by Charles M. Murray
In the middle of the night, a medical concern may arise for a loved one, and someone decides to call for help. When an emergency strikes, we call 911. We may not give much consideration to which hospital we need; we just know a loved one needs to be seen by a medical professional.
Please keep in mind that not all hospitals are the same, and we have to be mindful of these limitations. For example, a rural hospital may have one doctor in the Emergency Room, but no other doctor is in the building until an emergency strikes. Other doctors are on call, and it takes time to assemble the team.
A trauma center is a special designation that only some hospitals will achieve. It is ready to handle patients suffering from major traumatic injuries. The highest level of designation is a Level 1 and the lowest is a Level 3. The highest levels will have specialized medical and nursing teams across multiple fields such as emergency, trauma, critical care, neurosurgery, cardiology and orthopedics. These centers have advanced radiology and anesthesiology staff and the highest sophistication of surgical and diagnostic equipment.
On the other hand, a major hospital may not be as ready for crisis as we expect. The Plain Dealer reported in October 2016 that although some major hospitals, including one in Cleveland, have some of the finest surgeons in the country handling complex cases, these same surgeons are not fully prepared for crisis events. Because the staff schedules and prepares for surgery on a regular basis, they are equipped to have everything go smoothly. So they are now preparing with simulations, just in case.
It is important to think about a plan BEFORE a crisis occurs. Is the closest hospital the best hospital to handle the situation? Should we insist on having the loved one transferred to a higher level of acuity? Lower level centers may be able to stabilize someone, but we need to think about transferring to the next level right away.
We should also have emergency medical papers such as health care power of attorney forms available before the need arises. We should discuss expectations with doctors and family members, so that we have the best opportunities for reducing anxiety and confusion. A great book on the subject is Being Mortal by Atul Gawande.