2024 Trauma Report A Reminder of Miracles
The University of Tennessee Medical Center’s Level I Trauma Center works daily to advance trauma care in East Tennessee and beyond. As the only Level I Trauma Center to receive verification from the American College of Surgeons in our region, we are committed to performing at the highest level of care for our patients and their families. We offer comprehensive care, beginning with the first responders and continuing after discharge with physical therapy, support services such as the Trauma Survivors Network, and other vital resources. Our hard-working and humble providers are committed to the best outcomes for our patients, regardless of their ethnic background, gender or social situation. This report acknowledges the Emergency and Trauma staff and their unwavering dedication to their community. Acknowledgments
Changing of the Guard
Brian Daley, MD, FACS, MBA, FCCP, CNSP
Under the guidance of Brian Daley, MD, FACS, MBA, FCCP, CNSP the Trauma Center met new goals and achieved national accreditation. Daley, who is stepping down from his role as Trauma Medical Director in 2025, has held that position since 2010. During his tenure Daley held roles with organizations that, through funding or lobbying, impact Trauma Centers around the state. This included serving as chair of the Trauma Care Advisory Council, under the Tennessee Health Facilities Commission. When asked what he enjoyed most about his role as Trauma Medical Director, Daley pointed to guiding the medical center to verification as a Level I Trauma Center under the American College of Surgeons. This is the highest designation available in the country. What’s next for Daley? “Taking on other leadership roles at the medical center and state to continue improving quality across the spectrum of care,” he said.
Theresa Day MSN, RN, CCRN Trauma Program Manager
Brian J. Daley, MD, MBA, FACS, FCCP, CNSP Professor, Department of Surgery Program Director, General Surgery Chief, Division of Trauma and Critical Care Department of Surgery
Reagan Bollig, MD, FACS
Reagan Bollig, MD, FACS, will take over as Trauma Medical Director when Daley steps down. Bollig, Assistant Professor in the Division of Trauma and Critical Care Surgery, has been a surgeon with the medical center for more than a decade.
Table of Contents
A Reminder of Miracles....................................................................4 Celebrating 10 years of the Zimbabwe Nursing Project..........6 Trauma Survivors Network..............................................................8 UT Medical Center’s PTSD Protocol .............................................9 Leadership......................................................................................... 10 Surgeons ............................................................................................11 Trauma Services Program Staff ..................................................12 Trauma Registrars and TSN Staff................................................13 Trauma Patients by County of Residence..................................14 Making the Most of Life.................................................................16 Pastoral Care ...................................................................................17 Causes of Traumatic Injury............................................................18 Arrivals and Hospitalizations.......................................................19 Trauma Admissions and Visits ...................................................20 Trauma Patient Distribution ........................................................21 Trauma Center Statistics ...............................................................22 SBIRT Program .................................................................................23 Trauma Patients 55 and Older ...................................................24 Injury Prevention .............................................................................25 Organ Donation ..............................................................................26 Guardian Angel ...............................................................................27
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A Reminder of Miracles
A Reminder of Miracles In 2022, Jason Lanzilotta was using his tractor to move a 1,500-pound pole off of a trailer for a barn he was building on his Cumberland County property. The pole slid off the hooks and fell.
Jason and Jennifer Lanzilotta with their family
to my brother, ‘Don’t worry. You did everything you could. It’s in God’s hands now.’” But the first responders acted quickly and decisively, meeting every obstacle thrown at them. The first task was to control the bleeding. A military blood clotting drug called TXA had just been cleared for civilian use but hadn’t yet made it onto the ambulances. But, that morning, UPS delivered a box of TXA to the head of the county’s EMS training service. He was able to get it to the scene, where the team gave it to Jason. Because his pelvic artery was severed, even with the TXA, Jason was in danger of bleeding out. He needed nearly eight pints of blood, and the ambulance didn’t have enough to transfuse him. The TXA bought him enough time to stop at a nearby hospital for a pit stop. The first responders worked with UT LIFESTAR to meet them where they could safely clear a landing zone. The team drove Jason 26 miles where UT LIFESTAR picked up Jason and transported him to the medical center.
“I saw the tractor jump and knew it was coming,” Jason said. He tried to push the pole away, but it dropped on top of him. It crushed his pelvis, fractured his spine, damaged his bladder, liver and spleen and caused massive internal bleeding. Lanzilotta, a Security Police Officer at a nuclear plant, called 911. The dispatcher recognized him, because she knew Jason’s brother, Rick, a sergeant in the Sherriff’s department. The dispatcher called Rick, who happened to be three minutes away from Jason’s location. “That never happens,” Jason said. “God knew my brother would keep me alive long enough for the medics to get to me.” At the same time, Jason’s wife, Jennifer, a nurse, had a premonition that something was wrong, so she and the kids were already driving to the property to check on him. “My brother and my wife were with me before the first responders, and they were able to get an ambulance out quickly,” said Jason. When the EMTs arrived, the first responders paged the medical center’s aeromedical helicopter, UT LIFESTAR. But in an unexpected twist, the helicopter wasn’t flying to that area due to windy conditions. “I knew, without the helicopter, I was going to die, because of the internal bleeding. So, I told my wife and kids goodbye, and I said
Almost three years after his accident, Jason is back at work full-time as a Security Police Officer.
