FOCUSED ON EXCELLENCE
2 0 1 0
T R A U M A
R E P O R T
left: For patient transfers,
Harborview partners with
Airlift Northwest and other
medical transport agencies.
right: Mark Taylor, R.N.,
is Harborview’s trauma
program manager.
DEAR COLLEAGUES,
We invite you to read Harborview Medical Center’s 2010 Trauma Report. Our trauma program is
best portrayed through the voices of our patients and families. Meet Lily James, a child who fought
courageously to survive after a boating misadventure; Lorrie Jones, who will savor more days with
her grandchildren; and Derrick Roland, who again can pursue his dream to play pro basketball.
Three other vignettes highlight how we improve trauma care through research. Together, they
illustrate the scope and quality of care we provide as the only Level I adult and pediatric trauma
and burn center in Washington, Alaska, Montana and Idaho. In 2009, our Emergency Department
managed more than 80,000 visits; 5,647 involved patients with major injuries and hospitalization.
From the operating room to the bedside, our UW Medicine physicians, nurses and staff save lives
and restore patients to their fullest potential. Mark Taylor, R.N., our trauma program manager, works
to recognize and continually improve best practices at Harborview for trauma-related care. Our
Harborview Injury Prevention and Research Center investigators pursue the same goal, sifting data
for clues about the causes of injury with an eye toward prevention. They work with peers nationwide
to improve care by translating research into clinical practice.
We gratefully recognize the unsung heroes of trauma care in the prehospital setting — the
individuals who staff Medic One, urban and rural ambulance units and other emergency medical
services agencies, and Airlift Northwest. Your poise in difficult circumstances makes your work that
much more admirable. We also value the insights of regional emergency health-care professionals.
By using UW Medicine’s 24/7 Transfer Center, you save valuable time, preserving the “golden hour.”
No one expects to land in Harborview’s trauma unit, but
everyone who does — people like Lily, Lorrie and Derrick —
experience our dedication to excellence. Thanks for your
commitment to Harborview Medical Center and to the highest
quality trauma care.
Sincerely,
Eileen Whalen
Executive Director
Dr. Gregory “Jerry” Jurkovich
Chief of Trauma Services
PATIENT STORY | LORRIE JONES
It was a week before Christmas 2009. In
Covington, Wash., Lorrie Jones planned to
take her grandkids to dinner but struggled
to find the parking brake in her son’s Dodge
Durango. She was half in, half out of the
rig when its 4,600 pounds started rolling
backward. She tried to stop it by bracing her
left leg but in a moment her 115-pound frame
fell under the wheels.
“I heard cracking,” Jones, 64, recalled. “I will
never forget that sound.” The results were
severe: a crushed femur, multiple pelvic
fractures, eight broken ribs, a broken mandible
and internal bleeding.
The five surgeries Jones underwent that week
not only brought her back from the brink, they
also gave her the opportunity to recapture her
active lifestyle.
“My first memory is my daughter telling me
I’m going to make a complete recovery,” she
said. “That seemed strange because I hadn’t
determined yet that I wasn’t having a bad
dream.”
When she realized she was at Harborview, in
the care of UW Medicine, she was grateful.
“The nurses never left my side,” Jones
said. “I felt so safe. Teams of doctors telling
me what had happened, explaining my plan of
care and answering my questions. The team
constantly inquired about my well-being, my
pain level, asking if there’s anything more they
could do. I was cared for as well as I could
imagine any institution caring for a person.”
Jones started bearing weight on her left leg
three months into a slow, steady recovery. She
longs to return to the movement of yoga.
A L L T R A U M A PAT I E N T S B Y I N J U R Y S E V E R I T Y
S C O R E ( I S S ) higher number indicates greater severity
2007
2008
2009
<9
1,295
1,306
1,459
9 to 15
2,249
2,113
2,024
16 to 24
1,075
974
997
25 to 40
948
962
910
41 to 49
129
118
128
50 to 74
121
85
70
75
41
49
36
Asphyxia/suffocation,
drowning, electrical injury
18
14
23
5,876
5,621
5,647
Total Admissions
Harborview
is the region’s
only center
qualified to
care for the
most severely
injured
patients.
