Season 4: Episode 3 It’s early in the evening on the Monday after Thanksgiving, and the Emergency Department at UC Health’s West Chester Hospital has been full since sunset.
Mondays tend to be busy, especially after holidays. Outside of the hospital, rain pours down, causing heavy traffic in the local area.
Sanjay Shewakramani, MD, medical director of the Emergency Department at West Chester Hospital and assistant professor of emergency medicine at the University of Cincinnati College of Medicine, ensures every patient receives the best treatment when they come to the Emergency Department.
“Our first goal is to get the patient feeling better, then to establish what is wrong,” said Dr. Shewakramani, or “Dr. Sanjay,” as he is known to patients.
Dr. Sanjay has already seen 15 patients since his shift started at 3 p.m. There’s a consistent flow of patients into the Emergency Department, all with varying symptoms and concerns. On average, Dr. Sanjay sees as many as 30 patients during his shift.
He is joined by two other physicians in the Emergency Department, along with a skilled team of residents and advanced practice providers who are ready to act at a moment’s notice. Dr. Sanjay effectively communicates to his team how they will manage the flow of incoming patients for the remainder of the night, and how they will respond if a trauma patient — someone suffering from severe, life-threatening injuries — is transported to the hospital.
Dr. Sanjay knows a trauma patient may arrive at any moment.
“You want to discharge or admit patients safely but quickly to keep the department as ready as possible for disaster,” Dr. Sanjay said. “You never know when you’ll get that call.”
At 5:51 p.m., Cassi Jeffers, RN, receives a phone call from a local EMS agency. A multiple car accident on Interstate 75 causes serious injuries to a 30-year-old female behind the wheel of one of the vehicles. EMS calls to give a heads-up that they’ll arrive in 15 minutes.
Cassi quickly tracks down Dr. Sanjay after he admits a patient to the hospital to have more testing.
“We are always prepared for moments like this,” Dr. Sanjay says.
In a matter of minutes, the trauma team springs into action. As a Level III trauma center, West Chester Hospital is equipped to quickly assess, resuscitate and treat injured patients through intensive care and surgery.
The trauma team at West Chester Hospital includes an emergency medicine physician, one trauma surgeon and multiple nurses and medics. On this night, D. Millar, MD, director of trauma, surgery and emergency surgery at West Chester Hospital, assists the team. There is a trauma surgeon on call 24 hours a day.
“There are no other small trauma centers in the region that can provide this level of care,” Dr. Millar said.
Dr. Sanjay and Dr. Millar huddle at 5:58 p.m. with the rest of the trauma team to develop a plan to treat the patient when she arrives. Because she was in a car accident, their biggest concerns are head injuries, potential blood loss and the possibility of hemorrhagic shock, or decreased oxygen delivery to the organs.
EMS transports the patient to the Emergency Department just before 6:05 p.m. With a plan in place, the trauma team rushes her into one of the trauma bays. Although she is alert, she is clearly in a lot of pain.
Dr. Sanjay relies on his Emergency Department team to keep a close eye on his other patients while he tends to the trauma patient. His colleagues don’t hesitate. Another physician and Dr. Sanjay’s physician assistant check in on each patient to ensure they still receive the best care, making them feel confident and comfortable. Dr. Sanjay knows every patient is in good hands with his compassionate, experienced team of physicians, advanced practice providers, nurses and medics.
“We have the best team,” Dr. Sanjay says. “Everyone is willing to step up and go the extra mile to ensure every patient receives the same superior level of care.”
The team continues to examine the patient at 6:10 p.m. She has a “strong palpable pulse.” Her pelvis is stable, but she experiences excruciating pain in her belly and sternum. Dr. Millar orders X-rays of the chest and pelvis. Her lower extremities are intact, but an ultrasound reveals that she is bleeding internally. She also suffers from hypotension, or very low blood pressure.
Dr. Sanjay comforts the patient by telling her she will be OK and asking her basic questions about her health and condition. He then walks over to review her X-rays with Dr. Millar.
“No one wakes up expecting to have to come to the Emergency Department. Recognizing that allows us to make the biggest difference on what is often the worst day of a patient’s life,” Dr. Sanjay says.
After she receives pain medicine, the trauma team wheels her into the operating room for an emergency procedure to evaluate the source of bleeding. She needs this surgery, but she makes a full recovery after spending a few days in the hospital.
The trauma team successfully treats the patient in a quick time to save her life in only a matter of minutes. Everyone on the team remains calm and communicates clearly. Dr. Sanjay returns to check on other patients in the Emergency Department.
“Trauma is a team sport. None of it can be done independently,” Dr. Millar said. “It’s really rewarding to come down and spend time with other really smart colleagues and very capable nurses — all with a common mission.”
As a team, physicians and clinicians at West Chester Hospital deliver the highest level of clinical care. They work closely with local community emergency services to ensure patients are easily transferred over to the hospital after an accident. Their collaboration allows for seamless transition with EMS providers so paramedics can answer more calls and rescue more victims.
“I’ve worked in a lot of hospital systems. At most places, people talk the talk but don’t walk the walk. Here, everyone is aligned to the same mission,” Dr. Sanjay said. “Decisions are always made in the best interest of the patient.”