Star of Life Award EMS and UT LIFESTAR
The first responders on scene worked together in extraordinary ways to save Jason’s life. “They had all these hurdles,” Jason said. “No helicopter? No way to stop the bleeding or get me more blood? Whatever got thrown at them, they figured it out. They refused to take ‘no’ for an answer.” As a result, these emergency responders, including members of UT LIFESTAR, received the Star of Life Award from the Children’s Emergency Care Alliance. The Alliance recognizes exceptional front-line care across eight EMS regions in Tennessee. “I was able to walk into that ceremony and personally thank them for not giving up,” Jason said.
Pelvic Fractures
Alexander Cavalea, MD, FACS, works in Trauma, General Surgery and Surgical Critical Care and is an Assistant Professor of Surgery at the medical center. “Jason suffered a severe pelvic fracture called an open-book fracture, where the pelvis splits down the middle so it opens like a book,” he said. According to Cavalea, recent research shows these fractures have a 20-30 percent mortality risk due to the hemorrhaging associated with them. Because of Jason’s internal bleeding, the Trauma team gave him multiple blood transfusions in addition to what he’d received on his way to the hospital. “We also placed an endovascular balloon called a REBOA through an artery in his leg, which fed into his heart and stopped the bleeding,” Cavalea said. A pelvic binder closed Jason’s pelvis and decreased the hemorrhaging even more. After that, the team was able to surgically repair the internal bleeding. “I believe the REBOA and the transfusions saved his life, because it let us streamline his management and control his bleeding,” Cavalea said. “The pelvis is notoriously difficult to control hemorrhage in surgically.” Nearly three years later, Jason is back at work full-time as a Security Police Officer. He’s also finishing the pole barn he’d been working on the morning of the accident. He said, “This was a good reminder about miracles and how strong love can be—and how God makes these unexplainable things happen.”
Fracture Types
Your pelvis is the ring of bones between the spine and legs. It supports the hips and spine, helping to anchor the muscles and protect the organs inside the lower abdomen. Pelvic fractures occur when one or more of the pelvic bones breaks.
UNSTABLE FRACTURE Two or more breaks in the pelvis where the ends of the broken bones don’t line up. STABLE FRACTURE One break in the pelvic ring where the ends of the bones still line up correctly. OPEN BOOK FRACTURE A severe, unstable pelvic fracture where the pelvis separates in the front, causing the ring of bones to open up like a book.
Common Causes
• Car or motorcycle crashes • Osteoporosis (fragile bones) • Athletic activities
• Crush accidents • Falls
By the Numbers
Percentage of pelvic fractures in overall pelvic injuries
3%
Percentage of open pelvic fractures Percentage of deaths from pelvic fractures Percentage of deaths from open fractures
5-16%
2-4%
20-30%
Percent of patients over 65 who die from a pelvic fracture
20%
Jason suffered a severe pelvic fracture called an open-book fracture, where the pelvis splits down the middle so it opens like a book. He stayed at the medical center more than three weeks before returning home to start physical therapy.
Nationwide average percent of admitted trauma patients with pelvic ring fractures
8.5%
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A Reminder of Miracles
Since 2015, team members from the Emergency and Trauma Center have traveled to Zimbabwe to train medical care workers in partnership with the Rotary Club of Knoxville.
In 2015, three nurses from the Trauma Services department traveled to Bulawayo, Zimbabwe to begin a nursing education project that now celebrates its 10th year. Celebrating 10 Years of the Zimbabwe Nursing Project
2015 The medical center partnered with the Rotary Club of Knoxville to send three medical center nurses, Theresa Day, RN, Niki Rasnake, RN, (no longer with the medical center) and Deborah Tuggle, RN, to Bulawayo, Zimbabwe. The team taught an Advanced Trauma Life Support course (ATLS) and an Advanced Trauma Core Nurse course (ATCN) to nurses at the St. Philips Nursing School. Day, Rasnake and Tuggle did a lot of preparation before arriving in Africa so that their work was able to start as soon as they arrived. The learners came from countries in and around Zimbabwe, had preregistered and were ready to begin their course. The first course identified a few of the best learners as having instructor potential. The team trained these learners and then mentored them through teaching their first class, giving them the skills they needed to continue teaching nurses after the medical center team returned home. Day, Rasnake and Tuggle were joined by two trauma surgeons from the medical center, two other physicians from the Knoxville area and three from South Africa to help as instructors. This was the first time Zimbabwe and South Africa had entered such a joint venture.
2015-2018 Over the next three years several courses were held marrying courses at the medical center with courses held in Africa. These courses were held via ZOOM so the learners in Africa and the learners at the medical center were able to attend the courses as one. During this time, the instructors trained during the first visit were able to conduct the skills stations and proctor the exams. 2018 Trauma Services nurses Day, Tuggle and Gigi Taylor, RN, returned to Africa to provide another set of in-person courses much like the 2015 visit. At the conclusion of the second visit the team was part of a first-time ever, formal signing ceremony to complete the Memorandum of Understanding between Zimbabwe and South Africa to continue with the trauma training courses through the American College of Surgeons. 2025 In February 2025, Day, Tuggle and Rebecca Layne, RN, returned to Zimbabwe to conduct another group of courses, including an instructor course. This was needed as many of the instructors from the first course retired or moved out of the area.
