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Emergency response to trauma makes life or death difference

ambulance gurney
An ambulance arrives at the scene of the shootings in Atlanta on Thursday

The injured were taken to Grady Hospital, the only Level 1 trauma center in Atlanta. CNN's Holly Firfer explains why.
Windows Media 28K 80K

July 30, 1999
Web posted at: 10:47 a.m. EDT (1447 GMT)

In this story:

Trauma centers often not the closest, but the best

Minutes, even seconds, are critical


From Correspondents Dr. Steve Salvatore and Holly Firfer

ATLANTA (CNN) -- Emergency medical response to incidents involving multiple casualties, such as the Atlanta area shootings Thursday afternoon, emphasize the importance of two key elements: training and speed.

Medical professionals say there is a "the golden hour" -- a limited time period that a physician has to restore life functions quickly to a trauma patient. If that window of opportunity is missed, fatal brain damage or irreversible shock will occur.

Trauma centers often not the closest, but the best

Many of the Buckhead shooting victims were transported nine miles to Grady Memorial Hospital in downtown Atlanta. Grady was not the closest hospital to the scene, but it is Atlanta's only level-one trauma center.

To be classified as such, emergency rooms must contain "things like CT (three-dimensional X-ray) scanners," Grady Hospital's Dr. Leon Haley said. "Angiography, anesthesiology are ready and available where it can be used at a moment's notice."

Specially trained staff must be available 24 hours a day. Grady's shifts included two board-certified surgeons, seven or eight residents, nurses and support staff. Other medical specialties, such as orthopedics and neurosurgery remain on call.

Atlanta's Grady Memorial Hospital is one of Georgia's premiere trauma centers  

On a average day, Grady's emergency room is staffed with between 10 and 15 people. When word of the shooting reached the hospital, it was in the middle of a shift change, so there were close to 40 trauma team members present.

"Depending upon the discipline that the physicians are in -- we will train them according to that discipline," said Haley. "So the emergency medicine physicians will go through a three-year training program, the surgery resident will go through a five-year training program."

Level-one trauma centers deal with gunshot wounds, motor vehicle accidents and burns.

Grady's resources were tested in July 1996, when victims of Atlanta's Olympic park bombing were transported there. Recently, several Heritage High School shooting victims in suburban Rockdale county were treated at Grady Hospital.

"We are used to sort of a high volume of trauma," said Haley. While treating the shooting victims, the center continued to handle other emergencies in a routine manner.

Minutes, even seconds, are critical

Trauma surgeons agree that an equally important part of emergency response is the 911 system. It began as a central, easy-to-remember number, that would provide quick, highly trained medical response.

Paramedics "scoop and run" in a trauma call. The idea is to get the patient to the trauma center as quickly as possible, without wasting time at the scene. That way, patients can get the specialized attention they require. Paramedics are especially mindful of "the golden hour."

The "golden hour" concept began during the Korean War. Doctors noticed that soldiers' survival rates improved greatly if they were treated within an hour after being wounded.

So essential is that time frame, that some trauma surgeons even refer to a "platinum half hour." This is reserved "for patients who are at the extremes," said Grady's Dr. David Feliciano, "and really need immediate resuscitation in the emergency room."

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