Hello, my name is Doctor Sarah Walker, and I'm honored to serve as the 2025 president of the El Paso County Medical Society.

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What exactly is a trauma center?

And really, what exactly is a level one trauma center?

It's a big, big deal.

I know.

Unfortunately, in El Paso, in our region, we have suffered some major trauma over the last several years.

And thank goodness that we do have a level one trauma center and also a level one medical team that not only saves lives, but more importantly, addresses the long term impacts that patients have and their families have.

This program is underwritten by university Medical Center, and we also want to thank the El Paso County Medical Society for bringing this show to you.

And you may notice that we are in a new filming and taping facility.

This is actually the home to the El Paso County Medical Society.

It is a Trost building, a Henry Trost Building that was built over 100 years ago.

And the El Paso County Medical Society has been housed here from 1966 on.

And they have their board meetings here and powwow meetings.

But it's a great place to be.

So welcome to the Turner Home.

I hope that you enjoy this program.

I'm Kathrin Berg, and this is the El Paso physician.

Neither the El Paso County Medical Society, its members, nor PBS El Paso shall be responsible for the views, opinions or facts expressed by the panelists on this television program.

Please consult your doctor.

Hello.

Thanks again for joining us.

We're going to speak tonight about what happens inside of a level one trauma center.

What exactly does that mean?

With us today We have a veteran, and I say this because we've been doing this program with the El Paso County Medical Society now for 28 years.

And Doctor Tyroch, I just found out from you, too.

And we're gonna have some fun with this.

Doctor Tyroch came to El Paso in 1997.

That's the year my daughter was born, and she was in a little cage.

And I remember--a cage-- Little carrying cage.

But you were.

You were that guy.

So welcome back.

And thanks for not leaving.

We appreciate that.

Thank you.

Doctor Alan Tyroch is chief of surgery and trauma medical director at UMC.

He's also professor and founding chair of surgery at Texas Tech University Health Sciences Center.

And the guy that hired him is Doctor Leo Mercer.

And thank you for doing that.

Doctor Leo Mercer is the associate trauma medical director at UMC and also the associate professor of surgery at Texas Tech University Health Sciences Center, El Paso.

That's always so much to say.

You're going to have even more fun.

And then we have a doctor, Tiffany Lasky, and you have several titles.

Doctor Lasky is a pediatric trauma medical director and also is the associate trauma medical director and is a professor of surgery at Texas Tech University Health Sciences Center, El Paso.

I think we rehearse that a little bit, and I hope I got that.

All right.

But tonight we're going to talk about, we're going to talk about some ugly stuff, but we're also going to talk about how and why it is so great that El Paso has the UMC level one trauma center.

So what I'd like to do first before we do anything.

And Doctor Tyroch, even though, I said to the audience what your title is and for both of you, all three of you, I like for you to kind of let the audience know what it is that you do on a daily basis.

I know that's always the hard one.

Sure.

Well, I guess I can start.

I was on call last night.

Oh, geez.

In the hospital we take in house call and and with our residents.

It's a big team of people.

Not just surgeons, but nurses and respiratory therapists, different specialists.

So whatever comes through that door, we deal with, and we see a lot of patients in transfers all over, not just El Paso, but southern New Mexico.

I think last night we had probably about 7 or 8 people coming to us in transfer.

Oh my gosh--about half of those come by helicopter.

Okay.

So we see a lot of helicopter transfers, but we're very busy--car wrecks, people falling down.

I think somebody fell off his horse.

We had surprisingly two people fall off their ladders.

We were very busy with ladders.

This week.

It's not even Christmas lights hanging time We usually get that.

Yes, in the wintertime.

Geez what I'm going to do.

I'm writing notes here because I want to go back to that as well, because when we talk about the level one trauma center that you have here, it really is for a big geographical area.

So, doctor.

Mercer.

So you coming back to El Paso, you're in El Paso And then you left to go to Australia for a while?

Did I understand New Zealand.

And then you came back.

So now what do you do all day, every day in your role and all paso.

The same thing.

The same.

Okay.

Next.

No, but but it's--No I mean, Alan and I and Tiffany worked closely together.

We're all quite busy.

We see the same demographic sometimes of Tiffany, who, through administrative standpoint and guideline development, works on the side.

I work primarily on the adult side.

Okay.

Clinically we see the same sorts of injuries, the same types of patients.

Yeah, same for transfers and things of that nature.

And we're going to get into some.

And I know every time we've got Tyroch again on the show there's always these stories that just leave me with my jaw on the ground.

Just like, they did what?

So we're going to hear a bunch of those stories today.

And again Doctor Lasky, you work more with pedes and everybody else on this panel, right here, but do you have, like, a not a daily routine?

That's not what I'm going for.

But again, just so the people that are listening at home or in their cars, wherever they are, you know, know what it is that you do.

Yeah.

I think one of the interesting things that really attracted me to trauma is that you don't just do trauma.

You're a surgical intensivist.

You work in the intensive care unit.

And so not only are you in the emergency room, in the operating room, and all of the acute care, things that we do, but we also get to spend time in the intensive care unit, and that that was really my first love.

Okay.

And I love that you brought that up.

I know in the opening statement we talked about, yeah, saving lives, but also the long term impact of what happens and I Again, with trauma.

It's not like something you can cure it and you're done.

I mean, this is something that lasts and goes on for years and years and years.

And I know that your team at UMC has a lot of that put together, too.

So what I'd like to do, and Doctor Tyroch, I'm going to start with you because I'd like to explain what a UMC level one trauma center that's verified by the college, American College of Surgeons.

Like, why is that so important?

Because you hear trauma center here.

But there are different levels and there are different types of trauma centers.

And I'd love for you to educate us on what those are.

Sure.

So there's four levels of trauma centers in Texas.

There's 296 trauma centers total one, two, three, and four.