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A Reminder of Miracles
Attendees of the Fundamentals of Critical Care Support course, a joint program between the medical center and St. Philips Training Center in Bulawayo, Zimbabwe
A team leader, trained as part of the medical center’s outreach program, instructs a class.
Our goal was to credential the leadership in Zimbabwe and South Africa, so they were able to hold any future instructor courses on their own. Many positive things have happened as a result of the partnership between the country of Zimbabwe and Trauma Services. There have been 20 ATCN courses and over 250 nurses and doctors trained in trauma care from that region. Shortly after the first courses in Zimbabwe, there was a bombing at a government building. Because of the training received during the course, the medical staff were better able to care for the injured and no lives were lost. St. Philips School of Nursing in Bulawayo, Zimbabwe has been certified as the national training center and is currently the only such center in all of Africa. The country of Zimbabwe has mandated that all physicians practicing in that country must now have taken the ATLS course.
In April 2024 the team held the first-ever joint Fundamentals of Critical Care Support course between the medical center and St. Philips Training Center in Bulawayo, Zimbabwe. This course is supported by the Society of Critical Care Medicine and provides health care professionals the training to manage the critically ill patient. The medical center has offered this course for many years. However, this is the first time it has been offered in real time, internationally. The team used Zoom to allow learners at the medical center and in Africa to participate together. It was a success, and the team held a second course in January 2025. The medical center has also been contacted by Cape Town, South Africa to consider coming their to do exactly what they were able to do in Zimbabwe.
The Univesity of Tennessee Medical Center and the Knox County Health Department partnered to bring SAIL classes to East Tennessee seniors. Are you looking for a way to SAIL to better health and prevent falls at the same time? Join the Knox County Health Department and the medical center for the fun, popular strength and balance classes, Stay Active and Independent for Life. This evidence-based program for older adults focuses on building endurance, strength, balance and flexibility. These classes feature fun instructors, lively music and exercises to keep attendees strong and independent. Debi Tuggle, RN, CEN, Injury Prevention Coordinator, is the SAIL Coordinator for the medical center and provides administrative support of the SAIL program. “This evidence-based program is designed to prevent falls,” she said. “It includes exercise classes, educational materials and self-assessments.” Rachel Frazier, Public Health Educator for Fall Prevention, said, “Our participants are stronger, have better balance and feel better. Our goal is to help people stay independent, active and prevent falls, and our instructors are experienced and skilled.” Call 865-215-5175 for more information, including finding a class near you. SAIL: Build Strength and Balance
Trauma Survivors Network
The Trauma Survivors Network, or TSN, is part of a national community of patients and families who are looking to connect with one another and rebuild their lives after a serious injury. The TSN website provides a place for trauma patients and their loved ones to connect with others and get the information they need to help rebuild their lives. You can visit the website at traumasurvivorsnetwork.org for more information and to connect with other survivors. The TSN provides the following programs: Peer Visitation Former trauma patients and caregivers are trained to be peer visitors. Peer visitors volunteer their time to visit patients and their families in the hospital and share experiences from the road to recovery after a serious injury. Peer visitors can answer your questions from the perspective of someone who has been there. This year we continued phone peer visits to provide support for patients who have discharged. Snack and Chat Family and friends of patients currently admitted to our Trauma Center are invited to take time to relax, have a snack and learn more about the emotional impact of trauma. Mobile Snack and Chat occurs at 10 a.m. on Thursdays with TSN going to 7, 9 and 10 East to serve trauma patient family and friends. Survivors Support Group, Let’s CHAT This is a general support group for trauma survivors that is held the first Tuesday of the month. The support group is a hybrid of in-person and virtual starting at 6 p.m.
TSN’s outpatient support group, Let’s CHAT, provided monthly hybrid support group opportunities to trauma patients and families during 2024. The medical center’s TSN group promoted the national TSN program’s monthly support group by providing additional care. Elizabeth Waters facilitated a national TSN support group during September with 10 participants from the United States and Australia. In 2024, the medical center’s program supported 500 patients, with 19 percent receiving follow-up visits. During the initial visit patients and their families receive any resources or information they may need, in addition to the Trauma Patient Handbook, a brochure about the TSN program
For more information about TSN programs please contact the TSN coordinators at 865-305-9970 or TSNCoordinator@utmck.edu.
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PTSD Protocol: Progress Over Time
Growing the PTSD Program PTSD screening went live in January 2018 with trauma patients scheduled for follow up visits to the trauma clinic utilizing the PTSD Checklist (PCL-5), which is a self-report questionnaire with 20 questions, to be completed by the patient during their visit to the trauma clinic. Completed questionnaires are then collected and scored by the BI Social Worker. If a patient scores a 31 or higher the BI Social Worker will reach out to the patient and discuss the screen and any concerns or needs for further help. Patients who score at risk for PTSD receive a follow-up call and are rescreened at 30, 60 and 90 days after the initial screen. In 2019, the Trauma ICU Pilot Expansion was implemented to reach more trauma patients who could potentially suffer from PTSD. Trauma ICU patients must be in the ICU for four or more days and fit into at least one of the following categories: • Injuries in two or more body systems (ortho, neuro, trauma) • Psychopathology (death involved in the traumatic event,
Acute Stress Disorder
Acute Stress Disorder (ASD) symptoms persist for a minimum of three days and last no more than one month.