A L L T R A U M A PAT I E N T S
B Y H O S P I TA L D I S C H A R G E
S TAT U S : 2 0 0 9
Lived
5,417
Died
230
Total Admissions
“Every day is better. Every day I am stronger.
Every day I am able to do more,” she said. “It’s
been quite a journey.”
5,647
Our 4 percent
trauma mortality
rate is lower than
the 6.97 percent
rate nationwide.
MEDICAL DISCOVERY | DR. DOUG ZATZICK
Adolescents are a high-risk age group for
traumatic injury. Research suggests that, as
with adults, teens injured via assaults or risky
behavior, such as alcohol use or reckless driving,
are more at risk to develop depression and
post-traumatic stress disorder (PTSD). These
conditions can draw them into isolation and push
them toward more risky behaviors.
A L L T R A U M A PAT I E N T S B Y M O D E O F
A R R I VA L : 2 009
Helicopter
1,019
Fixed-wing plane
555
Ground advanced life support unit
Ground basic life support unit
1,795
996
Private vehicle, police, self
1,282
Total Admissions
5,647
P E D I AT R I C PAT I E N T S B Y
T Y P E O F I N J U R Y: 2 0 0 9
Blunt
570
Dr. Doug Zatzick, medical director of
Harborview’s consultation liaison psychiatry
service and a UW Medicine professor of
psychiatry, is testing a two-pronged intervention:
1) Using cognitive behavioral therapy to help
the adolescent address the injury’s frightening
context and resulting anxiety; and 2) Connecting
the adolescent with a primary-care provider who
can continue therapy during follow-up meetings.
The goal is to reduce PTSD symptoms and
post-injury risk behaviors by making intervention
the norm at Harborview. Zatzick would then work
to test the model on a national scale with other
trauma centers.
“We are seeing the injury itself as a teachable
episode,” he said. “The child has suffered a major
injury, so there’s time on the inpatient ward to
reflect. We establish a collaborative relationship
with an empathic care manager who comes to
the bedside, meets you, asks if you’re in pain,
meets your family, and goes with you to an
outpatient appointment.
Asphyxia/suffocation,
drowning, electrical
injury
261
“A lot of kids acknowledge their vulnerability in
a way they haven’t before, and that the help is
useful.”
Total Admissions
901
The intervention more firmly links Harborview’s
clinical care with a teen’s primary care provider or
community services during recovery.
Penetrating
70
In 2002, we helped establish
Injury Free Coalition for Kids of
Seattle to reduce childhood injury
in south-central Seattle.
“Even if we are not successful with 100
percent of these kids, this type of post-injury
psychosocial support is much better than what
happens with conventional care,” Zatzick said.
P A T I E N T S T O R Y | L I LY J A M E S
At age 6, Lily James had a double black
diamond (expert) ski run in her rearview mirror.
She was preternaturally athletic and destined to
race, said her dad, Greg.
At age 7, as Lily struggled to turn on a junior
slope, Greg and his wife Carol recognized their
daughter’s other virtues: Grit. Perseverance.
In July 2009, between those two ski
seasons, Lily’s legs were crushed near the
ankles and her right foot nearly severed.
While boating on Lake Washington, the family
towed Lily and her brother on an oversized tube.
On the way home, a gust pulled the tube from
its cleat and into the air. Its line caught Lily’s legs
and yanked her overboard. Carol dialed 9-1-1.
Greg pulled Lily back into the boat.
“I didn’t think she would have her right foot
by night’s end,” he said. “It was amazing to
hear they were able to reattach it. I had no idea
about Level I trauma centers and how Harborview
handles so many difficult cases. We were lucky to
land there. We were in very good hands.”