Wow.

But the highest level is level one, verified by the American College of Surgeons and then designated by the state of Texas.

So we've been a level one since 2001.

We are actually also designated in the state of New Mexico.

The only other level one in New Mexico is up in Albuquerque at U.N.M.

So we cover a big area 44,000m, 1.25 million people in far west Texas and southern New Mexico.

But we're a level one, the only one for 270 miles.

The next nearest would be up in Albuquerque, and in Texas it would be, I guess, Lubbock, 347 miles from here.

So we are an island to ourselves.

So when you say you cover for, you know, 4000 miles, even though there are these other trauma centers, there's only certain things that that you all do that other places don't do, like Albuquerque, like Albuquerque and El Paso.

If you were to compare between the two its a four hour Drive plus yes and then helicopters, etc..

So how is El Paso different from Albuquerque?

Well, they're similar in reality because you're a big city just like we are.

But actually the population of El Paso is bigger than Albuquerque, right?

But closer and we're closer to all the other hospitals and cities in southern New Mexico.

So these are small hospitals.

Most of them don't have operating rooms.

If they do, they don't have surgical capability.

So 43% of all our trauma patients that we see, we see about 3900 trauma patients per year that we admit to the hospital, about 20% are kids, about 24% or so are geriatric, meaning 65 or older.

So we see all ages.

And, these hospitals just cannot take care of them.

So they come to us and transfer about 43% or so come in transfer that we see.

So that's a great transition Doctor Mercer and talking about transfer.

So I know we joked so everything that Alan does you do too.

So I'm going to when you have transfers you've got helicopters for the most part coming in number one.

Who deploys the helicopters.

Is there a medical center and or a hospital.

And let's just say it's Deming.

Let's say it's a place that's that's pretty populated, but it's still far away from anyone else.

How was the dispatch first made?

Helicopter gets there.

They get to you.

Are you even involved with any of that?

Or is it just once they hit the ground in El Paso at UMC, that's when things get going.

Most helicopter dispatchers handle either by the local regional nine one one center or little hospitals can call them directly.

Helicopter services are largely provided by private companies and have a contract with whatever organization, hospital or county region they're contracted with.

But that's the communication.

We're not involved in making those arrangements.

We don't have our own helicopter UMC.

Okay.

So most of that comes from from about 40, 45% of it comes of our of our transfers in from, from New Mexico.

Come by air.

Okay.

We have a local based helicopter, Fire Star, which represents a collaborative relationship between a private company and El Paso Fire Department.

So, pardon my, my lameness.

But when you think of different TV shows that we're watching and they're, they're medical shows and it's like, okay, everybody go meet on the roof because the helicopter is coming.

Is that and walk us through what happens once the helicopter comes.

Hopefully there's some kind of communication with the person that's in the helicopter, with the patient that says, okay, here's a little bit of a heads up of what's happening, but walk us through that, Dr. Mercer?

So I wouldn't know because I don't watch those shows.

Okay.

Really?

Not a one?

No.

--Did I ask earlier if he cracks a smile or not?

But I believe you.

--Sporadically.

I believe you.

--Sporadically.

Right?

Uh, no.

We get we get a communication from from their dispatch center.

All of these individual helicopter companies have their own dispatch center, and they communicate with us what their inbound time is.

and we, we're alerted.

And if it's a level one trauma transfer, then the team is activated.

So I like that I'm going to start using that word to a trauma transfer.

And doctor Tyroch, you said about how many what's the percentage of transfers?

Because that was a large number.

It's about 43%.

About 43% some come from El Paso.

The other was in El Paso.

Okay.

We get ones from Alpine.

Marfa in that area, Las Cruces.

Oh a lot from Las Cruces.

- -I know that there was recently the the mass shooting in Las Cruces.

And I'd like to talk about that because I don't think people understand even though Las Cruces is there.

Yes, there are some hospitals there.

But transferring everybody that needed that type of care to El Paso, just walk us through that night if you could Sure, it was a Friday night, if I recall, around 11:00 or so.

I got a call from the surgeon on call at UMC saying we got a mass shooting in Las Cruces.

We're getting three victims.

So I contacted a couple of their trauma faculty in our surgery residence, and they all came back to the hospital.

And I think we received seven victims that night.

And of those seven, we operated on three of them, emergently.

So three out of seven.

And so walk me through also, because there are only so many surgeons.

Yeah.

Right.

And so when somebody has to when you you're in this situation, you've got incoming seven people.

And then the evaluation process and Doctor Lasky I'm just going to turn things over.

Because you haven't been able to talk for a while.

So and by the way, on this program, feel free to come back and forth to each other.

I kind of I love that, but once you have a certain number of people coming in and you're looking at the trauma center, how does the evaluation process work?

You know, and maybe there isn't a lot of information coming in because you have a lot of people coming in.

How does that walk us through how that would occur?

So we have varying levels of traumas.

Patients that are the sickest would be what we call a level one trauma.

So they would have low blood pressure, high heart rates, physiologic signs that indicate to us that they're in shock or that they're sick.

And so those patients would get the highest priority because they would be the most likely to have to go to the operating room.

And we'll deal with those patients first, and then we'll work our way down the rest of the list, and we'll have varying amounts of, levels of trauma in an MCI, or a mass casualty incident.

So if you have an influx of, say, seven patients from Las Cruces, they'll be a varying degree among those patients.

Some will be level ones, like the three that went straight to the operating room.

And then they'll meet maybe varying other types of patients, maybe a level two or a three patient, depending on what their physiologic status is.

And you were talking to, a bit ago about intensive care.

And so there is the, there's the night whatever that night or that day is when surgery occurs, things try to get as puzzled back together and matched up and fixed as possible.

But now we're looking at the recovery time.

And recovery from a heart attack is very different from a recovery from a gunshot.

