Tucson Lifestyle — August 2011
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At The Highest Level
Gillian Drummond

The University Medical Center Level 1 Trauma Center has become known nationwide for exemplary lifesaving efforts. But what the public sees is only the beginning of what the team at the heart of the Center hopes to achieve.

In the field of trauma care, where every second counts, four years sounds like a lifetime. But when it comes to building up a hospital facility, four years is remarkable.

University Medical Center and the University of Arizona are understandably proud of how quickly UMC’s Trauma Center achieved Level 1 status, established a cutting-edge team of physicians and researchers, and carved a reputation as one of the nation’s best.

Rainer Gruessner, M.D., a German-born general surgeon with an interest in transplants and pancreatic, liver and bile duct cancer, took the post of chairman of UA’s Department of Surgery back in June 2007. At that point, the Trauma Center — one of the divisions he heads — had, in his words, “fallen apart.”

“Most of the center’s group of surgeons left in 2006 and 2007, and only one of them had stayed on,” he says.

It was Dr. Gruessner’s job to help reverse the brain drain and turn the facility into one that would be the envy of the nation. First on his list was to recruit a Trauma Center chief who had such a solid reputation and innovative ideas that he or she would lure other top people, too.

That person was Peter Rhee, M.D., a man whose face is now familiar to many as a result of his life-saving efforts on Jan. 8 following the attempted assassination of U.S.

Rep. Gabrielle Giffords, which left 6 dead and 13 injured. Dr. Rhee and one of his recruits, neurosurgeon G. Michael Lemole, M.D., were both thrust into the limelight as the hospital’s two designated spokesmen for the victims and, in particular, Rep. Giffords.

But although the public learned much about Rep. Giffords and her head injury, what they perhaps didn’t know was the tale behind the Trauma Center itself. Nor would they know that had the shootings happened four years ago the outcome might have been quite different.

“We would not have been equipped to deal with it,” says Dr. Gruessner. The right personnel were not in place. Building a department from scratch, “you have to have a vision as to where you want to go, and it’s important to have people that are like-minded,” he says.

Assembling The Team

Dr. Rhee, at the time recently retired from the Navy and with a wealth of battlefield trauma experience, was sold on two promises from Dr. Gruessner: the opportunity for research, and the prospect of turning the Trauma Center into a national, even international, player.

“It was University-based and about to be the only Level 1 Trauma Center in town,” says Dr. Rhee. “I thought with that combination of raw material I would have an opportunity to build this facility into one deserving of international fame and recognition.”

When he came to Tucson in September 2007, the Center consisted of Dr. Rhee and one other trauma surgeon. So for a time — and at great expense — the hospital would fly surgeons in from Phoenix, Los Angeles and New York to help.

But as the facility’s reputation grew, it piqued the interest of other specialists. “It’s a snowball system,” says Dr. Gruessner. “Suddenly people understand there’s something going on at UMC.”

Dr. Rhee says he’s on track with his growth plan, is happy with the results, and hoping for additional funding. UMC’s Trauma Center is ranked in the top five in the country in terms of survival rate, brief length of stay and low cost, he says. He is close to meeting his target of ten surgeons; numbers eight and nine start in August 2011. Within a year he wants to erect a burns center. He’d like to see a transplant center built too, a place that provides facial transplants, and for military personnel with amputations to have their limbs re-attached. And there are discussions about whether or not the Trauma Center should have its own free-standing tower.

A comprehensive trauma center, “is from resuscitation to rehabilitation,” says Kari Schlachtenhaufen, director of development for UA’s Department of Surgery. She points to the state-of-the-art Ryder Trauma Center at the University of Miami/Jackson Memorial Medical Center in Florida as the sort of facility the UMC’s Trauma Center aspires to. “They have trauma, ICU, operating rooms, a burns unit, laboratories, offices for the staff, a rehabilitation center and a trauma prevention center,” she explains.

There also is the hope that Dr. Rhee can establish an endowed chair, as happens at the likes of Harvard University, Duke University and Seattle’s University of Washington. This would free him up to do more research and lab work, rather than clinical. “It protects the academic specialists so that they can do innovative things rather than just turning widgets out in a factory,” is how Dr. Rhee puts it. However, an endowed chair costs $2.5 to $3 million, and so far the facility only has a donation of $25,000.

The Trauma Center costs $47 million a year to run, says Schlachtenhaufen. That Funding comes from three sources: a percentage of revenue from casino gaming in Arizona; health insurance payments; and charitable donations through the University of Arizona Foundation. But casino proceeds fluctuate; in 2011 Ms. Schlachtenhaufen anticipates a 20 percent reduction in casino money. The facility’s costs are pushed up because it treats many people who are under-insured or have no health insurance. And up until the start of this year there were no private donations to the center.