Dr. Nicholas Vedder, UW Medicine chief of plastic
surgery and a microsurgery specialist, and
colleagues repaired Lily’s broken bones and kept the right foot
alive by restoring blood flow with two vessel grafts from her
upper leg. In a subsequent procedure, Vedder transplanted
one of her latissimus muscles to replace tissue around Lily’s
right ankle.
“She is the most courageous patient I have ever treated,” said
Vedder, inspired by Lily’s upbeat attitude during her monthlong stay at Harborview.
Lily has more surgery ahead but has come far, fast.
“She gets around pretty well,” her dad said proudly. “I admire
her toughness.”
P E D I AT R I C PAT I E N T S I N J U R Y S E V E R I T Y S C O R E ( I S S )
In collaboration
with Seattle Children’s,
Harborview was
designated as a Level I
pediatric trauma center
in 1995.
2007
2008
2009
<9
330
364
362
9 to 15
301
277
268
16 to 24
140
140
120
25 to 40
92
123
114
41 to 49
11
10
12
50 to 74
13
10
11
75
5
6
2
Asphyxia/suffocation, drowning, electrical injury
2
3
12
894
933
901
Total Admissions
PATIENT STORY | DERRICK ROLAND
The firecracker-loud snap of Derrick
Roland’s right tibia and fibula and his leg’s
resulting contortion brought grimaces to fellow
hoopsters and thousands of spectators at UW’s
Hec Edmundson Pavilion.
Roland, 21, a superbly conditioned athlete at
Texas A&M University, had landed awkwardly
after attempting a basket. No collision, just a
freak accident.
“I remember hitting the ground and a
burning sensation,” Roland said. “Seeing
people’s reactions in the crowd, I knew that I was
going to have surgery.”
A L L T R A U M A PAT I E N T S T R A N S F E R R E D T O
H A R B O R V I E W from other acute-care facilities
2007
2008
2009
2,768
2,643
2,562
Alaska
96
104
108
Montana
86
81
78
Idaho
34
32
39
British Columbia
14
8
12
Other
60
64
63
3,058
2,932
2,862
Washington
Total Transfers
A L L T R A U M A PAT I E N T S B Y T Y P E O F
I N J U R Y: 2 0 0 9
4,273
Penetrating
578
Asphyxia/suffocation, drowning,
electrical injury
796
Total Admissions
“I met Dr. Wahl just before my surgery,” he said.
“I remember him saying I was in good hands. He
did a great job repairing my leg.
“I’m in rehab three times a week and continue
to get stronger. I started walking without a boot
faster than anybody expected. Doctors here are
amazed at my progress and the job Dr. Wahl
did.”
UW Medicine’s 24/7 Transfer
Center coordinates urgent and
emergent patient referrals.
(888.731.4791)
Blunt
That was Dec. 22, 2009. Four months later, back
home in College Station, Texas, the senior was
running on a treadmill, with physical therapists
marveling at his unusually fast recovery. Roland
credits UW Medicine orthopedic surgeon Dr.
Christopher Wahl, an expert in high-energy
sports injuries, for keeping intact his dream of
playing pro basketball.
5,647
Our penetrating-trauma volume
is relatively small compared
with other major urban trauma
centers.
Roland was fortunate to land at Harborview,
said Wahl, who is trained in both sports medicine
and trauma. Surgery was under way in about 90
minutes — important because the incidence of
infection in open fractures correlates directly with
the time between injury and surgery, he said.
Roland said: “You grow up and realize that things
in your life happen for a reason. You just have to
embrace it and overcome the adversity.”
That attitude bodes well for Roland’s recovery,
Wahl said.
MEDICAL DISCOVERY | DR. RON MAIER
Intensive care units have long struggled to
comprehend why trauma patients with essentially
the same injury and same care can have such
divergent outcomes: Some heal as expected, or
better; others develop inflammation, infection or
other complications.
“It became logical to assume that a major driver
is an individual’s genomic response to injury,”
said Dr. Ron Maier, Harborview’s surgeon in chief
and UW Medicine professor of surgery.
