Ryder is the only adult and pediatric Level 1 trauma center in Miami-Dade County and provides the following services to trauma victims:
At the Ryder Trauma Center at Jackson Memorial Hospital, patients arriving via ground or air rescue are rushed to one of five specially designed, newly renovated resuscitation rooms. Patients who arrive by helicopter on the center’s rooftop landing pad are carried by high-speed elevators to a resuscitation room in just 15 seconds. Awaiting patients in the Resuscitation area is a designated trauma team who remains in hospital and available 24 hours a day, ready to respond to the needs of those suffering severe traumatic injuries.
Rapid assessment and management of injuries is a critical factor in improving outcomes of trauma patients. Because of this, the Ryder Trauma Center is designed for rapid implementation of life-saving emergency treatments. Conveniently located in the Resuscitation area are radiology equipment, ultrasound machines, a new 64 slice Computerized Tomography scanner with a 128 slice CT scanning suite currently under construction. The proximity of these diagnostic modalities has been designed to provide critical information rapidly to the trauma team.
If the patient’s head or spine appears to be injured, the trauma team conducts a diagnostic scan to determine whether surgical treatment or medication is the best approach. The Neurosurgical team is also available in hospital 24 hours a day for consultation as their in-depth knowledge of brain injuries holds the key to successful treatment in most cases. The Neurosurgical team uses advanced techniques to monitor how much oxygen the brain is receiving and to induce hypothermia to minimize damage to injured brain tissue. Advanced technology and techniques are designed to improve the outcomes of those patients suffering a Traumatic Brain Injury or Spinal Cord Injury.
As the patient’s potential injuries are being evaluated by the trauma team, the center’s anesthesiologists are checking the airway for breathing obstructions or penetration wounds. Trauma nurses and physicians administer blood or other fluids and prepare the patient for surgery.
During the resuscitation phase, social workers at the center are called upon to help locate family members, provide emotional support to those injured during a traumatic event, assist staff members in communication with family, and help to identify unknown patients. Pastoral care, crisis and bereavement counseling are available 24-hours a day to patients, families and friends. If the patient belongs to a church or synagogue, the appropriate member of the clergy is contacted. The hospital’s pastoral team also offers spiritual care and counseling in keeping with a family’s values and cultural background.
The Ryder Trauma Center’s six operating suites are designed for multiple operating teams and equipment. One Operating Room is available at all times with an assigned team of anesthesiologists, nurses and scrub technicians to receive those patients requiring emergent surgical intervention. A team of surgeons can repair damaged blood vessels in a chest while a neurosurgery team works on a head injury, and an orthopaedics team re-sets a broken arm or leg. This multiple-team approach provides faster recovery times and promotes better outcome for patients.
Because low temperatures can be dangerous to trauma patients who have lost a significant amount of blood, the operating suites are equipped with special warm-air vents, warming blankets and rapid infusion devices that provide warm fluids – as much as the patient needs.
For patients who prefer not to receive blood, alternative care can be provided through Jackson Memorial Hospital’s Center for Bloodless Medicine and Surgery.
Because children tend to recover more quickly from injuries than adults, the Ryder team – which includes pediatric surgeons and pediatric intensive care specialists – usually takes a conservative approach, operating only when necessary. Head injuries are the most frequent cause of death in pediatric trauma cases; so pediatric neurosurgeons and neurologists play an active role in treating these cases.
The center’s trauma anesthesiologists are another integral part of the operating team. Since a patient who has lost a large amount of blood cannot be given the same dosage of drugs as a “normal” patient, the extra training and experience of the center’s anesthesiologists contributes to the team’s positive results.
After surgery, most patients stay in the center’s 25-bed, Trauma Intensive Care Unit (TICU), of which 5 beds are dedicated to critically injured burn victims. In addition to the ICU, a 18 bed Intermediate Care Unit for trauma patients has been added to the Ryder Trauma Center.
Two of the biggest concerns for trauma patients are infection control and nutrition. The center’s physicians and staff have developed post-surgical procedures that improve outcomes in both areas. For example, the types of common bacteria in the facility are monitored and cultured on a regular basis so that if an infection occurs, the proper combination of antibiotics can be provided immediately – rather than having to wait 24 to 48 hours for a new culture from the patient. Additionally, the (TICU) team at the Ryder Trauma Center has changed the way that daily rounds are conducted.
A mobile videoconferencing telemedicine system has been developed that allows the TICU team to watch a live video stream of the patient, view the vital signs on the monitor, see the settings on the respiratory ventilator and observe any patient wounds, all from a remote conference room. By utilizing telemedicine, the TICU team has maintained the educational value associated with rounds while reducing the spread of infection, due in part to a large number of healthcare personnel moving from bedside to bedside.
Trauma patients typically need 50 percent more calories and twice as much protein as a healthy person to rebuild their damaged bones and tissues. However, an injury to the throat, stomach, intestines or bowel may prevent normal feeding. These patients benefit from the center’s dedicated nutrition and metabolic support service team, which includes a medical director, nurse specialists, dietitians and a pharmacist.
Intensive 24 hour monitoring, assistance with bedside procedures and family support are provided by the specially trained ICU nurses. Serious wound care issues are also addressed by the center’s nurses. Because of the wide range and severity of injuries, nurses working int the TICU are experts in wound care and have access to the latest types of dressings, topical antibiotics and medications that promote wound healing.
All critically injured trauma patients are seen by occupational and physical therapists at Jackson Memorial Hospital. Range of motion exercises , assistance with walking and other supervised activities ensure that patients maintain the highest level of physical functioning possible while in an intensive monitoring environment.
Throughout the hospital stay, the social work team plans for discharge and helps the patient and family adjust to any lifestyle changes. As discharge approaches, the social worker coordinates ongoing care from community agencies, home health care and medical equipment needs as well as living situations and financial concerns. For patients who live outside South Florida, the social work team can make travel arrangements for the return home.
Rehabilitation services at the center are focused in three areas:
- brain injuries
- orthopaedic and spinal cord injuries
- pediatric injuries (age 16 and under)
Other types of rehabilitation therapy are provided through various Jackson Memorial Hospital programs and in the hospital’s free-standing rehabilitation center.
While rehabilitation generally begins as soon as the patient is stabilized, therapists may be called upon to evaluate a patient at an even earlier stage. Early intervention helps patients regain the maximum level of function as quickly as possible.
The center’s therapists assess the patient’s motor functions, ability to perform activities of daily living, communication skills and cognitive skills, such as memory and reasoning. Together with the center’s social workers, the therapists also evaluate the patient’s family resources, 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. A trauma patient who has suffered the loss of a hand, foot, arm or leg can also benefit from Jackson Memorial Hospital’s Orthotics/Prosthetics Laboratory, which fabricates or fits custom-made limbs and braces on the premises.
The Center’s neurological rehabilitation program helps brain-injured patients regain as many of their skills as possible so they can resume an independent life. Adult patients typically stay in the inpatient program for 30 to 45 days and a day treatment program is also available.
To provide ongoing care to trauma patients, daily outpatient clinics are held at the Ryder Trauma Center. These clinics provide continuity of care and allow the patient and family to return to a familiar setting for outpatient treatment, which may include post-discharge wound care, medications or other medical or rehabilitative services.