And since we're talking about gunshots now, but then we'll get into some of the other very interesting stuff that you guys deal with too, as, as trauma docs.

So intensive care there is that whole teams- What I'd like to do.

I know that we've got three M.D.s on the table, but then we've got the nurses that specialize in certain types of of recoveries.

Maybe talk a little bit about what those roles are.

And I know it's anywhere between a couple of days is sometimes somebody can be in a hospital for a year.

Hopefully not.

But how does that usually go down?

So once the patient's done in the operating room, and they don't need any further intervention that night, they'll usually go up to the intensive care unit.

If they're one of those level one patients that needs to continue to have blood or fluid, or a nurse that's going to give 1 to 1 or 1 to 2 ratio.

Our nurses are really facile with working between cardiac and neuro and trauma, but our surgical intensive care nurses are very good at trauma, and that's there.

That would be kind of their specialty that their specialty or more their area of emphasis, the where they practice the most.

Okay.

I think one of the things I always want to emphasize trauma is a team sport.

It's not just the three trauma surgeons that are here.

You know, that Friday night with the Las Cruces shooting, one of the guys that had to go emergently our hand surgeon, Doctor Diamond, took him to the O.R..

But we can have neurosurgery coming there or all the other orthopedic surgeons, the oral maxillofacial surgeons, plastic surgery, etc..

But you also have to have the anesthesiologists, the CRNAs in the various specialists, physical therapy, occupational therapy.

So it truly is a whole group of people just for a level one activation.

Right?

There's probably about 14 or 15 people that come into the trauma bay, including blood bank and laboratory X-ray and then Cat scan people, CT techs or standby waiting for us to go there.

I think we were running that evening two CT scanners at once, just so we could move the patients through the process and then once they get out of the O.R., there's respiratory therapy, and we have a pharmacy PhD and physical therapists and social workers, and the list goes on.

And, you know, Doctor Mercer, you we talk about it as a team sport.

And I've kind of expanded that is it really takes a village to do trauma.

Well, we have we have trauma teams, but we have other people, other teams to where it really involves so many people.

And it really does look like a village.

When I started in doing trauma, it depended a lot on me.

And that was kind of the nature of trauma 35, 40 years ago.

Now we tend to value what I call pit crew values, rather than cowboy values.

So explain those to the pit crew.

If you look at everybody comes in.

Yeah, everybody has a car pulls into the pit.

Right.

Needs new tires, fuel.

Everybody's assigned a job, and everybody knows the degree to which they do it safely.

Efficient, timely that it produces a good outcome.

If you don't if any member of that team forgets to tighten a lug.

Right on a tire, the first turn doesn't turn out well.

So to speak But so, yeah, it is, it is it is not an orchestrated approach to delivering trauma care.

Yeah.

To the extent that it works well, it's it's infinite to the extent that it sometimes goes off the rails because we can't always predict what, what injuries patients are going to have occasionally it looks like a cacophony.

But but that's the nature of what what people what Tiffany and Alan and I do is to try to control that and make sure that the patient is safely cared for.

So listening how this this pit crew kind of comes together.

What brings to my mind is back in I understand 1998 or so was the the desire for the process to apply for a level one, a trauma unit and I know that that takes a lot, but I think it's important for the audience to know what a big deal that is.

So everybody on that crew has been tested, tried and true.

You know, that those people are going to do their thing.

That is a level one.

How, Doctor Tyroch, when that time frame was coming together, how and what was the process of applying for, if that's even the right word, being accredited as a level one.

And again, this is with the American College of Surgeons.

That's the entity that that's they verify us in the state of Texas designates.

And they based on what the college says, okay, there's like a hundred and some requirements they have to meet maybe more actually now.

So going back historically in the mid 1990s, the state of Texas said we want a Texas trauma system.

And there was also some money for hospitals to become trauma centers.

So Thomason General Hospital was what we're now UMC.

They chose to go that route because most County Hospitals was wanting to do this so they could get some funding for, indigent care.

So and that's why I came here to help develop the trauma program at the county hospital.

We became a level two trauma center in 1998.

I probably didn't have that much to do because I came here late 1997, they had already started all that.

So the soon as we were a level two, we said, let's go for level one status.

Which requires more academic stuff, research actually had to have an MRI scanner, which we did not have back then.

Oh wow.

Yeah, we would get an MRI.

Portable MRI would come once a week to us.

And this is 1998.

That was probably 98 and 99.

Okay.

So then we we worked in those years from 98 to 2001 to become verified.

That's what we did back then.

Okay.

We've been verified every three years or so since then.

Now these two actually were trauma directors at their places, so they know the process just as much as I do.

So when they both joined me, to go for our 2021 Verification no.

2024 verification.

Wow.

It was a big asset for me because they knew what needed to be done for that.

And it's a lot of work.

It's not just us three doing this.

On trauma.

Director, meaning Lydia and then Sandra Gonzalez at the time they spent so much time putting a document together is probably about this thick.

I remember preparing for the program, and it might have been 2001, 2002 when you all were announcing this new designation.

And I remember receiving, via email, the du du du du du du, like the laundry list of names you all had to have checked off.

Yeah.

And I thought to myself, I have no idea how I'm going to go through this list on the program, but we kind of did it and it's grown since then.

It's I, I'm sure it has more sophisticated.

And I remember going through it's okay, there's 100 here, but let's take the top 50 from the top 50.

What are the top 20 that people are going to be most interested in?

In it's trauma.

Everything from, again we're talking about gunshots, blunt force car accidents.

And I remember saying this to you said to me, I said, car accidents is they're not car accidents.

The car wrecks, car crashes, car crashes.

So I would like to right now use that as a transition because car crashes is where people get messed up.

In a lot of other places, ATV crashes that we have here too.

Well, yeah.

And motorcycles are big, right?

Yeah.

Okay.

Big right now.

