly 150 feet. “At the scene, I knew my injuries were significant,” he told us. Two bystanders saw the crash and rushed to help. One of them called 911. Maxson asked the other to call ACH.

“I have been a trauma surgeon for 20 plus years. And I think even in that situation, I remember thinking here is what must be done. I must get a hold of the hospital. I must let them know we need back up,” he said.

Even with life-threatening injuries including a broken pelvis, shattered femur, and several broken bones, Maxon was able to tell EMS to take him to UAMS the state's only adult Level 1 trauma center.

“The ability to take an emergency and obviously none of that was scheduled, long operations the pelvic operation exceeded 12 hours alone. And to be able to get space in an operating room and having specialists trained to do that work and the space to do it is something you just don't get at a hospital that is not a trauma center,” said Maxson.

From the 911 call center; to the paramedics at the scene; to the trauma team at the hospital Maxon credits the state's trauma system.

“The fact they were able to do this so quickly and so efficiently I also credit to saving my life and being back to the level I am today,” he said.

Dr. Todd Maxson
Dr. Todd Maxson

Five Months later, Maxon is home recovering. He's able to walk around with the use of a walker and is back at work part-time. His commitment to doing what he does every day is stronger than ever before.

“I have this feeling that so many people did so much for me that my job is to work as hard as I possibly can daily to get back to where I can serve them again,” he said.

Dr. Maxom added his return to work is gradual but he hopes to be back doing trauma surgeries at Arkansas Children's Hospital by April 2018.