I recently finished taking several depositions of defendant healthcare providers in a case involving a Level I trauma center hospital in the Dallas-Fort Worth Metroplex area. I have to admit that even after these depositions I’m still just as puzzled as to how and organize trauma team so thoroughly dropped the ball.
First, let me tell you about what happened that brought our client to the hospital.
Our client was driving on a DFW freeway when his brakes went out. To avoid endangering other drivers, he steered his car off the road and ended up crashing head-on into a tree. It was an intense crash that caused airbag deployment. Emergency medical service (EMS) estimated that the motor vehicle collision (MVC) was at a rate of speed of 65 miles an hour.
EMS rushed this patient to the nearest trauma center, calling ahead to the hospital’s emergency department (ED). The ED activated the trauma team so the necessary doctors and healthcare providers could make their way to the emergency room (ER).
Upon arrival at the hospital, EMS transported the patient to a trauma bay, where he was immediately seen by an ER physician, trauma surgeon, ER physician assistant (PA), and trauma PA. Three registered nurses and a lab tech were also immediately present to meet the patient, and a radiology tech and respiratory tech showed up one minute later.
The trauma surgeon testified at deposition that this hospital typically has an EMS timeout in the trauma area of the ER. This allows the EMS personnel to brief the trauma team on the trauma/collision, mechanism of injury, treatments, and patient response. In this case, the medical record reflects that there had been a car wreck against a tree at 65 miles an hour. The patient was restrained, airbags deployed, and the patient was able to walk at the scene of the accident. He was immediately assessed as alert and oriented and with no neurologic deficits.
Standards issued by the American College of Surgeons Committee on Trauma recognize the importance of prehospital (EMS trauma care). Good EMS documentation and handoff communications to the trauma team allow hospital trauma personnel to have an understanding of the event for the purpose of evaluating the potential for injuries. This kept the standards particularly recognize the unique situation of high-velocity mechanisms where the patient has minimal injuries. Trauma teams have to be on the lookout for patients with occult (hidden) injuries.
Research shows that over 1 million patients are treated annually in the United States for blunt trauma injuries events with the potential for cervical spine (neck) injury. Of those, a cervical spine injury is confirmed in about 2–10% of the cases.
To protect patients who may have a hidden cervical spine injury, the standard of care requires bracing or securing their neck with a c-collar until the cervical spine has been cleared by health professional.
Emergency and trauma medicine specialists have come up with different tools to assist emergency and trauma teams in evaluating whether diagnostic radiology is needed to clear his cervical spine.
The NEXUS criteria call for imaging to clear the c-spine if any of the following factors are present:
• Focal neurologic deficit: Any motor or sensory abnormalities
• Midline spinal tenderness: The middle of the neck is tender to the touch
• Altered level of consciousness
• Intoxication: This can be from alcohol or medications
• Distracting injury: Severe pain in one area the body that completely occupies a patient’s attention, to the potential exclusion of other areas
The Canadian C-Spine Rule recommends imaging for cervical spine clearance when any of these factors are present:
• The patient is over 65 years old
• Extremity paresthesia: An abnormal sensation like tingling, pricking, or pins and needles
• A a high-speed motor vehicle collision, rollover, or ejection
• A bicycle or motor of recreational vehicle collision
As you might have surmised, the Level I trauma center hospital failed to image our client, despite the fact that he met several criteria that required imaging to clear his cervical spine. He was in a head-one motor vehicle collision with a stationary object, tree, at 65 miles an hour. He reported taking muscle relaxants, which can cause a form of intoxication. He consistently reported a pain level of 10/10, had a broken scapula, multiple broken ribs, a lacerated liver, a lacerated spleen, and abdominal bleed.
Even more confusing is the fact that the ER and trauma team ordered CT scans of his head, entire back, and pelvis—but deliberately marked out the cervical spine. It’s hard to imagine what they were thinking.
According to the medical records, within two minutes of his arrival in the ER, a trauma team physician assistant (PA) cleared his cervical spine without imaging. As a result, his neck was not secured with a c-collar. The patient was taken to the operating room for surgery to address his abdominal injuries. When he awoke from surgery, he couldn’t feel or move his lower extremities.
In a second shocking system error, the patient’s complaints of loss of sensation and motor function in the intensive care unit (ICU). As a result, there was a delay in obtaining additional diagnostic imaging—this time of the cervical spine—and returning him to the operating room for decompression surgery.
Today, as a result of this negligence, this man is left in a permanent state of quadriplegia. We filed a lawsuit on his behalf because doctors and providers at a Level 1 trauma are held to a higher standard of care and should know better.
If you’ve been seriously injured because of poor hospital, emergency room, or trauma care in Texas, then contact a top-rated. Houston, Texas malpractice lawyer for free consultation about your potential case.
