Advanced First Responder and Medical Capabilities Could Save Lives

When someone suffers severe injury, a few hours, several minutes - sometimes mere seconds - are all that separate life from death. And that depends on how long paramedics take to arrive on scene, assess the extent of injury and take the victim to the nearest medical facility.

When the injury is too serious for a standard emergency room, patients are treated at one of several hundred trauma centers in the United States - centers with advanced medical and surgical capabilities.

If such an incident occurs in or near south Florida, the victim is taken to the Ryder Trauma Center at the University of Miami/Jackson Memorial Medical Center. Certified as a Level I trauma center - the highest ranking - Ryder is the first, and often last, chance for addressing catastrophic wounds before it's too late.

Not only do the Ryder Trauma Center's doctors and surgeons save lives day in and day out, but they also perform scientific research and test technology that could lead to dramatically increased efficiency during triage in a mass casualty incident - preserving time, resources and lives.

Life-Saving Technology
The Ryder Trauma Center's doors are open 24/7, and it houses a top-notch team of surgeons ready to care for those rushed in by ambulance or helicopter. Having served the public since 1992, Ryder physicians see about 4,000 admissions annually. Thirty percent are victims of gunshots, stabbings or falls; and 70 percent are victims of blunt trauma, vehicular accidents and various other causes. In addition, doctors at the facility train Army forward surgical teams for deployment in Iraq and Afghanistan.

When it comes to administering patient care, Ryder has a whole different set of technologies in play, many of which could influence how triage is conducted.

The word "triage" is derived from the French verb "trier," which means "to sort." In the medical world, triage refers to how medical professionals decide who gets treated and in what order.

"There's a whole list of items we look for," said Hugo Rodriguez, chief of emergency medical services for Miami, about triage criteria that first responders use at trauma scenes. "Let's say they have no radial pulse - that's an automatic trauma center [criterion]. And we're dealing with injuries, obviously, as opposed to just medical problems. So if you have a penetrating injury to the head, neck or torso, that's enough to take you to the trauma center."

Other criteria include paralysis, a heart rate higher than 120, amputation, second- or third-degree burns to more than 15 percent of the body and long bone fractures, Rodriguez said.

Ryder doctors study how heart-rate variability - the measure of beat-to-beat variations in the heart - affects triage in the field and diagnostic care in the operating room. Dr. Kenneth Proctor, Ryder's scientific director of research and a professor of surgery, anesthesiology and biomedical engineering at the University of Miami, leads this area of investigation.

"When the helicopter lands at the site of injury, [paramedics] slap leads on the patient and start measuring heart-rate variability," he said.

Leads are insulated electrical conductors connected to heart-rate monitoring devices. One end of a lead has a pad that's placed on a person's chest to measure the heartbeat, and the readings travel through the wiring to the monitor.

"We're asking the question, ‘Can heart-rate variability be used to assess the severity of [trauma]? Can it be used as a triage tool?'" Proctor said. "Then once the patient arrives at the hospital, we're asking a separate question of whether heart-rate variability can be used to assess the severity of traumatic brain injury."

Heart-rate variability has the potential to save time, money and manpower if used to triage accident victims: A paramedic on the ground could read