'Time is of the essence': A look into how Wilmington Hospital's trauma center is run

Editor's note: The title for Dr. Mark Cipolle has been updated. 

When the trauma code sounds in the halls of Wilmington Hospital, a survival clock starts ticking.

Timing is everything when trying to save the life or limbs of a patient who might have been shot in Wilmington or severely hurt in a car crash on I-95. 

If ICU beds aren't available, if a surgeon hasn't been located, if an operating room isn't empty — it could be a matter of life or death. 

Christiana Care's Wilmington Hospital has been designated a level III trauma center for almost six months, meaning it can assess, resuscitate and perform surgery and other intensive care on injured patients.

The hospital spent 18 months working in a level III capacity before officially winning the title. Prior to that, it was a level IV trauma center, meaning it would stabilize patients and move them to a higher level center.

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The impact of the change on the Christiana system and its patients was immediate. Wilmington Hospital assessed about 1,000 trauma patients in the past year, almost double of what officials expected.

About one-third of the patients stayed at Wilmington rather than being transferred to Christiana Hospital in Stanton, the state's only level I trauma center for adults. That rating requires hospital keeps doctors of all kinds available 24 hours a day to treat emergencies.

"Time is of the essence," said Christiana Care COO Sharon Kurfuerst. "If we could provide that service more timely, it made sense to move toward Level III."

Here's what happens when a trauma patient is coming.

When the hospital is alerted that a trauma patient is coming, a page sounds on the overhead speakers in the hospital hallways. In most cases at Wilmington Hospital, trauma patients suffer serious injuries from a car crash, gunshot or fall. 

A trauma surgeon must be at the hospital within 30 minutes of the page. Intensive Care Unit beds need to be open. An operating room is required to be available around the clock.

COO Kurfuerst said Christiana Care didn't need to physically change the hospital when it decided in 2015 to become a level III trauma center. As early as 2009, the hospital system envisioned Wilmington Hospital becoming a level III center. That was when construction began on an emergency room redesign and the expansion of its south tower.

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Most of the changes were built around a redesign of hospital's workflow so that care is done quickly and efficiently. Sometimes, this meant nurses and doctors practiced on cardboard patients, Kurfuerst said. 

She said it also helped the hospital that many of its physicians and nurses also work at the level I trauma center in Stanton. 

Still, the trauma upgrade was a "big leap" for the hospital, said Linda Laskowski-Jones, vice president of emergency and trauma services for Christiana Care.

"You're going to keep the patient unless they require the resources of a Level I," she said of the new responsibilities. "It's not just the ED. You're talking about an entire hospital framework." 

As soon as a patient comes through the doors, the EMT or paramedic talks to the triage nurse about the patient and what his or her injuries are. In most cases, the ambulance has called ahead and the patient is taken directly to an emergency department room, said Mary Lamborn, trauma program manager at Wilmington Hospital.

The patients' injuries are then triaged, which is a way of ranking the importance of what needs to be treated first, with maintaining the ability to breathe and stopping any bleeding ranked at the top of the list. Part of that is determining whether the patient should be cared for at Wilmington Hospital or needs to be transferred to Christiana Hospital. 

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What are their injuries and where are they located, the nurses and doctors will ask.  What are their vital signs? Are they alert?

Patients are often transferred to Christiana Hospital if they require neurosurgery or complex orthopedic surgery, officials said. 

Dr. Mark Cipolle, director of outcomes research for the surgical service line at Christiana Care, said CAT scans have changed the way trauma surgeons perform medicine because they are "amazing images from head to toe to figure out what's wrong with you."

"When I was a resident, if you had a scratch on your liver and blood in your abdomen, you had an operation," he said. "Now we can look at the CAT scan and see your liver has a small laceration and watch you closely. Same with the spleen and other organs."

Another "revolutionary" advancement is how interventional radiologists can insert a catheter into a person's artery to locate bleeding and stop it, Cipolle said. 

There are times when Wilmington Hospital doctors and nurses decide to transfer a trauma patient to Christiana Hospital hours after the patient has been admitted. This might be because of the complexity of the case or the worsening of a patient's condition.

When this happens, the hospital might dispatch its helicopter to transport the patient. The flight crews — who consist of a nurse, paramedic and pilot — are available at all hours of the day. They also go to accidents, often landing on highways or in backyards.  

It takes two minutes to get to the Delaware-Pennsylvania state line in the helicopter, and the crew can get to Christiana Hospital in about five minutes, significantly faster than the 20- to 30- minute drive.

When a patient must be transferred, he or she often is not conscious.

The trauma staff will push the patient's stretcher about a dozen or so yards to the elevator, where they'll go up 10 floors to the helicopter pad. The flight nurse and paramedic will meet them to help secure the patient in the helicopter. 

Though compact, the helicopter is a "flying ICU," said Gary Bollinger, a flight nurse. It's equipped with a stretcher, ventilator, heart monitor, IV drips and 45 different medicines. 

When it lands, the flight nurse and paramedic open the back of the helicopter and roll the patient to the hospitals' nurses and doctors.

When they'll head back to Wilmington Hospital to see if anyone else needs help. 

Contact Meredith Newman at (302) 324-2386 or mnewman@delawareonline.com and on Twitter @MereNewman.