Intrusion
Negative mood
Dissociative symptoms
Avoidance
Arousal symptoms
Post-Traumatic Stress Disorder
PTSD symptoms begin within a month of the trauma but sometimes can begin years afterward.
suicide intent, substance use) • CRRT, ventilator or dialysis use • Have the flu, C. diff, lice or COVID
Re-experiencing
The Trauma Services PTSD Program has been successful in providing resources and referrals for treatment to trauma patients who are at risk for PTSD. With continued review of the PTSD protocol in 2024, TSN became more involved with in-patient dissemination of PTSD information and resources for trauma patients.
Avoidance
Changes in arousal and reactivity
Changes in cognition and mood
TSN provides an informational resource letter to trauma patients who meet the following criteria:
Trauma Services has been able to meet trauma patients and their families using the TSN to address ASD symptoms. The American College of Surgeons supports efforts to screen and refer trauma patients with PTSD symptoms. In 2018, efforts to identify and address PTSD symptoms experienced by trauma patients began with follow up from the Brief Intervention Social Worker (BI Social Worker) and trauma patients were able to talk with someone and be linked to resources for treatment.
• Follow-up from TSN • Received a peer visit • Received a Pastoral Care consult
• Expressed interest in additional emotional support Those patients will also receive a three-month follow-up letter with the PTSD Checklist to complete and return to the BI Social Worker for scoring and follow up.
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A Reminder of Miracles
Leadership
Medical Director
Associate Medical Director
Vice President
Medical Director
Heather Tiftickjian, MSN, RN, NEA-BC Emergency, Trauma, Critical Care, UT LIFESTAR
Brian Daley, MD, FACS, MBA, FCCP, CNSP Trauma Services
Reagan Bollig, MD, FACS Trauma Services
Heath R. Many, MD, FACS Trauma Surgical Critical Care
Trauma Multidisciplinary Liaison Team A multidisciplinary trauma peer-review committee was formed to include liaisons from all the subspecialty groups that are involved in trauma care. This committee meets monthly to review all aspects of trauma care, including systematic review of all mortalities, significant complications and process variances associated with unanticipated outcomes. Our goal is to improve patient care, including prehospital care, acute care issues, post-discharge requirements as well as outreach and injury prevention.
First Row J. Doug Keller, DO Trauma Anesthesia Liaison William E. Snyder, Jr., MD Trauma Neurosurgeon Liaison Brian M. Tonne, MD Trauma Orthopaedic Surgeon Liaison Second Row J. Michael McCoy, DDS Trauma Oral and Maxillofacial Surgery Liaison Jeffrey W. Cloyd, MD Emergency Department Liaison
Steven P. Knight, MD Trauma Radiology Liaison
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Surgeons
Brian J. Daley, MD, FACS, MBA, FCCP, CNSP
Davis P. Berry, MD
Reagan Bollig, MD, FACS
Alexander C. Cavalea, MD
Jacob D. Edwards, MD
Justin D. Gerard, MD
John E. Griepentrog, MD
Devin Gillaspie, MD
C. Lindsay McKnight, MD, FACS
Kyle C. Lange, MD
Hannah M. Nemec, MD
Heath R. Many, MD, FACS
Todd A. Nickloes, DO, FACOS, FACS
Lou M. Smith, MD, FACS
Stephanie E. Scott, MD
R. Frank Roberts, MD, FACS
Acknowledgments • Department of Oral and Maxillofacial Surgery • Department of Radiology • Department of Surgery • Division of Plastic Surgery • Neurosurgical Associates
• Ryan J. Green, DO, FACEP • Benjamin T. Bevill, MD • Thomas J. Christianson, MD • Ralph C. Brooks, MD
• University Anesthesiology • University General Surgeons • University Orthopaedic Surgeons
• TeamHealth • UT LIFESTAR • Pastoral Care
A Reminder of Miracles
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Trauma Services Program Staff
Theresa Day, MSN, RN, CCRN Trauma Program Manager
The Trauma Program Manager is fundamental to the development, implementation and evaluation of the Trauma Program. In addition to administrative responsibilities, the Trauma Program Manager must show evidence of educational preparation, certification and clinical experience in the field of trauma care. Key responsibilities include: organization of performance improvement activities; management of the trauma registry; and coordination of outreach education and injury prevention activities at the community, state and national levels. Debi Tuggle, RN, CEN Geriatric Trauma Coordinator/Trauma Performance Improvement Coordinator The Injury Prevention/Pediatric Trauma Coordinator is instrumental in the development, implementation and evaluation of the pediatric trauma service and injury prevention in our community. Key responsibilities include: coordinating pediatric trauma performance improvement programs and participating in education and outreach programs, including injury-prevention programs.
Kelly McNutt, BS, RN, CEN, TCRN Trauma Performance Improvement Coordinator
The Trauma Performance Improvement Coordinator’s primary responsibility is to monitor and continually improve structures, processes and outcomes within the institution in collaboration with the Trauma Medical Director and Trauma Program Manager. The reports generated support a number of functions, including performance improvement activities; development of research projects for publication and presentations at national meetings; and providing information to support legislative and educational initiatives, which impact the safety of our community.