So I think always big.

But we had a rash of them lately okay.

It's getting warmer.

Everybody wants more of those getting better.

And Texas is a state that doesn't really mandate the use of helmets.

That's right.

So, yeah.

So there's a there's there's a lot of things that come together from a systematic standpoint that contribute to, to morbidity and mortality associated with motorized vehicles.

Right.

It is not just young people on motorcycles.

We're seeing 60, 70 year old guys riding motorcycles that are on various agents that cause they had a history of heart disease or stroke, they're on what we call blood thinners.

So when they crash, they bleed into their brain or their liver bleeds more.

So then we have to reverse it with various chemical agents or clotting agents.

So it's not just some young guy.

Yeah, exactly.

You know, somebody said if you want to live a long time, just stop doing stuff.

I'm like, yeah, but what's the fun in that Where is the fun in that?

What I'd like to do with, again, crashes, crashes, wrecks when someone has a blunt force trauma.

And let's, let's go away from shootings for a while.

That's a small volume.

Actually, the shootings and stabbings is about 10%.

Yeah, all the --people think it's a knife and gun club at UMC.

No it's not.

Yeah.

It's old people falling down.

You know, it's a whole people, right.

Falling down.

Yeah.

Climbing trees or young people falling down.

Kids falling down.

Now, I'm glad we said that because I could bring up the whole August 3rd thing.

And I do want to address that in some ways.

But to your point, that's not where the mass issues are that you're.

And just last week we had a 95 year old come in actually yesterday fell.

He hid his head went to the OR for a subdural hematoma, fell walking fell from a ladder?

Or you were talking about two people on a ladder and he tripped somehow.

Okay.

A ground level fall Okay.

Heart disease course.

Yeah.

The stuff we recently, in the last six months or so had a patient who had a heart transplant, 68 years old, was riding his motorcycle, and somebody pulled up in front of him.

So, I mean, that adds a level of complexity that requires a fair amount of expertise in terms of of managing.

Right.

And see that we have a whole nother line of questions for me.

Right.

So you're looking okay.

He needs a heart transplant and he needs it now.

And then there is the bank, the heart transplant or the organ bank.

And we are going to talk about blood in a while too.

But he had a previous heart transplant and was living his best life, was on a motorcycle, was injured in a motorcycle crash.

And if you if you look at the irony of that, statistically it's likely that his donor was was injured and ultimately was killed in a motorcycle crash.

So yeah, there's there's like there's a way of being circular.

Well, but the complexity associated with taking care of patients like that certainly, challenged the health care system and us and hence being in a level one trauma center, the likelihood of you surviving that injury, despite that, what we call comorbidity, right, is much higher.

Right.

And I'd like to right now since we can it's part of what's on the table right now.

Talk about organ donation.

I don't want to spend a lot of time on it.

But if you are considering that, you can call the DMV.

I understand the Department of Motor Vehicles.

I think, if you're interested in doing that, it's always a good thing to do.

But, Doctor Tiriac, I do want to talk about whole blood.

I know that last time we were together on the program, I don't remember exactly.

Maybe it was by talent, but we were talking about, the way that blood is processed now and going.

You said what's old is new again.

What's new is old again.

Correct.

But talk about that.

So people who donate blood on a regular basis and if you haven't and want to go donate some blood, somebody can always use it.

But what is whole blood when you hear that?

Now, what does that mean?

That's the whole thing That's so.

So the World War one and World War two were being Korea.

A soldier when they were injured would get a transfusion from another soldier, or they would bring some blood from the states over there and they would get basically plasma platelets.

And the red blood cells pack red blood cells, just the red cells, just the red just the red cells, okay.

Which is the oxygen carrying part of blood.

But there's more to blood.

Just oxygen carrying.

You got a clot.

And that's the clotting stuff that we have in blood.

But blood is a business.

So it made more sense to separate it because some people like that, or hemophiliacs or, they have immunosuppression.

They may just need the platelets because their platelet counts are low, but they may need the plasma.

Some people just need the red cells.

So they would separate it.

But so almost everybody that gave blood most it got separated not all the time.

It was most likely okay was okay.

I can just tell you it was in the 1990s and 2000.

So every time we have a war we learn stuff because that's trauma.

So when the soldiers went to Afghanistan, to Iraq, they had a hard time getting the blood, the components stuff.

So they realized, hey, we have a walking blood thing.

The soldiers that are there would donate and they would give to their colleagues.

So that's how they started it with the whole blood again.

And then when they started coming, the surgeons came back to the United States.

They started saying, well, what can we do this at our own trauma centers, right?

People said, no, you can't do that.

But, they started to figure out ways of doing that.

So we've initiated Whole Blood and UMC gets about 15 to 17 units of whole blood per week.

And we use it.

Okay.

And, so you get it.

From where?

--Vitalant is who provides it to us Gotcha.

Okay.

And I can just tell you and you all too can chime in.

It's a better resuscitative fluid than giving the pack cells, because now what we do is okay, we'll give them some pack cells Let's give them some platelets.

Let's give them some plasma.

We try to keep this on what we call a one to 1 to 1 ratio, which is hard to do.

But now we just get a unit, a whole blood.

It's a beautiful bag of 500 cc's.

Dr. Mercer You look like you want to add something to that?

No, no, this is amazing.

Yeah, I think that the, you know, we would tend to look at blood and blood products if you break it up into components.

And so each individual component and that's certainly associated with greater income for whoever's doing it.

And that's been kind of the model that's been used for a good many years if not decades.

But whole blood became more of a logistical issue.

And once we could solve the idea of taking whole blood from a patient, not breaking it up, and, storing it in such a way that it would last long enough.

And then, of course, we're big enough trauma center that that we, we don't have an issue with using the blood, the whole blood that's allocated to us.

But, in respect of what was done in the past until I came back to UMC in 2023, I had not given a unit of whole blood in my entire career.