Added to that, nine out of every 10 grant applications are not being funded, and UMC is facing “multi-million-dollar cuts” in funding from the National Institutes of Health over the next two years, says Dr. Gruessner. “That’s a dire situation.”

Taking The Next Step

And so, having strengthened its team, the UMC’s Trauma Center is focused now on its own life support: public fundraising. In its favor are the spotlight that was shone on the facility after Jan. 8. That spurred some high-profile philanthropists in Tucson to form a charitable group to support the Trauma Center (see Friends and Fundraising, page 34).

As well as reaching out to the public, the facility is looking to other quarters to boost its income. Shlachtenhaufen is talking to venture capitalists about funding a products side to the business. She wants to interest companies in distributing products and medical services on the back of some of the research going on throughout the whole Department of Surgery. Commercializing patented products like this is nothing new, she says; all universities are looking for extra income this way. “At this point we’re simply briefing venture capitalists about the innovations and developments coming out of the Department of Surgery in the hope that long term there may be products that could be successful in business,” she says.

The good news for Tucson is that the brain drain has truly been reversed. “People realize our center is up and coming. They want to be part of something that’s on an upward trajectory,” says Dr. Gruessner.

“People asked me, ‘Why start from scratch?’ but in hindsight that was exactly what made it so attractive to me,” he says of building up the Department of Surgery.

“Rather than step into something that’s established, here changes could be implemented. I was able to completely change its direction.”

In the world of trauma and surgery, Tucson used to be “a revolving door” as far as staff was concerned, he says. And now? “Suddenly it has become a major player.”

All In A Day’s Work

Dr. Rhee never thought he’d have the same adrenaline rush he used to get as a surgeon with the U.S. Navy, where he not only dealt with mass injuries and penetrating wounds, but a lot in a short space of time. Sometimes during his time in Iraq, he would treat 200 cases in an hour.

Then came Jan. 8 and the shootings outside a supermarket on the northwest side of Tucson.

It began like any other Saturday off: with a six-mile run. Then he received the call about the casualties. He phoned his wife, asked her to get his scrubs ready, and ran home. And he called his staff to tell them to all stay put.

Usually at that time — mid-morning Saturday — the night shift is handing over to the new day shift. That meant that he had two full teams at the ready, plus Off-duty nurses, physicians, technicians and residents who willingly dropped everything to come from home to help.

Dr. Rhee arrived at University Medical Center just as the first victims were arriving. Dr. Randall Friese, associate medical director at UMC’s Trauma Center, was assigned to deal with Christina-Taylor Green, the nine-year-old girl who was shot. She was being treated with CPR on arrival, and presumed dead. Dr. Friese attempted emergency surgery, opening up her chest and massaging her heart, but it was too late.

Next Dr. Friese attended to U.S. Rep. Giffords. “It took me aback,” he says of seeing who he was treating. “I remember being shocked … this was surreal.”

Then, after seeing her vitals were stable, he left a chief resident in charge of her.

Meanwhile, Dr. Rhee was triaging, talking to families of victims, and taking calls from senior military personnel and White House staff who wanted to be briefed on the situation.

Battle Tested

In medical circles, it is generally accepted that the best trauma surgeons come from the military. And so it was with Dr. Rhee, now chief of trauma at UMC.

Korean-born and the son of a Peace Corps surgeon, Dr. Rhee spent 24 years in the military before retiring from the U.S. Navy. He moved to Tucson with his wife and two children in 2007.

He travels three or four times a month, and he and his surgeon colleagues regularly put in 80 hours a week. When asked where he grabs a nap, he nods to a modest sectional sofa in the corner of his office. “It’s a life that’s not understood by anybody else. One of the long-term goals is to have my profession in some way resemble normality,” he says.

The military life may be behind him, but it’s never far from his mind. The high number of casualties that occurred with alarming speed in Iraq and Afghanistan prepared him perfectly for heading up the UMC’s Trauma Center. And other things did, too.

Ten years ago, he took part in research into topical hemostatic agents that help stem bleeding. The resulting product — a gauze impregnated with an inert mineral that helps form clots in the blood — was first used during the Iraq War. Today, Pima County sheriffs carry the same sort of combat gauze. It was used on some of the shooting victims on Jan. 8.

“Of the people injured, four were treated with that combat gauze. There’s no doubt in my mind that the research I did 10 years ago is the reason the sheriffs were carrying that product,” says Dr. Rhee. And did it save lives that day? “I think it was a part of it,” he says.

