Rawhide Down_ The Near Assassination of Ronald Reagan - Del Quentin Wilber [56]
As Giordano discovered, GW was no different. He spent a few weeks observing the ER and saw inexperienced interns leading inefficient medical teams. Chains of authority were conflicting and confusing. Care was often slow and haphazard. And when badly injured patients received inadequate treatment, follow-up was so lacking that it was nearly impossible to identify mistakes and assign responsibility.
His research taught Giordano that saving the lives of trauma victims required speed and coordination among doctors and nurses, and that this was particularly important in the effort to prevent the onset of shock, an insidious and deadly condition. A seriously injured person often bleeds profusely; blood flow to organs is reduced, and with it the oxygen supply. Deprived of oxygen, the heart, lungs, kidneys, and liver fail. Doctors had only recently discovered that they could reduce the impact of shock and save more lives by pumping patients full of fluid and blood and surgically stopping the bleeding. Only then, after stabilizing a patient’s blood pressure and eliminating heavy bleeding, should a trauma surgeon repair damaged organs and tissue. Gradually it became clear that if doctors prevented shock from setting in during the hour after a serious injury—a window of time that became known as the golden hour—survival rates improved dramatically.
Giordano wanted to observe this new approach to the treatment of trauma victims in action. Fortunately, a hospital in Baltimore, only thirty-nine miles up Interstate 95, was breaking new ground in trauma care. Officially called the Maryland Institute for Emergency Medical Services but more commonly referred to as Shock Trauma, the hospital was founded and run by R Adams Cowley, an innovative surgeon who was waging war on shock. With Cowley’s permission, Giordano spent a month in 1976 working at the state-of-the-art trauma center.
He was deeply impressed by the speed and precision of the center’s doctors and nurses, and by their comprehensive approach to treating patients, many of whom arrived in state police helicopters. As soon as a patient entered Shock Trauma’s assessment and resuscitation area, a team of experienced doctors and nurses went to work, inserting three IV lines—not just one—and delivering as much fluid as possible to stabilize blood pressure and prevent shock. The medical crews didn’t wait to type blood; they loaded patients full of universal-donor blood. X-rays were taken by a machine parked in the emergency room, not one down the hall in the radiology laboratory. Prepackaged kits for specific procedures lined the shelves, shaving precious seconds off response times. Shock Trauma’s mantra was to treat first, definitively diagnose later.
With the help of Craig DeAtley, an energetic twenty-six-year-old physician’s assistant, Giordano turned around emergency care at GW. He created specialized trauma teams, which consisted of doctors and nurses who already worked in the hospital. He established strict treatment protocols and gave surgeons and anesthesiologists pagers so they could respond promptly whenever they were needed in the ER. And because the Baltimore hospital received many more patients than GW, he mandated that every one of GW’s surgical residents spend a three-month rotation at Shock Trauma to learn how the system worked and to sharpen their skills.
Giordano and DeAtley also overcame opposition from some doctors in other departments who feared losing turf; they faced down skepticism from cost-conscious administrators at the George Washington University Medical Center, which oversaw the hospital, the university’s medical school, and the staff who worked at both of them.