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How a Trauma Center Prepared for Older Patients

NEW YORK (Jun 3, 2013)

The trauma center at NewYork-Presbyterian/Weill Cornell Medical Center is prepared for any patient who has sustained serious or life-threatening injury. Among them are dramatic cases that receive media attention such as the window washer who fell over 40 floors and survived and the person who fell from the Queensboro Bridge. Both of these patients, and thousands of others, owe their lives to the trauma center doctors and nurses.

Neal E. Flomenbaum, M.D.
Neal E. Flomenbaum, M.D.

But a large number of the victims of serious, life-threatening trauma brought to NewYork-Presbyterian/Weill Cornell are elderly patients who have fallen in ordinary places such as stairways and sidewalks. "We have a very large elderly population in our community who are active and that has put an emphasis on a unique type of trauma in this center," said Neal E. Flomenbaum, M.D., Chief of Emergency Medicine at NYP/Weill Cornell. Treating older adults with traumatic injuries can be especially challenging.

"When the elderly fall and hit their heads, there is significant bleeding and morbidity/mortality, even if they are not on anticoagulants," said Dr. Flomenbaum. "The elderly have very little reserve – far less than younger persons – and that is why expert treatment is essential and can make all the difference."

Soumitra R. Eachempati, M.D.
Soumitra R. Eachempati,
M.D.

Dr. Flomenbaum said that the emergency medicine and surgery staff has treated so many geriatric trauma patients in recent years that they have developed a special expertise. The center offers advanced facilities to speed the evaluation process with immediate access to magnetic resonance imaging (MRI), computed tomography (CT), and emergency bedside ultrasound. Radiology attendings from the Division of Emergency Radiology, headed by Keith Hentel, M.D., are onsite 24 hours per day to offer expert interpretation of radiographic imaging. "In trauma, every second counts," Dr. Flomenbaum said.

One of the most important requirements for a trauma center is having highly-trained specialists readily available to provide treatment. "This is very complex now and requires specialists in many different areas," explained Soumitra R. Eachempati, M.D., Director of the Surgical Intensive Care Unit. "Fortunately, we are a full service academic hospital and have the best orthopedic surgeons, neurosurgeons, cardiothoracic surgeons, and radiologists available. Patient survival rate has increased markedly because the center has so many specialists from all disciplines to help coordinate care."

Elderly trauma victims tend to have more "comorbidities," that is underlying conditions, than younger victims and they may require immediate specialized treatment for those conditions that preceded the acute trauma. For example, in addition to broken bones, the elderly person who fell may also have a heart condition or dementia that requires expert medical attention even as the trauma injures are being addressed.

The center's team of available specialists/subspecialists, rapid 24/7 access to its own transfusion medicine department, heart center, burn center, and psychiatric emergency center help it offer comprehensive care quickly. "If someone has a heart injury, a surgeon from our heart center can come to the Emergency Department to help within 5 minutes," said Dr. Eachempati. "Some trauma patients need as much as 80 units of blood, which we can provide because we have our own transfusion medicine department. Other hospitals may not have 80 units of blood available in their entire hospital."

Editor's note: in the future, we will feature articles on the emergency departments at NewYork-Presbyterian's Columbia University Medical Center and Allen Hospital.

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