Gigi Taylor, MSN, RN, TCRN, CEN ATLS and FCCS Course Coordinator
As part of our mission to provide trauma education to physicians, we offer Advanced Trauma Life Support and Fundamentals of Critical Care Support services. The Course Coordinator oversees the offering of these classes throughout the year. They are attended by providers locally, regionally and from across the nation. Sarah Dills, BSN, RN, TCRN, CEN Trauma Outreach Coordinator The Trauma Outreach Coordinator plays a significant role in ensuring that the Trauma Center serves as a community and regional resource. Outreach programs are an integral part of Trauma Center services, designed to help improve outcomes from trauma and prevent injury through public and professional dissemination of information. They also facilitate access to the clinical and educational resources of the Trauma Center. Kayla Henson, MSSW Brief Intervention Social Worker The Brief Intervention Social Worker is responsible for the Screening Brief Intervention and Referral to Treatment programs for substance use and Post-Traumatic Stress Disorder. Key responsibilities include: conducting assessments and providing brief interventions to trauma patients who screen positive for risky behavior or are at risk of developing PTSD; building and maintaining partnerships with area treatment programs, and following up with trauma patients with additional resources. Dani Crowe BSN, RN, CEN Pediatric Trauma Coordinator/ATLS Coordinator/Injury Prevention The Pediatric Trauma Coordinator/ATLS Coordinator is instrumental in the development, implementation and evaluation of the pediatric trauma service, in addition to providing trauma education opportunities to physicians and advanced practice providers across the state and beyond. Key responsibilities include: coordinating pediatric trauma performance improvement programs and coordinating multiple ATLS course offerings throughout the year.
Trauma Registrars and TSN Staff
Becky A. Kali, RHIT, CPC, CSTR/Lead Registra r
Yaritza Huichapa, RHIT, CCS-P
Vicki Harness, CSTR, CCA, CAISS
Linda Bushong, RHIT
Jan Ely
Karen Jenkins
Mandi Finchum, RHIT
Tiffany Garrison, RHIT, CPC
Traonna Smith, RHIT
Ellie McCammon, RHIT
The Trauma Registrar is an integral member of the Trauma Center. Trauma registry data is abstracted and entered by the Trauma Registrar. Trauma registry data is used internally in the continuous performance improvement process at the medical center. Data is reported to the National Trauma Data
Bank and the Tennessee State Trauma Registry. High-quality data begins with high-quality data abstraction and entry — it is the trauma registrar who performs this task and then analyzes the data and prepares it for distribution in its most useful format.
The TSN is a national program developed by the American Trauma Society. It helps trauma patients and their families connect with one another and rebuild their lives after a serious injury. The TSN coordinators at the medical center act as liaisons for patients and their families, introducing them to the program and giving them access to resources aimed at helping them rebuild their lives. The TSN is a free service to trauma survivors and their families. Trauma Survivors Network
TSN Development Coordinator Elizabeth Waters, LAPSW Submits and manages grant proposals for foundation and corporate sources
TSN Clinical Social Worker Haley Carver, BSSW Serves as a point of contact for program participants and office and clinical support personnel
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Trauma Patients by County
Robertson
Stewart Montgomery 3
Sumner
1
Lake
7
Trousdale
Obion
Henry
Weakley
Cheatham 3
Houston
2
Davidson
Wilson 6
1
Dickson 1
Benton
16
Dyer
Humphreys
Gibson
Carroll
1
Williamson Rutherford
2
6
Crockett
Hickman
Laurderdale
Henderson
Maury
Perry
Madison
Haywood
1
Decatur
Lewis
Bedford 2
Tipton
Marshall
1
Chester
Moore
Shelby
Hardeman
Lawrence
Fayette
Hardin Wayne
Giles
McNairy
1
2
1
Lincoln
2
Referring Hospitals Appalachian Regional Healthcare (Kentucky) Ascension Saint Thomas Highlands Hospital
2
Lake Cumberland Regional Hospital (Kentucky)
1
1
LeConte Medical Center
368
Big South Fork Medical Center Blount Memorial Hospital Bristol Regional Medical Center
77
Lee County Community Hospital Lonesome Pine Hospital (Virginia)
1
282
2
1
Methodist Medical Center
163
Claiborne Medical Center
89
Middlesboro ARH Hospital (Kentucky) Morristown-Hamblen Healthcare System
64
Cookeville Regional Medical Center Cumberland Medical Center Dickenson Community Hospitall East Tennessee Children’s Hospital
5
226
282
Newport Medical Center
96
1
North Knoxville Medical Center
137
3
Other
89
Erlanger
1
Parkwest Medical Center Rhea Medical Center Roane Medical Center
106
Fort Loudoun Medical Center
103 131
1
Fort Sanders Regional Medical Center Greeneville Community Hospital
83
6 4
Starr Regional Medical Center - Athens Starr Regional Medical Center - Etowah Sweetwater Hospital Association Turkey Creek Medical Center
106
Hancock County Hospital
25
Hawkins County Memorial Hospital Holston Valley Medical Center
1
167
2
72
Jefferson Memorial Hospital Jellico Community Hospital Johnson City Medical Center LaFollette Medical Center
79
2
14
105
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2
Hancock
Clay
Sullivan
Claiborne
Johnson
Hawkins
Scott
16
17
185
Campbell
117
39
Overton Fentress
201
115
Grainger
Union
Washington
6
Carter
108
Hamblen
91
8
5
Greene
245
1
Morgan
Putnam
14
Anderson
33
Unicoi
87
Knox Jefferson
274
4
275
Cumberland
Cocke
2005
White
257
