Continuum of Care
Care of the trauma patient involves many departments and services. The descriptions below highlight the continuum of trauma care.
The Cedars-Sinai Medical Center Emergency Department serves as a Base Station for Emergency Medical Services (EMS) operations, providing on-line medical control for the care of trauma patients in the field. This allows trauma patients to be transported to the closest, most appropriate trauma hospital. Prehospital continuing education for paramedics is done twice a month. Trauma-related topics are covered in these sessions.
Most trauma patients are first resuscitated in the Emergency Department (ED). The Emergency Department is the gateway to the hospital. Most trauma patients arrive by ambulance. Some are flown by helicopter, landing on the Medical Center's rooftop helipad. They are then taken by high-speed elevators to the resuscitation room.
The trauma patients are evaluated and treated by the trauma team. This team is led by trauma surgeons and includes emergency medicine physicians, trauma nurses, respiratory therapists and radiographers. Often, other specialty services are involved depending on the injuries sustained by the patient. During the initial resuscitation, the family receives support and crisis intervention from social workers. This support continues throughout the patient's hospitalization.
Cedars-Sinai Medical Center has a fully equipped operating room available at all times to treat patients with a vast array of traumatic injuries. Virtually all types of surgery can be performed in the suites, including laparoscopic techniques. The center's trauma anesthesiologists and operating room nurses are an integral part of the trauma team.
Surgical Intensive Care Unit
Patients with severe injuries who need to be watched closely are admitted to the surgical intensive care unit. These patients are cared for by the Trauma Service under the leadership of the trauma surgeon. Their care is also followed by the Surgical Critical Care team. This team is made up of attending physicians with training in surgical critical care, surgical residents and fellows, Intensive Care Unit nurses, pharmacists and nutritionists.
Pediatric Intensive Care Unit
The Pediatric Intensive Care Unit (PICU) is an eight-bed, self-contained unit with a dedicated medical director and clinical nurse coordinator. A board-certified pediatric intensivist is available 24 hours a day. (An intensivist is a doctor who specializes in the care of critically ill patients, usually in an intensive care unit.) The intensivist makes rounds daily with the Pediatric Intensive Care Unit team and the Trauma Service.
Once a patient is stable and no longer needs critical care, he or she is transferred to a surgical ward, such as the orthopedic, neurosurgical, spine or general surgery wards. Case managers and social workers work with the Trauma Service and the patient's family to plan the next phase of care, whether in rehabilitation or at home.
Rehabilitation services for trauma patients at Cedars-Sinai begin in the intensive care unit and on the ward. The Department of Rehabilitation provides services, including acute care and inpatient and outpatient rehabilitation. This care is supported by neuropsychology, physical therapy, occupational therapy and speech therapy when needed.
Rehabilitation usually starts when the patient is stable. Early intervention from the Rehabilitation Service helps patients return to their most optimal levels of function. Therapists assess the patient's ability to move in various ways, do activities of daily living, speak and communicate, and use cognitive skills, such as memory and reasoning.
Working with social workers, the therapists also evaluate the patient's family resources and home and work environments. Physical and occupational therapists help patients regain control of their muscles, while speech pathologists and respiratory therapists focus on speech, breathing and swallowing. Vocational and recreational therapists look at lifestyle and job-related skills. Learning to feed oneself, take a bath, get dressed or prepare a meal are major victories for some patients. Others must face issues relating to driving, going back to school or work, or interacting with others in a new way.
To provide ongoing care to trauma patients, outpatient clinics are held at Cedars-Sinai Medical Center. These clinics provide continuity of care and allow the patient and family to return to a familiar setting for outpatient treatment. This includes follow up clinic visits for trauma care. This also may include care for a wound after the patient has left the hospital, monitoring of drugs and other medical and rehabilitative services.
Family & Social Support
Family support services are available 24 hours a day from the Case Management Department. A social worker is assigned to each unit that treats trauma patients. The support services available include support for coping with being in the hospital, adjusting to injury and making the transition home. Throughout the patient's hospital stay, the social work team plans for discharge along with the case managers and the Trauma Service. The team coordinates the care required after discharge from the hospital.