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Morning News

Survive Your Drive: Paramedics and Trauma Teams Provide Heroics to Those with Trouble on the Roadways

Aired August 25, 2000 - 11:00 a.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

DARYN KAGAN, CNN ANCHOR: We will start talking about something that affects everybody who gets in a car. It is summertime, still, when millions of vacation travelers take to U.S. roads, and that fact calls to minds the danger that lurk around every curve and the continuing efforts on many fronts to divert those dangers.

CNN is spending this entire day showing you how to stay safe on our roadways.

And Jeff Flock has been with us all morning long helping us to do just that. He is joining us from Maywood, Illinois, showing us some of the heroes that help those of us that might get in trouble on the roadways.

Jeff, good morning once again.

JEFF FLOCK, CNN CORRESPONDENT: Good morning to you, Daryn.

Indeed, we are at Loyola Medical Center. We have got our cameras are over this medical center today, both here, outside, as well as inside, watching the trauma care professionals that provide such good service.

One of the key things they do here at Loyola is they train the people that provide the care. This is paramedic training, we are going to get demonstration of paramedic training this morning.

Dan Carlasio (ph) handles the training here at Loyola. What are we watching as we speak right now, Dan?

UNIDENTIFIED MALE: Hi, Jeff.

What we ware seeing is a demonstration of what we call the rapid extrication maneuver. This maneuver helps get the victim, the crash victim out of the car, in a very quick way in times when the patient may be unstable or the scene may be unstable.

FLOCK: What they doing right now, as we speak?

UNIDENTIFIED MALE: They are taking the patient out of the car with a rapid extrication move. They have got the patient on the backboard, and they are making sure that the patient's cervical spine is immobilized, that the patient has got some oxygenation, that have assessed an airway, that they have got an assessment of the breathing parameters. And now they are making sure that she is all stabilized and moved as a unit.

FLOCK: Why is immobilizing her in this way so important?

UNIDENTIFIED MALE: Because we don't what's going on with the cervical spine and the back, In many cases, when there's a high speed car crash, the victim's spine is frequently injured, and we don't know because we don't have the X-ray capability in the pre-hospital world.

FLOCK: Now what's that I see over her face? is that some sort of a breathing apparatus?

UNIDENTIFIED MALE: Yes, that's a little oxygen mask, we are going to give her 100 percent oxygen by mask, and supplement her regular breathing.

FLOCK: The key, obviously, is to get her out of there as quickly as possible. That wasn't always your priority, right?

UNIDENTIFIED MALE: No, 30 years ago, we didn't do that, we kind of stayed and played on scenes frequently. Now, with today's modern paramedics, we want to move the patient out of the vehicle quickly, get him to the hospital, get him moved on to the trauma center.

FLOCK: I want to talk to a couple of your other instructors here about how these guys did, because I'm curious as to how they did in their training. But first, I want to give our viewers a sense -- some people had asked earlier, we gave some number on states with the highest crash rates, the most dangerous states to drive in.

We want to give you the other side of the coin, that is the states with the lowest crash rates. The way they measure it is crashes per 100,000 roadway miles. If we look at the numbers, it is Massachusetts on the top with only 0.8 crashes per 100,000 road miles. Next in line, New York, New Hampshire, Connecticut, California, some of the safest states, and New Jersey, all of those fairly safe places, at least comparatively to drive.

Now, I want to bring in Danielle Cortes, who was critiquing what the students were doing there. How did they do?

DANIELLE CORTES, PARAMEDIC INSTRUCTOR, LOYOLA UNIV. MEDICAL CENTER: Hey, Jeff. They did really well.

The lead paramedic made sure that he kept speaking to the patient, to make sure that her level of consciousness was still there. Also, they also made sure that they kept the C-spine intact, with means the cervical spine was kept in alignment.

MANN: This is a lot of pressure on a paramedic. They are the first on the scene. Paramedics are not doctors, but in some sense they are almost functioning that way out in the field, right?

CORTES: They are. When they go through their training they almost have to learn as much as a doctor would because we don't know what we are going to expect to see when we come on the scene. So we have to be prepared for anything that may be there when we get there.

FLOCK: And you are providing, the first line of providing this care, if you don't do your job right, then what they do back at the hospital doesn't make any difference, in some sense. You are the first line.

CORTES: We are the first line. So we need to make sure that we get in there, do everything right, and rule out everything so we get to the hospital, then everything can be done proper for the patient.

FLOCK: We are out of time. Thank you so much. Jeff, thank you.

Once again, just to remind our viewers, that this was a demonstration obviously, a demonstration of extrication techniques that they training at here at Loyola Medical Center, a level one trauma one. They see some of the worst of it here, and we've been watching all day.

Daryn, back to you.

KAGAN: Jeff Flock, thank you very much in Illinois.

After the crash victims come out of the wreckage, they have to go to the hospital emergency room for immediate care.

For a look at that end of the rescue, let's go to Jim Hill. He is standing by at UCLA Medical Center in Los Angeles. We are about to get a tour now of what happens in their trauma room.

Jim, good morning again.

JIM HILL, CNN CORRESPONDENT: Good morning, Daryn.

This is UCLA Medical Center, the trauma room, the life-saving room, if you will. This is one of 13 facilities around the county that deal with trauma patients.

We can go out side right now, about 30, 40 feet from where I am standing to the ambulance port. That is where about 90 percent of the patients who need trauma care arrive at UCLA Medical Center, typically accompanied by two paramedics who bring them into the trauma room.