173
Roane
11
Sevier
206
Loudon
531
Blount
215
Bledsoe
Warren 2
583
6
Meigs
Rhea
26 45
Monroe
McMinn
274
1
172
Polk
Hamilton Bradley
13
7
13
1
Trauma Patients’ Home States Alabama
20
North Carolina North Dakota
88
Arkansas
7 6 2 4 2 2
1 1 1
Arizona
Nebraska
California Colorado
New Hampshire
New Jersey New Mexico
5
Connecticut
1
Delaware
Nevada New York
2 9
Florida Georgia Hawaii
73 53
Ohio
46
2 4
Oklahoma
2 2
Iowa
Oregon
Illinois
14 42
Pennsylvania South Carolina South Dakota
15 33
Indiana Kentucky Louisiana
258
1
7 4 7
Tennessee
6,444
Massachusetts
Texas Utah
16
Maryland Michigan Minnesota Mississippi Missouri Montana
3
20
Virginia
57
2 7 7
Washington
1
Wisconsin
5
West Virginia
14
1
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A Reminder of Miracles
Caleb Limbaugh Making the Most of Life
In May 2023, 16-year-old Caleb Limbaugh was riding in the bed of a friend’s pickup truck. Going 65 in a 30, the truck hit a culvert and flipped. Caleb was ejected from the truck bed and landed in the middle of the street. The crash broke his spine, snapped his wrist and caused a traumatic brain injury. Once Caleb arrived at the medical center and the medical team evaluated him, they realized that they would need to do a craniectomy. That’s a surgery where part of the skull is removed to take pressure off the brain. The skull is not immediately replaced, but left off until the brain has healed. Richard Boyer, MD, a board-certified neurosurgeon with the medical center, did the craniectomy. No surgery was needed for the spinal injury. Instead, Caleb wore a brace until his spine healed. A couple of weeks after entering the medical center, Stephanie Scott, MD, a general surgeon, performed surgery to repair Caleb’s wrist.
In 2023, 16-year-old Caleb Limbaugh, a football player at Halls, was thrown from the back of a pickup truck and suffered broken bones and a traumatic brain injury
About a month into his recovery, Caleb, who wore a helmet to protect his head, went to Shepherd Center in Atlanta to receive treatment. He attended PT daily and, after two weeks at the center, he was jogging on his own. By August, Caleb was back home, and in September, Boyer reattached his skull, so Caleb could leave the helmet behind. In January 2024, Caleb went back to high school on a part-time basis. His driver’s license was reinstated a year after his accident, and now he drives himself to school and to work out daily. Now 18, Caleb plans to go to Pellissippi State Community College and continue his education. “Caleb suffered some short-term memory loss at first, but his recovery has been nothing short of miraculous,” said his mom, Jaime Limbaugh. “Now, you’d never know to look at him that he’d been in an accident. He’s making the most of his life.”
Caleb underwent a craniectomy to take pressure off his brain and allow it to heal.
Why It’s Dangerous To Ride in the Bed of a Pickup Truck According to Tennessee Traffic Safety, more than 200 people die each year as a result of riding in the cargo bed of a pickup truck. More than half of these deaths are children or teenagers. Pickup trucks are not designed for people and offer no protection during a crash. Here’s what makes them dangerous: • No safety restraints • Riders are exposed to elements, road debris and carbon monoxide • Passengers can more easily be thrown from the truck According to one study riders are three times more likely to be killed in the open bed of a pickup than in the front seat. To be safe, ride inside the truck and wear your seat belt.
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Craniectomy
A craniectomy is a major, life-saving surgery where a physician removes part of the skull to relieve pressure on the brain.
It is used to treat:
Swelling
1 2 3
Performed to relieve pressure on brain
Stroke
Traumatic Brain Injury
Bone flap surgically removed
Blood Clot
Hematoma
Bone flap not put back right after surgery
Pressure
Pastoral Care Pastoral Care chaplains are a presence at the bedside, but that’s just the beginning of what this highly skilled and educated team offers. Their calming presence also helps keep patients and families centered, whether they’re in the high-paced and stressful environment of the Emergency Department or receiving an infusion at the Cancer Institute. As core members of the trauma team, our chaplains work with physicians and nurses to determine how to best care for patients and their families. When team members need support, Pastoral Care offers that, too.
Dexter Mims Director
William Bean Staff Chaplain
Natalie Riley Staff Chaplain
Ben Lewis Staff Chaplain
Coy Callicott Certified Educator
Craig Katzenmiller Certified Educator
Lisa Casey Coordinator
Leah Ryan Staff Chaplain
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A Reminder of Miracles
Causes of Traumatic Injury
1.7%
2% 1%
2%
6.6%
3%
3%
4%
6%
Injuries Blunt vs. Penetrating
Causes of Traumatic Injury 52% 21%
6%
Stab Wound Pedestrian ATV Assault GSW Other Blunt Motorcycle Crash Other MVC Fall
91.7%
Other Penetrating Blunt
Injury Severity Score
To meet Level I Trauma Center criteria, annual trauma admissions must equal at least 1,200 patients or 240 patients that have an injury severity score (ISS) of more than 15. This is a scoring system that applies a numerical value to a patient’s anatomical injuries. In 2024, Trauma Services at The University of Tennessee Medical Center admitted 1,257 patients with Injury Severity Scores greater than 15, which is more than five times the national requirement for a Level I Trauma Center.
