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Details on our Clinical Care and Resources
Overview
The MGH Division of Trauma, Emergency Surgery and Surgical Critical Care specializes in the treatment of trauma and non-trauma surgical patients who require acute care. Trauma care provided includes treatment for internal organ, bone and soft tissue, and neurologic injuries. Non-trauma emergency surgical care provided includes acute inflammatory surgical diseases, soft tissue infections, hollow visceral perforations, alimentary tract bleeding, and visceral obstruction. Care is managed by trauma/emergency surgery specialists, in consultation with appropriate specialty services, including orthopaedics, neurosurgery, plastic surgery, oral & maxillofacial surgery, psychiatry and others.
Our Mission
The MGH Division of Trauma, Emergency Surgery and Surgical Critical Care is committed to: a) providing exceptional and complete patient care from the acute stage through long-term care and rehabilitation to full functional recovery, b) inventing new methods of treating critically ill trauma and emergency surgery patients by producing basic science, translational, and clinical research, and c) training the next generation of physicians in the care of trauma and emergency surgery and shaping the future leaders in this field.
MGH Trauma Center
Massachusetts General Hospital is a Level 1 Adult and Level 1 Pediatric Trauma Center, meaning that we have been verified as able to treat the highest severity of trauma patient. We admit, on average, 2,000 trauma patients and another 2,000 emergency surgery patients per year, and although the vast majority of our patients are from the Boston metropolitan area, patients are referred to our facility from all over the country.
The trauma team provides around-the-clock coverage for trauma and emergency surgery cases, at all hours of the day and night. Coverage by dedicated orthopedic trauma, neurosurgical trauma, and psychiatry trauma specialists is also provided in a seamless and uninterrupted fashion. Plastic Surgery, Oral and Maxillofacial Surgery, Ophthalmologic Surgery, and many other services are immediately available upon consultation. A rich network of nurses, physical and occupational therapists, social workers, chaplains, respiratory therapists, and others ensure smooth transition from the acute stage to rehabilitative care and full recovery.
Our physical proximity with the Spaulding Rehabilitation Hospital and close association with multiple similar facilities in Massachusetts allows integrated care from A to Z.
Of note, MGH is also a Level 1 Burn Center and one of a few centers around the country that have the highest level of accreditation by the American College of Surgeons in adult trauma care, pediatric trauma care, and burn care. This enables us to offer care for the whole family in one location, should multiple members of the same family experience traumatic injury.
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Non-trauma Emergency Surgery
Our Trauma Center also handles non-trauma emergency surgical cases. We believe that surgical emergencies can be optimally managed by the team concept which is central to trauma care. Acute inflammation (e.g. appendicitis, cholecystitis, diverticulitis, etc), perforation (e.g. duodenal ulcer, instrumented colon, etc), bleeding (upper or lower gastrointestinal bleeding), and obstruction (small bowel or colon obstruction) fall under the domain of non-trauma emergency surgery and are managed by our team by using the resources, organization, and infrastructure available to trauma care.
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Surgical Critical Care
Traumatic and non-traumatic acute surgical disease frequently requires intensive care. The trauma team at MGH provides critical care services in a seamless fashion from the Emergency Room to the Surgical Intensive Care Unit. The SICU is run jointly by the surgeons of the trauma team and anesthesiologists from the MGH Department of Anesthesia. All members of the SICU team are experienced intensivists with qualifications and credentials in critical care. The active participation of the trauma team’s surgeons in the SICU ensures continuity of care and optimal management according to advanced surgical principles.
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Typical Course of Treatment
The section below describes a typical patient course of treatment, from arrival through discharge and beyond. It gives you a quick overview of the types of care we deliver, the resources and people involved in treating injured patients, and some of the special aspects that make the MGH Trauma Center uniquely equipped to treat critically injured patients.