Meanwhile, the shooting reunited him with a former college classmate — retired Army Colonel and top neurosurgeon Jim Ecklund, M.D. Dr. Ecklund was summoned to Tucson to help consult on the head injury to U.S. Rep. Giffords.

So for a few days in January, things came full circle for Dr. Rhee, who never dreamed he would encounter such violence in a place like Tucson, “about as nice and peaceful a community as you can get.“

But the man who was thrust into a media glare in the weeks following the January tragedy is happy to have the brouhaha die down.

Mild-mannered and modest, he is far from the “rock star” label given to him by some media outlets back then. He gets most excited when he’s talking about the future of the Trauma Center. “We are growing at a rate much faster than anybody had anticipated,” he says with a smile.

Suspended Animation: Stopping Lives To Save Lives

It sounds like something out of a sci-fi movie, but in fact to the medical community it’s nothing new.

Medical tests in which dogs and pigs have been put into a state of induced hypothermia — effectively putting their lives on hold — are several years old. Now, thanks to a grant from the National Institutes of Health, researchers at UMC are about to take this to the next level and test humans.

UMC will be one of six facilities in the country to take part in clinical trials on trauma patients that involve cooling their bodies down to very low temperatures.

The goal, says Dr. Rhee, would be to infuse the body with cold saline to stop the heart and brain.

This “suspended animation” would last for about an hour and a half, with the patient attached to a heart and lung machine, while surgeons repair bleeding vessels and organs.

“It helps preserve body tissue while you’re getting the blood under control,” he explains.

The ideal patients for the study are ones who have just died or are about to die from trauma to the chest or abdomen. And since 95 percent of those die under current circumstances, “there is not much to lose in trying another approach,” he says.

Friends & Fundraising

Two nights after the Jan. 8 mass shooting in Tucson, nine friends gathered at Tucson’s historic Arizona Inn for a birthday celebration.

The women meet on the same date every year, but in the shadow of the tragedy the mood was a little less celebratory than usual.

At the same time, at the request of Dr. Rhee, the hotel was putting up some senior military physicians and White House staff who had been flown in to consult with him.

Dr. Rhee and Dr. Randall Friese made their way over to the hotel, and as they walked into the dining room they received a standing ovation.

“We all stood up and applauded them,” says DeeAnne Gibbons, who attended the birthday party. The women offered to buy the doctors a drink but, still on duty, they refused. Instead, the surgeons sent wine to the ladies’ table.

And that would have been that, except this was no ordinary group of women but rather a collection of professional philanthropists. Among them they have raised Money for Angel Charity for Children, Steele Children’s Research Center and Casas de los Niños.

Says Gibbons: “The doctors came back and we all started talking. That’s when we found out that the Trauma Center really needed some help. We all said, ‘You’ve come to the right place because that’s what we do, we’re fundraisers.’”

The women set to work. They called friends, who in turn called their friends. They met. They brainstormed. And the Friends of the University of Arizona Trauma Center was born.

The group had its formal launch in April with a sold-out lunch at which Dr. Rhee and Dr. G. Michael Lemole spoke.

At press time, the group included around 50 members, and had raised $86,500. The next big fund-raiser is Oct. 22 — a M*A*S*H* BASH at Pima Air & Space Museum. Tickets are $250 per person. Information about tickets may be obtained by calling 626-2222.

For Gibbons, this effort is not just about the headliners from Jan. 8, but staff working at all levels in the Trauma Center. “They all work hand in hand. The trauma surgeons might be the ones in the news but they will be the first to tell you they don’t do it without that basic foundation.”

What Is a Level 1 Trauma Center?

UMC’s trauma center achieved Level 1 status in July 2009, following three years of construction that doubled the size of the hospital‘s previous Emergency Department and Trauma Center.

Level 1 status means the facility meets all the needs of a trauma patient (somebody who has been in an auto or motorcycle accident, a shooting, or has had a fall or blow to the head) and has up to 15 specialists.

UMC is the city’s and Southern Arizona’s only Level 1 Trauma Center; the next nearest is in Phoenix. Patients come from as far away as Show Low to the north and Nogales to the south.

UMC’s Level 1 Trauma Center: The Facts

• Southern Arizona‘s only Level 1 trauma center, treating around 5,000 patients a year

• 96.7 percent survival rate

• 88 percent of injuries are “blunt” trauma, from car/motorcycle/bicycle accidents, and falls

• 11 percent of injuries are “penetrating,” from gunshots and knives

• Busiest trauma program in Arizona, with patients from Tucson, Southern Arizona, Western New Mexico and Northern Mexico.

Source: U of A College of Medicine, Department of Surgery