Oh, wow.

And I started as a resident at UMC Thomason Hospital in 1980, so it simply wasn't available.

So yeah, it was it was something new to me, but and, you know, to put it into something of a numerical sense of how valuable it is, people that are resuscitated with whole blood have about a 40% less likely chance of dying as a consequence of their injury.

Oh my gosh.

Okay, so if we were looking at the percentage of let me see how I can frame this question if if, if Doctor Lasky was going to go give blood tomorrow, is there a questionnaire that says, I want to do whole blood donation, do you want to separate?

Like how does that work in a vitality type of a situation?

And maybe, you know, maybe you don't I don't know, but I'm just I'm asking that question for people who are listening that are curious about this.

Now, I haven't give blood in like ten years, let's say, or now five years.

What does that process like now at a blood bank.

And this is an I don't know the answer.

I'd be, I hope you know, because I don't you on the spot.

I'm sorry.

I'm glad you asked her I can't I haven't worked in the lab for more than 20 years.

But when I did, the, the situation was that they.

Donors don't get to decide.

You don't really get to decide if you're going to give whole blood or if you give component.

And the components, like Doctor Tyroch alluded to earlier, are more lucrative to split them up into pieces or parts.

So making the plasma and the red cells separate would would get you more bang for your buck.

And there were also some storage issues in the past, our technology has improved drastically.

And, you know, the blood substitutes haven't taken, flight yet, but some of them will.

And we'll have different types of plasma, like liquid plasma we're talking about.

They have lyophilized, plasma that they can reconstitute.

And, we even have cell Saver now, which is used much more often in the O.R.

in the trauma setting than it was when I first started my career.

Now, over 20 years ago, there's times now where we can take the patient's own blood and and wash it and give it back to them in better ways than we did before.

So a donor doesn't really get to decide.

I get you--To some extent, the donor does decide based on what their what their what their blood type is and their RH so so if you're if you're an O-pos donor, then you're more I mean, we're more likely to be using your blood or the collection or that's what it is.

Okay.

So that's the universal donor for me for a long period it would be better.

But that's a rare blood type.

So we use o pos So effectively as a donor if you do you have O positive blood then that's lot more likely to be used in the whole blood supply chain okay.

I do think the El Paso region is going to hear more and more about whole blood because as we were talking earlier, the state of Texas, we took initiative in 2024 that we want to roll out prehospital whole blood across the state, all 254 counties, small hospitals to have it.

And we'll have a process where that blood is getting old, that small hospital reciprocate it back to the level one trauma center or somewhere.

Right.

But we want that blood out there because it makes more sense Here's a perfect example.

And I use this all the time when I talk about this, Van Horn, Texas, 120 miles from here, a level four trauma center, Interstate ten terrible crashes.

We see those all the time.

Takes a while to get here.

You can barely get a helicopter out to them because of the distance sometimes where they go.

So get some whole blood out to them.

They can get the blood as they're being transported to El Paso.

So we're going to start hearing about that more.

There's some legislative efforts in the state of Texas to put out about $10 million every two years to support that, and it's now being looked at the federal level.

The American College of Surgeons just came out about six weeks ago to say whole blood in the pre-hospital setting is sort of like seatbelts were in the late 1960s, saving lives.

Yeah, that comes from the National Highway Traffic Safety Administration study that was recently reported that the impact of pre-hospital blood is likely to exceed.

That just makes sense, right?

When it's just a logistics that we got to save blood in the end, you don't have to give as many units to that person that gets the whole blood.

Yeah.

And it's also safer.

That person is getting one unit of blood from one person.

If you do components, you have other people.

And blood is still safe, though.

But still all that stuff.

Yeah, that's what's going to be happening in this to become the standard of care fairly quickly.

Yeah.

Sorry.

Happening.

Well I'm glad to talk about it.

I remember we talked about it last time.

I had no idea what you.

Okay.

So the other thing you remember with homework is not just for trauma.

Yeah.

I use we all use it for, cirrhotic patients.

Patients that are bleeding, people that are ob ob patients, in some places actually see more for them than the trauma population.

Yeah.

Interesting.

It does save lives.

I look forward on doing a program on it.

I think you will hear.

Right.

Yeah.

To be clear, component therapy or component product therapy has a role.

We're talking about trauma and our approach to resuscitating people who are in hemorrhagic shock.

Shock is consequence of blood loss.

And we're all convinced, that that whole blood is a better resuscitating fluid.

Now, there are patients who, for one reason, who are not injured, who are not in hemorrhagic shock, who may well benefit from component therapy.

A patient who has a coagulopathy or can't clot needs specific therapy, then yeah, that that's that's best given component.

So are patients who are who have a platelet disorder and just need platelets.

But from from a trauma perspective, from an injury perspective, whole blood is something that we tend to want to use more often.

And that makes sense.

That makes a lot of sense.

Doctor Laski, I'm going to ask you, do you specialize in pediatrics?

Which is great.

So I'd love to talk about trauma.

Pediatrics.

Not that I love to talk about it, but I we haven't touched base on it yet.

So the protocol at UMC for pediatric trauma patients, and I don't even know how to describe that would be if you want to give a case study or two that's always helpful for people to understand, what you're talking about.

But how is UMC equipped for pediatric trauma issues?

So we're an adult trauma center, verified by ACS, but we take care of a large number of children, and we have a constant state of readiness for both children and adults.

And that is not just this whole village or team that we talked about that runs to the trauma.

One is activated.

We have the same levels for pedes that we for adults based on their physiology.

But with the pediatric traumas, we have that additional layer of support with the children's hospital.

We have pediatric intensive care unit doctors, and we have E.R.

doctors that specialize in pediatrics.

So we have that layer of extra support.

We have child life specialists, and others.