Harborview is in the eighth year of a 10-year
grant studying the effects of genetics on
recovery after a traumatic injury. The grant
involves multiple U.S. trauma centers and
crosses medical disciplines.
“When you understand the genetic changes
happening in an individual patient, it truly
does become personalized medicine,” he
said. “It greatly increases the chances that a
treatment will benefit the patient, and it avoids
patients going through unnecessary risks if you
know that the treatment likely will not help them.”
A major injury significantly changes how genes
express proteins — whether they express more,
heightening inflammation and risk of organ
P E D I AT R I C T R A U M A PAT I E N T S B Y
H O S P I TA L D I S C H A R G E S TAT U S : 2 0 0 9
failure, or express less, lowering an individual’s ability to fight
infection, he explained. These changes affect two-thirds of
a person’s genes, which, in time, return to their normal state
during recovery.
“Right now to plan treatments we have to walk the line between
inflammation and infection with incomplete knowledge,” Maier
said.
“Through the study, we have found patterns of gene expression
among patients that go on to poor outcomes versus good
outcomes. We’re putting together selective panels of changes
that we hope will be predictive of how the patient will respond
to an injury and allow us to monitor treatment effects.”
P E D I AT R I C PAT I E N T S ( 0 - 1 7 Y E A R S )
BY AGE
2007
2008
2009
<6
363
384
399
6 to 11
135
180
169
Lived
Died
892
9
12 to 14
150
128
125
15 to 17
246
241
208
Total Admissions
901
Total Admissions
894
933
901
The 1 percent mortality rate,
unchanged over recent years,
reflects kids’ resilience and our
pediatric trauma expertise.
Dr. Brian Johnston, our chief of
pediatrics, directs the editorial
board of the international journal
Injury Prevention.
Box 358046
815 Mercer Street
Seattle, WA 98109
www.harborview.org
LEARN MORE about our patients
and medical discoveries online.
w w w. uw me d i ci ne . org / traum a
MEDICAL DISCOVERY | DR. SAM ARBABI
“I’ve fallen and I can’t get up” is more than a generational
catchphrase. It depicts the aging U.S. populace, whose
numbers are increasingly hurt in falls. What’s more, bloodthinning agents taken by millions with cardiovascular conditions
can pose peril to a benign-looking bump on the head.
“The patient usually arrives with a minor trauma, but when
someone is anticoagulated, the blood accumulates in the
brain and a patient can die in a few hours,” said Dr. Sam
Arbabi, acute care chief at Harborview’s Injury Prevention
and Research Center and UW Medicine associate professor
of surgery.
Quickly restoring patients’ coagulation reduces mortality
and leaves survivors with better cognition. Arbabi is leading
a statewide study monitoring anticoagulated patients who
receive care after traumatic events.
A L L T R A U M A PAT I E N T S B Y A G E
2007
2008
2009
648
692
693
15 to 25
1,179
1,113
1,032
26 to 35
881
806
812
36 to 45
894
802
730
46 to 55
863
835
827
56 to 65
565
552
665
> 65
846
821
888
5,876
5,621
5,647
< 15
Total Admissions
Our aging populace is more at risk of falls
and resulting intracranial bleeding, which
can cause death or impair cognition.
Fast recognition of the bleeding danger and
treatment are paramount. That likely means condensing
the steps that lead to administering a reversal agent,
specifically the clinical exam, diagnostic workup and the
order of the agent – usually frozen plasma, which may
need 90 minutes to arrive from the blood bank and thaw,
Arbabi said.
“Before we implement changes, we need data to
show how long it takes now,” he said. “If we can show
physicians that a patient’s treatment was four hours when
it should have been two, changes start to happen.”
Arbabi also has worked to get the state’s Washington
Trauma Registry to identify anticoagulated patients in its
database so physicians can recognize danger sooner in
such cases.
“We think we can significantly lower mortality,”
he said, “but my focus is not only mortality. We want to
affect cognition, so if a patient arrives as an independent
person, they have a better chance to become
independent again.”