Trauma Patient Distribution by Injury Severity Score
Top Three Mechanisms of Injury by Age Group
ISS
# PATIENTS
AGE
1
2
3
Other Blunt ATV/MCC MCC MCC MCC Other Blunt
1,551 2,273
Falls Falls Falls Falls MVC MVC
<8 8-15
MVC* MVC MVC MVC Falls Falls
Minor Moderate Serious Severe Critical-Maximum
0-13 14-17 18-25 26-45 46-65 >65
760 417 39
16-24 25-40 41-75
*Motor Vehicle Crash **Motorcycle Crash
18
A Reminder of Miracles
Arrivals and Hospitalizations
.4%
.1%
1%
4%
3%
8%
8%
46%
40%
9%
16%
Transport From Scene of Injury to Hospital
Disposition After Leaving Emergency Department
L&D Interventional Radiology Death Transfer OR ICU Home Floor
39%
25.5%
Other Helicopter Private Vehicle UT Lifestar Referring Hospital Ambulance
Units of Blood Used Units of Blood Used
4,000
3,000
2,000
1,000
0
2014
2015
2016
2017
2018
2019 2020 2021
2022 2023 2024
19
A Reminder of Miracles
Trauma Admissions and Visits
As a Level I Trauma Center, the medical center is required to have general surgeons, Emergency Medicine physicians, Intensive Care physicians and anesthesiologists in house at all times. Other specialists and a full range of equipment must also be available 24/7 year-round. On-Call Specialists Top Three Groups Receiving the Most Consults
Oral and Maxillofacial Surgery
Orthopaedics
Neurosurgery
Specialty
3,414
1,134
2,128
Consultations
2,116
837
103
Operations
Patient Distribution By Day of the Week
1,065
1,056
974
959
995
1,205
1,048
Trauma Volume and Admissions Per Year Total Admits Total Volume
6,830
5,980
5,535
5,167
4,473
4,378
4,017
3,894
3,821
3,489
2014
2015
2016
2017
2018
Trauma Patient Distribution
Gender Distribution
Patient Distribution by Hour of Day
7 AM 8 AM 9 AM
10 AM 11 AM 12 PM
1 PM 2 PM 3 PM 4 PM 5 PM
53.4% 46.6%
Patient Distribution by Month
6 PM
7 PM
8 PM
9 PM
800 700 600 500 400 300 200 100 0
10 PM
11 PM
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
Jan Feb March April May June July Aug Sept Oct Nov Dec
0
250
500
7,545
7,514
7,415
7,308
7,026
6,829
5,166
5,101
4,996
4,932
4,869
4,863
2019
2020
2021
2022
2023
2024
Trauma Center Statistics
1.7%
.3%
1.8%
2% 1%
2.2%
3%
4.6%
5%
7%
8%
8.9%
8%
Financial Distribution
Discharge Destination
Military HMO/PPO Self Pay Workers Comp Auto Other TennCare Commercial BCBS Medicare
11%
21%
LTAC Hospice
50.5%
53%
11.4%
Other Death Home Health Rehab Nursing Home Home
Nationally, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) program has served more than 450,000 individuals, with a 128% increase in the percentage of clients reporting they had not used alcohol or illegal drugs within the past 30 days between initial screening and six-month follow up (SAMHSA.gov). Fast Facts
Trauma Patients Distribution By Age 2,000 1,000
900 800 700 600 500 400 300 200 100 0
<14
14-17
18-25
26-35
36-45
46-55
56-65
66-75
>75
A Reminder of Miracles
22
SBIRT Program
At some point each year, about 25 percent of adults in the United States drink too much, which leads to a higher percentage of injuries. The Screening Brief Intervention and Referral to Treatment, or SBIRT program, was developed to help identify, reduce and prevent problematic drug and alcohol use, health-related consequences, traumatic injuries and deaths. Approaching patients during the “teachable moment” of their traumatic incident provides a higher chance to bring awareness to their substance use and refer them to treatment. Research shows that SBIRT can reduce DUI arrests, health care costs and cut alcohol-related trauma incidents by up to 50 percent. Implementing this program with a universal screen helps Trauma Services identify the hazardous substance use patterns. Our Brief Intervention Social Worker, Kayla Henson, LMSW, implements the program so that the patients’ needs are not overlooked during their Trauma Center admission. All admitted trauma patients are screened for risky substance use, which includes drugs and alcohol. Admitted trauma patients who screen positive receive a brief intervention. The SBIRT program also has a community component to support trauma patients who are ready for change through the SBIRT Task Force. This group consists of community partnerships that provide resources and referrals for individuals in need of substance use treatment and mental health services. If the patient is interested in treatment upon discharge, they are then referred to an external treatment facility that is best suited for their needs. The Brief Intervention Social Worker provides educational material, connects patients with resources within the community, and helps patients analyze triggers and find coping skills. In 2024, the medical center’s SBIRT program completed a total of 522 screens with the SBIRT coordinator, conducting 351 brief interventions, placing 23 referrals for trauma patients committed to substance use treatment post discharge, as well as 350 educational resources to trauma patients and their families. It is the program’s goal to provide the best care to admitted trauma patients addressing the emotional effects of trauma.