So like specialists, well, it's not my role, but their role is like a social worker, but specific to that patient's family and to supporting them to get back to, into their former life.

Okay.

And this is, again, what I really like about what you all do as a trauma center.

It's not just what's happening then, it's about what happens after.

And I'd love to touch base on that too.

But I feel like we're, we're not running out of time.

But I want to get to some very specific things.

Yes, please.

Pediatric.

So yes.

So it's a combined project with El Paso Children's Hospital.

Of course.

That's a separate hospital, but all together.

So small child we'll move them over to to EPC.

We have privileges there and they have the specialists talk the last minute.

There's a few things that might be different, but we basically do airway, breathing and circulation with the children just like we do with the adults.

But we do our weights and kilograms.

And we make sure that all of our, all of our child traumas are treated expeditiously.

And there's a lot of very specialized equipment based on the size of the child, especially those under 40 kilos.

So we have protocols and procedures, specialized--And the partnershipt with children's and UMC.

Like the way that again, yes, they're in the same building or right in that geographical area.

But are there doctors that cross?

That specialize in both hospitals, both hospitals?

Oh yeah, yes.

All of our adult trauma surgeons are credentialed over, children's hospitals.

Do you?

Okay.

Yes.

Credential was word I was looking for.

-- Intensivist will come to the level one trauma pediatric traumas to help us out if we need them.

We're lucky here.

Yeah, we're really lucky here.

Yeah it's a really nice relationship.

- -Doctor Mercer, I'm going to ask you something that I have no idea what this is, but it's ECMO, right?

It's the extra corporal membrane oxygenation.

What in the world is that?

But it's obviously exciting.

In February at UMC, this is the first time that somebody had received this life changing treatment.

What is that?

Help us out.

So extracorporeal membrane oxygenation is a specific technology that's that's been around for a good many years.

Actually the first patient who was put on extracorporeal circuit in order to oxygenated blood because they had injured lungs and allowed the lungs to recover, was in fact the victim of a motorcycle crash.

Had severe chest injuries, and that patient was put on what's called the circuit, bloods taken out through a pump into an oxygenator and returned to the patient so that we can rest their lungs, while the lungs recover.

And then we can wean them off of that-- So the machine is doing the oxygenation work for the patients.

Correct.

Okay.

So.

And it's been a it's been an aspiration here for, for, for a number of years.

And we brought the program up on January 31st of this year, along with, Ivan Garza, who's our director of, well, and a very large team of people who are specially trained to take care of a patient that circuit Doctor Lasky and I are two what are called attending ECMO specialists We also have, two attending ECMO specialist and pulmonary critical care as well that work with us.

And then we have 24 nurses or a respiratory therapist who have experience in ICU.

That contribute.

-- So talk through what type of patient this would be.

So you said earlier that someone who's lungs or their lungs are either damaged or I don't know if this is a lot for little tiny, itsy bitsy ones whose lungs aren't really developed yet.

But are there types of patients?

Well ECMO has been around - adult ECMOs What we're talking about know it has broad application in children's, in children and neonates.

Well, a bit of a different.

Yeah, that's exactly where my head went to.

But yeah.

So it's, it's, it's been well recognized as a, as an effective, modality for a good many years for things that are unique to, to that population.

Now, from a trauma perspective, it's patients who have significant chest injuries, patients who develop pneumonia or adult respiratory distress syndrome as a consequence of their injury or as a consequence of pneumonia that we simply cannot safely oxygenate without further damaging the lungs.

By using what we would describe as high pressure ventilation.

The lungs do not like to be, ventilated.

With high pressure.

You get over distinction of the little air sacs, and that causes scarring and fibrosis and.

while we can ventilate them ten years after we get them off the ventilator.

We see, but fairly fixed incidence of a pulmonary fibrosis that requires lung transplant.

So we don't want to do that.

So having the ability to put them on an ECMO circuit and let their lungs rest, so that we don't have to, to, to ventilate them at high pressures in order to oxygenate them or ventilate them at all.

Has been shown to, to improve survival.

If you look at the, the European literature, patients who were put on a VV or veno-venous circuit for, for injury, about an 85% chance of surviving.

Now, if we had to ventilate a certain number of those patients, the injury to the lung or ability to even ventilate them.

Yeah.

Without ECMO we think of Covid every time I hear ventilation, and that's one of the things.

Yeah.

Brought it back.

Okay.

That was one of the things that that made ECMO in the model that we used to deliver ECMO different prior to, to Covid, prior to my experience with where ECMO started in 2009, in North Texas, during the H1n1 flu, epidemic in Texas, we developed a program in North Texas, and so I had some experience coming back here.

There was an interest in setting up the ECMO program here.

Well, thank you sir We, which were able to do again with, with with, a lot of people involved.

Nice.

Very intensive.

Yeah.

It's amazing.

I can't even.

Yeah, I'm just trying to picture it too.

And you say what it brings to me is like when you give the lungs a rest.

I mean, that just you can almost picture that being the case is let me do the oxygenation for you.

And you kind of hang out for a while.

- -When you put someone on ECMO, They pretty much live in the hospital.

Oh, at least the first day or two.

It's just so intense.

Yeah, there's a crew of people we'll have a third surgeon joining us, or some more pulmonologist coming, tell he we're the the closest ECMO center outside of El Paso is I always I always love to tell people that.

- -The the closest ECMO center, outside of El Paso is in Chihuahua, Mexico Oh, wow.

So, that and then the next closest after that, it's 270 miles away in Albuquerque, and then 365 miles away in Lubbock.

In the past, many of our patients who required ECMO would be transferred to San Antonio to performing medical center with your medical center in San Antonio.

They would bring a crew in.

They would canulate or put cannulas in that allows us to drain blood off and then return it.

After it's oxygenated and put the patient on a plane and fly them back to San Antonio So we were joking actually, before the show of thinking about if we were able to access shows from 28 years ago, just what is so different now between then and what will be different.

