Treating the Worst of the Worst

Roxie Albrecht, MD directs Oklahoma's
only Level I Trauma Center

Aboard an ambulance 18 minutes away from OU MEDICAL CENTER, an emergency technician calls Oklahoma's only Level 1 trauma center with an alert about his patient. Within seconds, 46 pagers begin to buzz.

In a hospital hallway, surgeon and center director Roxie Albrecht, M.D., reads the message, then shrugs matter of factly. Members of her well-prepared team of specialists, sub-specialists, nurses, therapists and technicians will be waiting for the ambulance when it arrives, but there won't be the familiar adrenaline rush or the furious race against the clock. Not this time.

This time the patient is a 33-year-old man with a broken jaw and complaints of head pain. Vital signs are in the normal range. With no apparent multi-system injuries, his trauma category is down a notch at Level 2.

It's a relief but a bit of a letdown for the personnel who thrive in the constant state of readiness that Level 1 trauma centers must maintain if they are to respond rapidly and efficiently to critical, time-sensitive injuries.

Saving the lives of Oklahoma's most gravely injured patients is the sole purpose of the Level 1 Trauma Center, which treats approximately 1,600 of what Albrecht calls the "worst of the worst" injuries annually. About 2,500 injured patients who enter the hospital through the trauma center are admitted for further treatment or observation.

Adjacent to the emergency department, the trauma center comprises six large treatment rooms on the west side of the hospital's Presbyterian Tower. It replaced inadequate, if cozier, trauma facilities in Everett Tower to the east.

The improvements were made possible when voters approved State Question 713, which authorized the use of higher cigarette taxes to fund a statewide trauma system that included the Level 1 center.

Albrecht ticks off the improvements of the new facility:

  • The entry is on Lincoln Boulevard and just blocks away from I-235 and I-40. "Before, the ambulance had to go around two more corners to get to Everett. We're more accessible, and it's saving valuable minutes," she said.
  • The state-of-the-art trauma rooms are better equipped and more private than before, and a CT scanner is just a few feet away. "A majority of the patients that we see have traumatic head and potential inter-abdominal or thoracic injuries that we want to assess rapidly," Albrecht said. "We not only got a closer scanner, we got a faster, newer-generation scanner."
  • A dedicated elevator takes patients to the operating room, which is linked by a private hallway to intensive care. Before the move to Presbyterian Tower, taking a patient to the CT scanner meant a long trip through public areas in Everett Tower, Albrecht said. "You could see the eyes of the little kids when we'd roll by with blood dripping off the stretcher," Albrecht said.

"There would be families in the hallways that hadn't seen their loved one yet. You'd go by with him, and they'd say, ‘That was Jimmy!' And we hadn't even been out to talk with them yet."

The transfer from trauma center to operating room was made on public elevators. "Now," Albrecht said, "we have a dedicated elevator in a controlled environment."

In Oklahoma City, all Level 1 traumas (multiple blunt or penetration injuries requiring immediate intervention) go to OU MEDICAL CENTER. Responsibility for Level 2 traumas (potentially time-sensitive conditions) rotates between eight area hospitals, with OU MEDICAL CENTER taking its turn every fourth day. Level 3 patients have injuries that aren't life-threatening or jeopardize vital organs. Tulsa currently has one designated Level 2 trauma center at St. John Medical Center.

As the team leader when she is on duty, Albrecht is much like the director of a well-rehearsed orchestra - but one whose musicians don't have sheet music, she said. "There's nothing in front of you except that patient, and he's not acting right. They always throw curve balls at you.

"You want people around you who are thinking and acting as fast as you are, and that takes a lot of training and teamwork and trust. I do get worried every now and then [about a patient], but I know the people around me are skillful," Albrecht said.

"For five years we've been working and working and working in perfecting this, and each time, we reflect on where we could do better, and as a team, we try to do that."