The other method of arrival is about three floors above the trauma room, that being the heliport at UCLA Medical Center, the county operates three or four helicopters designed for emergency transport. The goal is to get someone into this trauma room within about 20 minutes so doctors like Marshall Morgan, the chief of emergency medicine, can do their job.

Welcome, doctor. Can you give us a rundown of some of the things that you use in this beautifully equipped room.

DR. MARSHALL MORGAN, DIRECTOR, EMERGENCY: Yes. I will start with the first thing that we usually access when we come into the room ourselves, which is before the patient arrives, which is this personal protection equipment. These lead aprons protect us from X-rays. We use impermeable gowns, face masks, and eye shields to protect us from body fluids, and these gloves serve the same purpose, and we wear these when we are working on patients here.

After a patient arrives, we become very concerned with assessing the patient and monitoring the patients' vital signs. This machine is a monitor. This is the one that we use to actually transport the patient out of here because this room is really only a way station on the pathway that these patients follow. They go to X-ray, they go to the ORs, they go to the ICUs, which are equally important, if not more so, in the care of these patients.

The parameters that we monitor, or the functions that we monitor are the electrocardiogram, the patient's electrocardiogram is continuously displayed on this machine, as they are cared for in here.

HILL: That is for the heart.

MORGAN: That is for the heart function. The blood pressure is monitored by this automatic blood pressure machine. It can be set to take the blood pressure every two or three minutes. And the blood pressure of heart rate are displayed here. This monitor's cardiac function as well.

This machine will give us a readout, a continuous readout of the patient's oxygen saturation of the blood, which monitors the pulmonary function. And so, these are the ways in which we keep track of the patient's vital signs.

HILL: Now, breathing, of course, is critical. This is quite a sophisticated machine to help the patient actually breathe.

MORGAN: Right, this machine will actually breathe for patients. It is a ventilator, so called, and we use this machine to provide breathing for patients who we have already control their airway and intibated for a need to control their airway or to breathe for them.

HILL: Now, you have some manual devices which do basically the same thing. Can you tell us a little bit about these?

MORGAN: Yes. Well, this is the preparatory work that we do, this is a bag valve: mask apparatus, we can actually breathe for the patient without intibating them by using this mask. These tubes are designed to fit into the windpipe. Once the tube is in there, we have complete control of the airway and can breathe for a patient.

Probably 25 percent of our patients need to have this tube put in. When we put the tube in for a patient, we sedate the patient, paralyze the patient. Use this device, which is called Loringus (ph) scope to look down into the mouth, through the mouth really, on to the windpipe, and then put the tube in place.

And then we attach this to the tube, and use it to actually breathe for the patient, until the patient has been stabilized, and we put them on the ventilator. HILL: Now, as I understand it, many trauma patients suffer a lot of blood loss, fluid loss, and so forth, and this machine here is capable of putting, what, up to a liter of fluid into a patient in three minutes.

MORGAN: Yes, and doing so repeatedly, not only does it put in the fluid rapidly, but it warms the fluid in this warm water bath on the way in, which is very important as well.

The way this thing works is that the fluid bag is put into this compartment, this face plate is closed, the bag is trapped in here, and then we turn on this little inflatable device, which actually pushes the fluid through this rather large IV tubing into the patient.

HILL: OK. Let's move over here just a moment, by the table itself.

Can you give us a quick rundown of, typically, what happens when a trauma patient is wheeled through the door and placed on the table?

MORGAN: Certainly. The first thing that happens all happens before the patient get here, and that is our team is assembled from all over the hospital. We will have as many as five to seven physicians, depending on the case, respiratory therapist, X-ray technologist, there will be a radiology next door to read the films, three or four nurses in the room. And so there are a bunch of people in here waiting for the patient when the patient arrives.

The patient then is wheeled through that door by the paramedics and is brought right up here on their gurney, or wheeled cart. And we will move the patient over on to this bed. At that time, while the paramedics are telling us their story of what happened in the field, as they know it.

At this point, we will have a couple of physicians on this side, a physician here managing the airway, a lot of people talking to the patient, doing things to the patient. And the things that we are doing include cutting off the clothing, taking X-rays, putting in IV lines, putting in catheters. It gets pretty busy in here at that point. And we just sort of work from there.

If the patient's airway needs controlling, we will then give the patient drugs for sedation and paralysis and go through this airway procedures that I described.

At the time, usually within a few minutes, we have a pretty good idea of what is going on.

HILL: Let me ask you, at this point, how critical is the time to all of this? and how much time would have gone by in which the things that you have just described took place?

MORGAN: The time is quite critical. Patients who have trauma usually die, if they are going to die, because they are bleeding. And there are two things that have to happen, one of them is that we have to figure out where the bleeding is. It can be into the head, causing neurological problem, into the chest or the abdomen. We figure that out, and then we decide whether there is so much bleeding that it needs to go to the operating room right away, or whether we can take some time, go to the X-ray suite, do CT-scans and figure out exactly what is going on, before the surgeons work on the patients.

HILL: All right, very good. Thank you very much, Dr. Morgan.

A little bit later we are going to talk to a young man, a 6-year- old boy, who very nearly died and was saved. He owes his life to a trauma suite very similar to this one, but that will be coming up later.

I'm Jim Hill, CNN, reporting live from Los Angeles.

KAGAN: Jim, thank you very much.

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