Doctor Tyroch, I would love for you to talk about the Burn Center, and I know, I know, there's money.

I know there's politics, there's bond issues, there's this, there's out, there's bond issues done.

Thank goodness.

But, but there are always patients.

Yes, there are always patients.

And I would love to bring you in too, did we have a children's burn care unit here or I don't know - -The nearest burn center's in Lubbock You know what?

We had a program where somebody came down from Lubbock and we had a program about that.

But it was years ago.

And I'm looking at you guys.

I remember the little tiny ones that all the photographs were there, but talk to talk to all of us.

The excitement that's going to be happening I mean burn unit, it's so again that's time, right?

You have an extra hour of transporting someone when they're burnt first degree burns, etc.. Talk about why this is so important.

First of all, burns are trauma.

It's a type of traumatic injury.

We started talk about Jacob's control and the CEO and I started talking about this in 2017.

This is how long it took to get this rolling.

So we talked about it and Covid world hit us.

And then we realized we don't have enough beds to do a burn center.

Right.

So that's why the bond was so crucial to give us more ICU beds.

Give us more, ability to actually do a burn unit right, even though we're not a burn center.

Now, for the last four years, we averaged about 80 to 100 burn patients that meet American Burn Association criteria to go to a burn center.

But we try to keep them here because Lubbock is so far away.

So we've been managing about 75% of those patients.

But this now will allow us to actually take care of bigger burns more critically in our burn patients.

We actually have a burn director coming.

Doctor Fiedler will join us in late summer.

We get all those paperwork done, which takes forever nowadays.

But he will help lead that effort with the trauma surgeons.

It's like, once again, it's not just the trauma surgeons, the plastic surgeons, the therapists, etc.

he's going to be very busy educating all of us how to really take care of a major burn patient and throw out some, some examples of, of burns.

You know, I'm thinking, let's think about the the Metro bus.

Oh my gosh.

Yeah.

Where they had to go to Phoenix.

They were going to go to Lubbock.

But Lubbock, the weather was too bad.

So they had to go to Phoenix.

And we faced that multiple times where we've had major burns and we say, let's go to Lubbock.

But especially in the winter time, the weather's so bad, the planes can't fly, you can't go, you can't use a helicopter, it's too far away.

So you have to do what we call fixed wing.

But if the weather's bad, we can't get them there.

So we had to manage them for days.

Sometimes.

So when you have, If you're saying we have 80 people in your burn, I know burn unit what we're doing, well, we'll be utilizing it.

Most of the burns are actually outpatient.

Okay.

Where they'll come in, we'll take care of in the emergency room, maybe something quick in the OR, and they go home the next morning or so.

But there will be some that will stay in the ICU.

Okay.

Yeah.

Okay.

But this this will allow us to keep these patients here in El Paso because we've seen we bring them to Lubbock.

The family goes with them and they have no place to stay.

And then how do they get back to El Paso?

Right.

And we actually did with Doctor Griswold who's running the burn center there.

We do have a Tela burn clinic with Texas Tech and Lubbock and UMC Lubbock, so they can see the major burns when they're coming back here when they're repatriated.

But this will allow more and more patients to stay in this area.

It's one of those things if you build it, they will come.

Yeah.

So we know that's one of my biggest fears.

It's going to grow too fast, but you'll have an option of it.

And that's going to be it's a good thing.

Yeah.

So if you look at the top 30 cities in the country, there's only two other cities that don't have a burn center, the top 30 population.

We're one of them.

And the other ones are very close to a burn center.

We're not.

Right.

So it's something the region deserves it.

Yeah, yeah.

It's time.

Just like ECMO, it's time For ECMO.

- -We have, It's time for I like that.

We have about ten minutes left, and it goes by super fast.

But one of my favorite questions, that I like to ask is usually what's coming up in the forefront.

Trauma is different.

So, the question is, what is it that you all have had to deal with?

I'm gonna ask all three of you the exact same question, and I feel like I want to ask you first because you haven't gone for a while, but that puts onus on you that that's not fair.

But in your your world of working as a trauma doctor in the medical world, what have you seen that you've been able to fix, for the lack of a better word that has been life changing?

That's literally one of the questions that I have.

What has impacted your life so much?

Because I feel like this, this type of medicine is like, boom, like what?

What can that be?

I'm going to let anyone take it.

Who wants to take it first?

Ladies first.

Oh, that's mean.

But its pedes too, right?

I can imagine there's there's quite a few really lovely stories there.

Yes.

Yeah.

There.

Well, you know, one of my recent patients, reminded me of a lot of things.

Even though I've been doing trauma for a really long time.

You get a sense, when someone comes in, whether you think they're going to live or not.

You know, and this was a kid that got just torn up in a motorcycle collision, and, I didn't think he'd ever walk again, let alone live or survive to make it out of the hospital.

But the day he showed up in my clinic, walking, smiling, going back to school with a bouquet of flowers, I had to step out of the room because I teared up.

I thought, this is why I do what I do.

Yeah, and he's going to have so many more life years ahead of him.

He may go to college.

He's interested in medical things now.

His mother's a nurse.

She came back.

She's.

We've recruited her to UMC.

So you recruited her.

So she's now.

Oh, I didn't recruit her, but she liked what she saw when she was when she was, at our facility.

So it's always good to get another, talent to come in another a new professional, to our facility.

And, we love to see that.

We want to see people move on and move up and, so he he was good for me because he, he taught me that old lesson that I had learned before and forgotten that I'm not a higher power.

I work for a higher power.

And, that some people that you think are going to, are going to pass are going to are they're going to live.

- -And how old was he?

He was only 16.

He was 16 when this happened.

Okay.

And then look how that came.

Full circle his mom is now working in the.

Yeah.

