Time is of the Essence Time is critical in trauma or near trauma scenarios like these.

That nights charge nurse, Scott Miller, said it involves quick, precise coordination and communication. Everybody swarms in to get the job done as fast as possible. In a case like this you have Dr. Tran coordinating and everybody trying to feed information to him as to what theyre finding at the same time as they carry out his orders. When the whole trauma team is activated, a whole slew of specialists from surgeons to anesthesiologists to radiologists to lab techs converge on the spot, making teamwork even more essential. According to Kathy Warren, You have a lot of people and everyone has a different role and, hopefully, they know their role so theyre not getting in your way and youre not having to tell them everything. It usually works pretty well, and its amazing the amount of things that can be done for a patient in a short amount of time when you absolutely have to. But thats what a trauma center is supposed to be able to do. Emergency care often starts with the rapid response of rescue squads on the scene. Paramedic Tom Quinlan was among those responding to the 911 call that found Doe lying unconscious. He was not breathing. He didnt have a pulse. So we started our CODE 99 (for clinically dead cases) protocol, which is intubate him, start an IV and do CPR. We ended up shocking him a couple of times. We finally got a pulse back and he continued to breathe for us on the way to the hospital, he said. Added Dr. Tran, Time is of the essence here. After so many minutes, it doesnt do any good, so its all speed and skill. The man probably experienced sudden death when his heart went into fibrillation, meaning it didnt pump any blood and, so, the brain promptly became unconscious and he fell down and hit his head and only by actions of the paramedics did he come back. He was extremely lucky to have had everything done in that time, otherwise he would be dead by now. Dr. Tran said the fall resulted in about a five-centimeter hematoma on the back of the head. Since Doe was found unresponsive and bore a scar on his chest indicating a history of heart surgery, the question on Dr. Trans mind was whether the patients vegetative state was due to the fall or to some new cardiac event. Not wanting to overlook a potential cerebral cause, he called in part of the trauma team after all. As Scott Miller, explained, Were assuming now he had some sort of heart event that caused him to fall and hit his head. We will be doing a CAT Scan to make sure theres not something else going on, like a big bleed in his head. We dont think thats the case, but you cant always tell for sure. Later, it was confirmed a cardiac event did trigger the trauma. As for the long-term prognosis, Dr. Tran said, Im not sure of the condition of his brain function later on. By then, Doe was identified and his family contacted by nursing resource coordinator Regina Christensen, who met with family members. Part of hers dutie entails fielding inquiries from news hounds looking for material. She noted with incredulity some sound disappointed when a case is upgraded from critical to stable condition. When treating a trauma, there is no room for bruised feelings. The required care must be delivered NOW. Hashing out differences can come later. One of the reasons nurse Jackie Engdahl likes working in

the ER is the maturity of the people working there. When I worked in other hospital areas there were very clashing personalities and people always bickering back and forth. But here, its not that way. You say whatever you want to say to someone and then its over and done with. Theres never hard feelings. And, she said, where some physicians resent or reject nurse input this ERs docs welcome it. The doctors here work really well with the nurses. The doctors trust our judgment and they really listen to us. They allow us to do a lot of things, which is nice. What about departmental romances? There used to be between the nurses and paramedics, nurse Janie Vipond said. It just depends on the group you have at any given time. But, yeah, it happens.