Dr. Kevin Most: Trauma

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Dr. Kevin Most

Each morning we turn on the news in Chicago and hear about another shooting death or another overdose. It is sad to hear about the loss of any individual and it is more troublesome when we hear the young ages of some of the victims. From a medical view what is concerning is the upward trajectory of the rate of both of these incidents. This past year homicides in the city of Chicago were well over 750 and approaching the record levels we saw in the 1990’s, many of those victims were innocent bystanders. The more concerning number is that we also saw 5,000 shooting victims this year as well. The view from the emergency rooms is also concerning. Often the victims of gunshot wounds are dead before they reach the Emergency Rooms. We know the impact these deaths make on the immediate family but we also have the secondary victims. The secondary victims are the caregivers who try to save the lives of these individuals in the ER’s across the city. The moral distress these nurses and doctors feel everyday can not be minimized. Sure it is part of their training but each one of these takes a toll on the caregiver.

We learned during the Civil War that having medical care on the battlefield saved lives. Even with the archaic treatment used back then, lives were saved because of quick care. Unfortunately we have had to view the city of Chicago like a battlefield. Recently two doctors in the Chicago metro area have stepped up to make an impact in this area. Dr Swaroop from Northwestern and Dr Tatebe from Good Samaritan have designed a program to teach first responders (often community members) what they can do immediately. The reason for this is that often a police officer or community member will be present prior to the paramedics and some basic medical training on slowing or stopping bleeding will make an impact and save lives. We talk about the second victim, these community members are also second victims, they arrive at the scene and they feel helpless as they don’t know what to do and thus feel they let the patient die.

These classes will not only educate and empower residents to provide lifesaving measures but also allows the course to discuss the impact of shootings and the community healing that also must take place. The first classes will be provided to local community groups in neighborhoods that have been impacted by these shootings.

Another trend in our communities is the impact of narcotics. Just last week we had the news of the high number of narcotic overdoses in Lake County. Deaths due to overdoses are also on the rise. This is partially due to the ease of obtaining narcotics both legally and illegally. Those of you who think this is only a problem for the inner city, you are wrong and you only need to understand what is happening in DuPage county to get a clearer picture. I will also tell you this is not a Chicago problem, this is a national problem with currently no end in sight. In Cincinnati a six day stretch in August of this year showed 174 heroin overdoses, this is a national problem. For scope, in 2014 there were 47,000 deaths due to drug overdoses, and since 2000 we have seen over 500,000 deaths from Opioid overdoses.

Going back to our theme of care delivered immediately on site versus hoping the paramedics get the patient to the ER in time, we have treatments that can now be given by the first individuals on the scene. We have a medication called Narcan. This medication can reverse the effects of an opioid in minutes. It does this by blocking the sites in the brain where the heroin or norco would bind. This drug has saved thousands of lives in the Chicago area alone. Until recently narcan was only allowed to be given by Paramedics. Allowing the police to carry and administer narcan has made a huge impact. In Dupage County alone over 100 lives have been saved by the quick use of Narcan by first responders in 2 years. Think about that for a minute, in one small county 100 lives were saved by simply training and allowing the first responder to give this life saving drug. Do the math and you can see how important it is to give this medication to the first on the scene. As Rich Jorgenson the DuPage County Coroner says “Individuals who die from overdoses don’t have addiction treatment as an option anymore”

For both of these situations, many may say these are social issues that must be dealt with. The medical community could not agree more but until that occurs we need to do everything we can to save the lives of those affected.

Let’s finish with a more uplifting example of how getting treatment in the community is making an impact.

We have discussed strokes and heart attacks multiple times in the past and the impact a stroke or heart attack makes not only on the individual but also the family and community. For those individuals having signs of a Heart attack in the past we would have paramedics place patients on a simple monitor that gave us little information. With Bluetooth technology now, we are able to have the paramedics send a full EKG to the Emergency room from the home. This allows the diagnosis to be made right in the home. This allows the cardiac team at the hospital to be called in and be ready, often waiting for the patient. The quicker we can open up the artery the more heart muscle we can save.

Probably one of the most exciting is the new mobile stroke units that are being started across the country. Currently there are 6 cities with Mobile Stroke Units, parts of the Chicago metro area will soon have this technology. So lets go thru this for a minute. Currently a patient thinks they may be having a stroke and 911 is called. The paramedics come to the house, start the care of the patient and then transport the patient to the Emergency Room. In the ER they are seen by a physician who exams the patient and then orders the CT scan. After the CT scan, it is read and the results are given to the ER doctor who now contacts the neurologist to discuss treatment options. Each minute the blockage impacts the brain the chance of recovery declines.

So with our theme of bringing the initial care closer to the patient, we will soon have Mobile Stroke Units in Western Suburbs. This unit is essentially a large ambulance. The unique thing about it is the CT scanner that is in the ambulance!! Now a patient who calls 911 with the symptoms of a stroke will have the Mobile Stroke Unit as well as a community based ambulance deployed to the home. If the patient is thought to be having a stroke, they will receive their CT scan in the driveway. The images will be sent wirelessly to the neurologist. If it is a stroke, the neurologist will tell the team caring for the patient to give the patient tPa, the clot busting drug that the patient needs. This process has been shown to decrease the time for treatment dramatically. These patients are then transferred to the hospital by the mobile unit, while receiving medication the entire way. The team to further treat the stroke has now been mobilized 45 min sooner and the patients definitive care is started well before they would have with the current process.

The cost for this unit is not inexpensive, the unit we will have in the Western Suburbs cost one million dollars and was covered through a philanthropic donation. Northwestern will be the first unit in the Chicago metro area with this technology. Rush will be following with a unit for the Oak Park area sometime in the next year I believe.

These examples just show us that bringing care closer to the patient makes a huge impact in their health.