Has The Patient Been Forgotten ? WILLIAM B. LONG, PRINCIPAL ARCHITECT OF OREGON’S LEVEL-1 TRAUMA SYSTEM, THINKS SO There’s a certain joy when a first responder or surgeon helps someone become one of the unexpected survivors from a trauma incident. Bill Long has framed his entire career as a physician and surgeon around the simple notion that everyone, despite income level or situation in life, deserves high quality medical care when it is need- ed. In a time when priorities and politics are radically shifting the paradigm of quality care, he has devoted his retirement to sounding an alarm bell throughout the system to heed a warning so patients are not forgotten by the system built to care for them. Coming from a long line of medical professionals, Bill’s father, grandfather, and uncle (all were esteemed doctors in their own right) begged him to choose any other profes- sion than their own. They knew there was a distinct possibility that the harsh realities embedded in the current healthcare system would cause discomfort and deflect his long-term vision of hope. Over time and through significant training, he turned the odds in favor of the patient by becoming an international expert in trauma case sever- ity scoring and the opportunities to create a Level I Trauma Center at Legacy Emanuel Hospital in Portland, Oregon in 1982 and the Oregon Trauma System in 1988. As many medical professionals generally operate in “silos,” Dr. Long set a plan in motion to break down barriers to create a patient-first environment. “Look at how a hospital is designed by departments,” he explained. “Radiology is on one floor and surgery is on another, often widely separated. Time is of the essence.” Long designed a state-of-the-art trauma center adjacent to the ambulance bay and emer- gency department. He also trained emergency physicians and nurses to work as a team to diagnose a stable trauma patient within 20 minutes of arrival, Emanuel was the first hospital on the West Coast to have a dedicated emergency CT scanner in the new trauma center. Long then took his theories on the road. He created the mobile surgical transport team (MSTT) and armed first responders and rural hospital staffs with the knowledge on how to initially stabilize patients with critical need. “When you go somewhere in this region and are in need of care - we will come to your emergency department, stabilize you, and bring you back to our trauma center to fix you.” He further devel- oped a foundation that funded workshops to train doctors in rural hospitals on certain protocols and techniques for stabilization. Buy-in is easy once people answer one question: “Do you want this service for you if something happens?” Dr. Long’s commitment to the patient transcends that of a traditional health system architecture, which is built on a hierarchy of knowledge and expertise. He feels that those who are new to medical careers could use a clear refo- cus on the direction of individual practices. “Medicine can be lucrative,” Long notes, having received his fair share of patents and rewards for quality care along the way. “But, we can never lose sight of the most important reason why we choose this career - the patient comes first.” Long chose trauma as a career because he felt no one else wanted to take care of the patients with the highest need. “You cannot offer a certificate to practice thoracic surgery in three days,” he explained. “This requires mentorship, long hours, on-call commitments, and things that the medical professionals of tomorrow must re-learn as a matter of quality care.” He claims a system that should be designed to provide timely and effective care to pa- tients has become riddled with self-interest at all levels of health system management. “There should be no ‘profitability’ in ‘non-profit,’ he emphasized. Long references his desire for a denconstruction of healthcare administration to new patient care system based on service. In retirement, he commits his time to sharing knowledge from a career of more than 50 years dedicated to the “patient first principle.” He provides podcasts on the topic, will soon publish a book on his experiences, and is proactive about keeping the voice of the underserved at ‘top of mind.’ Dr. Long’s podcast is available online at: flatlinetolifeline.buzzsprout.com
William B. Long, III, MD FACS Trauma Medical Director (Ret) Legacy Emanuel Hospital
facts of trauma
Emanuel’s Trauma Program: 1. First hospital in the Pacific Northwest to:
a. Provide trauma fellowship, trained attending surgeons and anesthesiologists, and a trauma nursing OR crew to be in the hospital 24/7 to enable immediate surgery. b. Provide by contract with specific surgical specialists’ groups that each critical surgical specialist on call for that specialty would on call only for trauma and be in the trauma center within 30 minutes: Neurosurgery, OroMaxilloFacial Surgery, Cardiothoracic surgery, Orthopedic surgery, Vascular surgery, Urology. c. Educate and train nurses in the ER, OR, and ICU to be trau- ma specialty nurses or Trauma Resuscitation Nurses (TRNS) to stay with each trauma patient as the patient was moved from hospital department to department to document and provide continuity of care. d. Build a state of the art trauma center near the ED ambu- lance entrance, next to the trauma operating rooms, near the Emergency Department, and trauma ICU, and the satellite STAT laboratory and blood bank and cat scanner, e. Place a trauma dedicated trauma cat scanner in the new trauma center f. Direct to OR for unstable trauma patients. No surgery in the Emergency Department which is not an operating room. g. Create a Mobile Surgical Transport Team (MSTT) to fly to rural hospitals with patients too unstable to transport. h. Create a mobile blood bank to take with the MSTT to provide essential blood components which many rural hospitals don’t have i. Use a portable cardiopulmonary bypass machine to take with the MSTT to hospitals requesting assistance j. Develop a trauma CQI program for rural hospitals to help them address delivery of care. k. Training scholarships for rural surgeons and rural scrub nurses to learn how to work together as a team when using new technology and operating skills.. l. Establish a trauma training program for the Madigan Army Medical Center surgery residents to learn how to do mod- ern trauma care. m. Develop a multidisciplinary trauma CQI committee which in- cludes all surgical specialists, anesthesiologists and trauma nurses. 2. Develop the first western statewide trauma systems based on many of the principles described above.
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