Low-Risk Drinking Limits
Low-Risk Drinking Limits
Men
Women
No more than
No more than
On any single Day
3
4
drinks on any day
drinks on any day
**AND**
**AND**
No more than
No more than
14
7
Per Week
drinks per week
drinks per week
To stay low risk, keep within BOTH the single-day AND weekly limits.
Serving Size Recommendations
8-9 fl oz of malt liquor (shown in a 12 oz. glass) = =
=
12 fl oz of regular beer
5 fl oz of table wine
1.5 fl oz shot of 80-proof distilled spirits (gin, rum, tequilla vodka, whiskey, etc.)
about 5% alcohol
about 7% alcohol
about 12% alcohol
40% alcohol
Welcome to Our New Program Director
Kayla Henson Brief Intervention Social Worker Welcome Kayla Henson as our new SBIRT coordinator. Kayla graduated from UT College of Social Work with a master’s degree in 2019. She brings compassion to our trauma patients who are seeking assistance with recovery. Kayla enjoys following up with our trauma patients making sure they are receiving the care they need to be successful in recovery.
A Reminder of Miracles
23
Trauma Patients 55 and Older With people in the U.S. aging better and living longer, older adults are one of the fastest-growing groups in the country.. This has resulted in a steady increase in trauma-related admissions in this population. Consistent with patterns across the nation, at the medical center falls are now the leading cause of unintentional injury in the older adult population, accounting for almost 77 percent of the admissions. Numerous studies show an increase in death and disability in older adult trauma patients when compared to a younger population; therefore, it is imperative for older adults to be rapidly transported to a trauma center — ideally during the first hour. Minor Moderate Serious Severe Critical-Maximum
Injury Severity Score Age 55 and older
ISS
# PATIENTS
918 1,636 448 253 11
<8 8-15
16-24 25-40 41-75
2% 1%
1% >1% >1%
3%
>1%
3%
6%
7%
38%
9%
11%
Discharge Destination
Injury Patients 55+
10%
LTAC Other Hospice
GSW Assault ATV
77%
31%
Death Rehab
Ped. vs Car Motorcycle Other MVC Fall
Home Health Nursing Home Home
PERCENTAGE ADMISSIONS 55 AND OLDER
Total Admits
Admits 55+
6,000
59% 57.8% 59% 63% 65.6% 65%
5,000
56.8%
48.5% 49% 53.7%
4,000
47.5%
3,000
2,000
1,000
0
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
24
A Reminder of Miracles
5%
12%
Helmet Use by Motorcyclists
Though it may be unintentional, injury does not occur by accident. Trauma Centers have an important role in identifying injury patterns and risk factors in patients, families and communities. For many injuries, prevention is the best means of dealing with a public health problem. For adults and older children (who are big enough for seat belts to fit properly), seat belt use is one of the most effective ways to save lives and reduce injuries in crashes. But in 2024 only 70 percent of the patients involved in motor vehicle crashes seen at t the medical center wore seat belts at the time of their accident. Thanks to Tennessee’s universal helmet law and programs such Tennessee Motorcycle Rider Education Program, helmet use has increased. In 2023, 73 percent of motorcycle crash survivors at the medical center wore helmets. In 2024, that number rose to 83 percent. And according to the National Occupant Protection Use Survey, that number rose nationwide, as well, to 73.8 percent, the highest number ever recorded. However, there is still room for improvement and targeted injury prevention programs for motorcyclists. ATV riders who do not wear helmets are more likely to receive significant injuries to the head, face, and neck. Prevention strategies and enforceable helmet laws to increase helmet use among ATV riders are the most effective ways to save lives and reduce injuries in crashes. An alarming number of ATV enthusiasts do not wear a helmet while riding; in 2024 only 20 percent of the riders admitted to the medical center were wearing a helmet when their crash occurred. Injury Prevention Injury Does Not Occur By Accident
83%
No Helmet Helmet Unknown
4%
20%
Helmet Use by ATV Riders
76%
No Helmet Helmet Unknown
8%
22%
Seat Belt Usage by Adults
70%
No Seat Belt Seat Belt Unknown
25
A Reminder of Miracles
Organ Donation Update 2024 By the Numbers
Did You Know?
patients die every day waiting for a lifesaving transplant
person is added to the waiting list every 8 minutes
lives can be saved through one person’s organ donation
8
17
1
number of people waiting for a kidney transplant Organ Donation AT THE MEDICAL CENTER 308
175
68
organs recovered for transplant
kidney transplants performed
104,299 Number of people waiting for a transplant in the United States
2,765 Number of people waiting for a transplant in Tennessee
24,020 Organ donors across the country 48,137 Transplants completed in the United States
488 Organ donors in Tennessee
Transplants completed in Tennessee 1,371
An Extraordinary Commitment to Science, Health and Hope
Tennessee Donor Services (TDS) serves nearly 5.5 million people in Tennessee and Southwest Virginia. We are a team of professionals dedicated to saving and improving lives by connecting organ and tissue donors with patients who need them. We strive to extend the reach of each generous donor’s gift to those who are profoundly grateful for them. Our Work We are proud of our partnership with The University of Tennessee Medical Center. Our work together in 2024 resulted in 61 organ donors with 175 lifesaving organ transplants.
Core Values Our performance is measured by the impact we have on the lives of families who make transplantation possible, and the patients whose lives are saved and improved by their gifts. Each TDS employee commits every day to be selfless, hardworking, passionate and dependable.
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