Initial Evaluation and Care
Four teams, each staffed by an attending surgeon with a full complement of residents, interns, and nurse practitioners, manage all admissions. As soon as our base station at the Emergency Room is notified by prehospital health care providers (EMS, MedFlight, etc) that a trauma patient is on the way to our hospital, the trauma team is activated based on specific criteria. The different members of the trauma team –who all carry a designated trauma activation beeper - assemble in the ER to accept the patient together with our ER colleagues. Throughout initial care, evaluation, and final disposition to a hospital area, the patient is escorted and managed closely by qualified trauma team members. The Division of Emergency Radiology runs two high-quality CT scanners and one MRI scanner located in the Emergency Room and provides 24/7 real-time reading of CT scans and MRI’s by attending radiologists. The presence of state-of-the-art imaging technology and qualified radiologists in the Emergency Room provides an unparalleled environment for safe evaluation and prompt diagnosis.
Operative Intervention
An operating room for emergent intervention is guaranteed around the clock so that we can operate and treat surgical patients as soon as necessary. A designation system that is controlled by the trauma surgeon and characterizes each operation as emergent, urgent, or routine ensures that access to the operating room is timely and appropriate. The operating rooms at MGH are fully equipped to accommodate the most complex traumatic and non-traumatic surgical emergencies and are staffed by highly qualified nurses with extensive experience in acute care.
Non-operative Care
Patients who do not need immediate transfer to the operating room or the intensive care unit are admitted to a specialized area, the Trauma Rapid Assessment Care Unit (TRACU). The TRACU functions as a highly-monitored 23-hour observational area with a nurse-to-patient ration of 1:2. Although not designated as an ICU, the TRACU allows close monitoring and observation of all trauma and emergency non-trauma patients during the first few critical hours after the event. The in-house trauma team, under the direction of the trauma attending surgeons on call, manages the TRACU. After the initial period of observation and stabilization, the patient is transferred for further care to a regular ward.
Intensive Care
Critically ill patients are transferred to the 20-bed Surgical Intensive Care Unit. A joint team of trauma surgeons and anesthesiologists manages all patients. Other ICU’s of the hospital, such as the Pediatric, Neurosurgical, or Medical Intensive Care Units, may occasionally receive appropriate patients. The admitting trauma surgeon remains at all times the primary physician directing the patient’s care.
Surgical Subspecialties
A dedicated Orthopedic Trauma Service (part of the Department of Orthopedic Surgery) supports the Division of Trauma, Emergency Surgery and Surgical Critical Care in caring for patients with orthopedic injuries. The Orthopedic Trauma Service provides around the clock coverage, prompt response to consultations, timely transfer to operation, and inclusion of attending orthopedic surgeons in the decision-making and delivery of care. Having an attending-led orthopedic team dedicated to trauma care is a rare resource around the country and emphasizes the commitment of the MGH Trauma Center to optimal patient care.
Similarly to orthopedics, a Pediatric Trauma Service works in close collaboration with the adult trauma team to provide care to patients younger than 18 years of age. MGH is verified as a Level I Pediatric Trauma Center by the American College of Surgeons because of the resources it has dedicated to the multidisciplinary management of young patients and their families.
Major contributions in the care of central neurologic injuries are offered by the Neurosurgical Trauma Service and the Neurology Service. Both services work closely with the trauma surgeons to optimize protocol-driven management of severe head and spinal cord injuries. The Neurosurgical ICU immediately accommodates patients with isolated neurosurgical injuries.
Other services, such as Plastic Surgery, Oral & Maxillofacial Surgery, and Ophthalmologic Surgery also frequently are involved in the care of patients. In addition, the MGH Trauma Center has a dedicated psychiatrist, who specializes in the mental health and treatment of patients experiencing trauma or burn injuries.
In preparation for discharge, a strong Physical Medicine and Rehabilitation service at Spaulding Rehabilitation Hospital (affiliated with MGH) frequently evaluates patients and facilitates the transition between acute and long-term care. Early involvement of rehabilitation physicians, specialized in trauma care, sometimes on the patient’s first day in the hospital, allows an integrated plan with realistic milestones and ambitious goals on the road towards full recovery.
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