And you know and here he is, you know, not even 18 yet having another birthday.

Oh this is recently?

Yeah.

--This is very recent.

And finally here he is back to back to life again okay.

And kids will surprise you.

That's the wonderful thing about young traumas, trauma's a disease most of the time of the young, a lot of our trauma patients are under 44 now.

We have all these extremes of age as well.

But a lot of our trauma patients.

Trauma is not what people think it is.

It's not, it's not drunk people that come in all the time.

I love that you said that trauma is not what people think it is.

So as a doctor, as medical professionals, trauma includes what in your mind, not in the mind of what everybody else is thinking.

Trauma is you and me driving to work.

Trauma is somebody trying to get up on a ladder at their house, at whatever age or, trauma may be?

A kid out on the sports field, trauma is everyday activity.

And, and it's and it's all ages.

It's all ages.

And it's something that can happen in a split second and then changes their life.

you were just talking about someone who you said you're working last night and somebody fell off of a horse and there were two people that fell off of a ladder.

And I think you said there were nine people in the E.R., the - -And then one guy got stabbed - oh and one guy got stabbed.

But to your point, it's something that none of us foresee.

Yeah, it's just something that.

And that's why it's called trauma.

I'd love to hear what what you all have experienced.

And, I don't know, I think these are things that the audience will leave going, and stories that they'll remember.

Well, I can tell you a couple stories.

One was actually just recently happened.

I was in a meeting with some other people, and this gentleman walked by.

He goes, you don't remember me?

He works.

He works at the hospital.

And I go, you look familiar.

I was like, trying to stall as I figure it out.

He goes, I was a trauma patient.

20 years ago.

You took out my kidney, accidentally got stabbed by some guy, and on Doniphan.

Oh, geez.

Here he is now.

He said, you know, the only thing he.

I was going to make people look at me.

That's the first time I seen him, I. I completely forgot about the gentleman.

And they by day.

And they're never going to forget your face.

Yeah, yeah.

My other one is actually, what, a trauma patient.

But I was going to see a trauma patient.

And as I was going to see this patient was a level two trial patient.

This lady came in in cardiac arrest.

She was 23 weeks pregnant.

And I had to do a what we call perimortem C-section, which means doing a cesarean delivery.

And I remember pulling this baby out that was 23 weeks and looked like this.

And to be honest, it was pretty scary looking.

He look like an alien.

I'm thinking, oh my gosh, what did I bring into this world?

And this kid's now 23 years old, but mom didn't know I could.

But we knew that.

That's why it was a perimortem-- right.

Yeah, but right now, we got a 23 year old.

I lost track of her.

But I still think of her every year because she's, like, four months younger than my daughter.

Oh my gosh.

Yeah.

It was in January in 2002.

Now that's a story that I don't know.

I don't think I've ever heard a story like that.

Yeah I think about that myself, we all have stories like that.

Goodness.

Doctor Mercer?

I feel like its like jujujuju and then we'll add some.

But I've been doing this for a long time.

And you know, I go to get togethers and some people say, 'describe your worst trauma case.'

And I go, that's, that's not what this is about.

And let me switch gears a little bit, because I think all of us deal with patients as individual, and we deal with a lot of them, and we develop a relationship with them individually.

But the other piece of trauma is the development of systems that allow us to prevent injury and prevention.

Nicely said.

-And that it's not just one patient.

It's a population like our ATV initiative and trying to get helmets for, for for bike riders and kids, and burn centers.

And ECMO.

The ability of us, as trauma surgeons to be involved in the creation of systems of care that benefit people, like trauma centers and make sure that our trauma centers are open and ready and readiness is a big is a big issue.

That's that's what allows us to to deal with the mass casualty events as infrequently, fortunately, as they are.

So and we're involved in that.

It's just not the individual patients that we have contact with that we have good results and sometimes not so good results.

But systems of care that that we recognize have the ability, if done well and done with our input, have the the likelihood of improving larger numbers of patients and in fact, entire communities.

And one of the questions I wanted to ask, and we sort of prepped it earlier, is the stuff that you all learned after the mass shooting at Walmart.

And I, we don't have time to go into it.

That's a whole nother thing.

But but I can I can almost imagine we learned this.

We learned that we didn't do this right.

But now we, you know, that is a whole nother gamut of things.

And I cannot thank you guys enough for being here.

I want to tell the audience really quick in case you just tuned in, or if you are interested in the other programs at the El Paso County Medical Society.

Does trauma shows are always so interesting because we always run out of time because we get stuck on something like the blood.

We can talk about blood the entire time.

But there are several places that you can rewatch this program.

One is PBS El Paso, and that is a .org, because that is a, nonprofit organization.

But PBS El paso.org and just find the wording the El Paso Physician on there You see the logo on there.

You can access this program.

And the programs at the El Paso County Medical Society does.

And that being said, the El Paso County Medical Society website, that acronym is epcms.com and then also YouTube.

You can go to YouTube and just look up the word of the El Paso physician.

And for the most time I'll do it and it will be immediately whatever the last program is that's on.

So, if you want to watch these programs again, do that.

And you may notice that we are filming in a historical home.

This is the Turner home, and it belongs to the El Paso County Medical Society.

Doctor Turner, lived here and then donated it.

But it's a Trost built home, so we're going to be here for quite some time.

We appreciate you joining us.

Again, this program has been 'what happens inside a level one trauma center.'

And that's what you can look up when you're looking for this program.

Thank you so much for joining us.

I'm Kathrin Berg and this is the El Paso physician.

The El Paso County Medical Society is a nonprofit organization established in 1898 that unites physicians to elevate the health of the El Paso community.

We have been bringing the El Paso Physician Television program to your home for the last 27 years on PBS El Paso.

If you should have any medical questions relating to this program, you may email us at EPMEDSOC@aol.com.

And we will try to have our experts answer your questions.