The Trenton Times published the following article on July 10, 2013. To read the full article, click here.

The trauma room at Capital Health Regional Medical Center remains in the grip of violent crime

TRENTON — As the ambulance screams through the city streets toward Capital Health Regional Medical Center, the call goes out.

The hospital on Brunswick Avenue in North Trenton is the designated trauma center for the region. It is the destination for any shooting victim — from those with a graze wound to something far more life-threatening.

Loudspeakers throughout the hospital carry the call that will bring 15 people racing to one room.

“Trauma alert. Trauma alert to the ER.”

The alert summons a team including a surgeon, surgical subspecialist, anesthesiologist, nurse anesthesiologist, registered nurses and X-ray technicians, among others, to the trauma room in the back of the hospital. The team is scrambled to the bedside, assembling to provide care from every angle as quickly as possible.

Over the next minutes or hours, the members of the team will find out if they can save a life. They will make sure the patient is breathing, resupply lost blood and, most important, stop the bleeding as quickly as they can. Sometimes, they will even operate in the room, if the patient is too critically injured to take the four-minute trip and elevator ride upstairs to the operating room.

“Here, you only do what you absolutely have to because the patient will die in the next five minutes,” said Dr. Louis D’Amelio, director of trauma services for the hospital.

Practices like bringing all the medical staff to the bed at once mean that trauma centers like Regional cut down on fatalities by 30 to 40 percent, D’Amelio said. Inside the building formerly known as Helene Fuld Hospital, the trauma room is an unimposing two gurneys with shelves full of medical equipment.

“It combines the features you need immediately of an emergency room, an operating room, and an ICU all in one,” D’Amelio said during a tour and interview last week.

It’s warm inside the trauma room — 86 degrees, the temperature at which a naked human body does not need to provide its own heat.

“People who are warm bleed less than people who are cold,” D’Amelio said.

Ambulances pull in close to the trauma room door. Once the stretcher is brought inside, patients are undressed so doctors can make their examinations more easily. The team runs through the ABCs of keeping someone alive: Airway, Breathing and Circulation.

If needed, the patient is hooked up to a ventilator. Depending on where they are shot, an IV will be placed into the patient’s collarbone or groin to bring in fresh blood. The trauma room’s blood pump can get a liter per a minute of heated blood into a patient’s veins — and six liters are all a person has. The practice is literally battle-tested.

“All of our transfusion protocols in contemporary care are protocols that have been evolved in Iraq and Afghanistan,” D’Amelio said.

The trauma team will recollect as much blood as possible from the victim, process it to get out any impurities, and put it back in the body. But all that effort will be a waste if they can’t stop the bleeding.

The doctors plug the gunshot or stab wound by any means possible. They’ll use staples, stitches, balloons, even a finger pressed down.

“If the alternative is a corpse, yes,” D’Amelio said.

There is an X-ray in the room, heated towels and sanitized tools in prepared boxes. Work there is quick, coordinated, and just the beginning in a patient’s journey back from the brink.

D’Amelio has been director of the trauma unit at the hospital since 1999, and in that time he’s seen signs of a more violent city, including an increase in victims with gun and knife wounds.

“A linear increase over the 14 years I’ve been here, with kind of an abrupt escalation in 2005 and a linear escalation since then,” he said.

The hospital’s own data backs him up, showing an 88 percent increase in gunshot and stabbing victims since 2008. That year, the hospital treated 136 people who were shot and stabbed. Last year, it treated 256. So far this year, it’s treated nearly all of the 124 people shot in the city.

Not all victims are from Trenton, as the hospital is a regional trauma center for all of Mercer County and parts of Ocean, Burlington, Somerset and Bucks County.

As Trenton remains in the grip of violent crime that has killed 20 and left more than 100 others shot since the beginning of the year, the Regional Medical Center keeps one of its six operating rooms free around the clock for trauma victims.

“We notice a direct correlation between violent crime, and the presence of officers on the street,” D’Amelio said, referring to mass police layoffs in Sept. 2011 that took one-third of the Trenton Police Department.

D’Amelio has seven full-time trauma surgeons on his team. He normally has eight, but one is serving in Afghanistan as a major in the Army Reserve. Every one of those surgeons is what’s called “double-boarded”: board certified in both surgery and critical care. It’s unheard of — even Johns Hopkins University Hospital doesn’t have that many.

“Most Level 2 trauma centers in the country have one, usually their director, who is double-boarded,” D’Amelio said.

The doctors at Regional get plenty of experience, but for them — and their patients — that’s a positive.

“From a societal perspective, it’s not good, but you want someone whose blood pressure doesn’t go up when you see a gunshot victim,” D’Amelio said. “You want a guy who did another last night.”

City police are big fans of Capital Health and the Regional Medical Center.

“It’s a top-notch organization,” said Lt. Mark Kieffer, a police spokesman.

“From the medical techs to the doctors to the executives, we have a great working relationship with them,” he said.

Kieffer was in the hospital the evening of Dec. 4, 2012, after four people were wounded in a shooting on Passaic Street. He was floored at the scene inside.

“And we walk in there, like, ‘You got to be kidding me,’” Kieffer said.

As the victims were being treated in the trauma bay and elsewhere, more injured people from a bus crash were being brought in.

“Not matter what you throw at them, they handle it,” Kieffer said.
Police officers are rarely let in the trauma room, and if they do go in they must stand behind a line near the door. Questioning the patient is not a priority.

“Let’s fix this patient, and if he lives 30 or 40 more years, the legal process can go forward,” D’Amelio said.

What D’Amelio calls the “drama” in the trauma room — putting in tubes, patching wounds, saving lives — he estimates occupies about “10 to 15 percent” of a surgeon’s time.

“All the drama happens in the first few hours in the trauma room, but a lot of hard work happens in the OR and the ICU,” he said.

Over the last 18 months, the doctors have had more difficult cases as they’ve seen injuries from higher-velocity weapons that damage tissue from a blast effect, and a change in placement of gunshot wounds on the body.

“We’re seeing much more intent to kill,” D’Amelio said. “We’re inferring intent to kill.”
A lot more patients have head or trunk wounds, he said.

It’s an observation his exposure to the victims of Trenton violence allows him to make, along with one of compassion and empathy.

“I’m touched by, even the folks who I know are violent criminals … the vast majority of them are not inherently bad people,” he said.

He often thinks of his now-grown children when he sees teenage victims, like a 15-year-old shot in the abdomen.

“When my kids were 15, they were worried about a date for the junior prom, they got a ‘B’ on the geometry test,” he said. “And these kids are worried they took two in the chest, and they’re blood pressure’s 40 and they’re about to check out.”

“I grew up in a blue-collar neighborhood in Philadelphia that’s gotten pretty bad,” D’Amelio said. “I just think — there but for the grace of God go I.”

“They’re not inherently bad people, they went down the wrong path,” he said.

Contact Alex Zdan at azdan@njtimes.com or (609) 989-5705.