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EMT Gets a Patient's Perspective on Trauma Care



It’s hard to imagine a worse case of mistaken identity. Chaun Williams, 27, a St. Louis City emergency medical technician (EMT), was doing his laundry at a University City laundromat one evening last summer.

After leaving to run a quick errand, he returned for his clothes. As he was getting out of the car, he heard footsteps quickly coming up behind him and saw the flash of gunfire. He ran but didn’t get far. Falling between two cars, he heard more gunfire and managed to call 911 before he passed out.

When he awoke, he was riding in the back of an ambulance. This in itself wasn’t unusual for the EMT. But this time, Williams was the patient, having had the misfortune of being mistaken for someone who looks like him and drives a similar car.

As the University City EMTs gathered the standard information from Williams, he told them he was having trouble breathing, that they needed to decompress his chest and that he himself was an EMT.

When the ambulance reached Barnes-Jewish Hospital, Williams was rapidly deteriorating. Brian Fuller, MD, was the attending emergency room physician on call. “He was clearly critically ill from a number of gunshot wounds. At the time, we didn’t know how many, but we did know he had collapsed lungs,” says Fuller. Bilateral chest tubes were inserted and a quick ultrasound of Williams’ heart and abdomen was completed. It showed a lot of bleeding. “We got large-bore IV access started immediately to help with resuscitation including fluids and blood transfusions,” says Fuller.

Williams was hypotensive and in shock. His blood pressure was dangerously low but the ED team didn’t give him medication to raise it. According to Fuller, Williams was allowed to be permissively hypotensive, which means that instead of giving a patient medication and excessive fluid to raise his or her blood pressure, the trauma team works to resuscitate the patient maintaining a lower blood pressure. “For a patient like Williams with a hole in a bleeding vessel, it helps that they are a little hypotensive because it keeps the blood clot intact, creating less of a chance of re-bleed,” says Fuller.

Literally minutes after Williams came through the Barnes-Jewish ED, he was on his way to surgery. John Mazuski, MD, was the trauma surgeon on call and was assisted by Matthew Porembka, MD, chief surgical resident at the time. Still in dire condition in the operating room, Williams' heart stopped beating briefly, causing the team to defibrillate his heart and perform CPR. Mazuski and Porembka performed what is called damage control. “We stopped the bleeding but didn’t close the wounds. We then sent him to the surgical intensive care unit (SICU) with the sole purpose of keeping him alive,” says Mazuski. During the nearly 24 hours that Williams was in shock, the team continued the resuscitation and worked to stabilize him.

Williams’ care truly was a team effort. Two days after he was brought in, Robert Southard, MD, closed Williams’ chest and repaired his colon. A day later, Bradley Freeman, MD, closed Williams’ abdomen in his third and final operation. Porembka assisted in all of Williams’ surgeries and Fuller, who has a dual appointment in emergency medicine and critical care, treated him while he was in the SICU. Doug Schuerer, MD, and John Kirby, MD, cared for him in the ICU. Schuerer discharged Williams almost three weeks later.

Although multiple physicians and nurses cared for Williams while he was at Barnes-Jewish, the common denominator was the trauma multidisciplinary model of care reflecting best practices during the entire chain of survival. “The EMTs who brought him to the hospital did the right thing by getting him here as fast as possible. They didn’t stop to start an IV or to intubate him, providing him access to definitive care as soon as possible,” says Fuller.

The team also credits Williams for playing an integral part in his own recovery. “Chaun was young, healthy and in great shape to begin with. This went miles toward helping to make him better,” says Fuller. Mazuski, too, was amazed with what Williams was able to do. “Usually for a patient with these types of injuries, it takes six to nine months to fully recover. Chaun was an extremely determined young man,” says Mazuski.

Williams was back at work in two and a half months. Initially, he was frequently short of breath but now says he is as capable as he was before the shooting. After his experience, he feels he can relate to his patients even more. “I was an EMT for several years before the shooting but now I know the very personal feeling when it’s your emergency.”

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