Dr. Howard Champion was sitting at his desk in his small fourth floor office in the Washington Hospital Center when his conversation was interrupted by a piercing whistle from a loud speaker:
"Code yellow! ETA 5 minutes, Code yellow! ETA 5 minutes. Code yellow! ETA five minutes."
It was 3:37 p.m. Tuesday. By the time Champion had walked down the four flights of stairs to the hospital's ground floor emergency admitting area, a 13-member "code yellow shock team," part of Washington's first Shock Trauma Service, was already assembled, wainting for the gunshot victim orginally scheduled to arrive within five minutes.
While many hospitals would have emergency room staff waiting for a similarly injured patient, they would not have the uniquely trained staff waiting that comprises the new Washington Hospital Center code yellow team:
An attending surgeon - either Champion or some other senior surgeon with extensive trauma experience.
A team leader who is either the hospital's senior surgical resident or post-residency fellow in surgery, either of whom would be fully experienced in chest and abdominal surgery.
A third-year or senior surgical resident, two second-year surgical residents and a first-year surgical resident.
A specially trained operating room nurse.
A specially trained intensive care unit nurse.
An anesthesiologist, a respiratory technician, a respiratory therapist, a cardiovascular technician and an emergency room technician.
The goal of the program, said Champion, is getting the resources of an intensive care unit "to the acute patient" as he enters the hospital. Standing in the center of the hospital's surgical intensive care unit, of which he has been director since July, Champion said, "We're bringing the resources used here to the front door of the hospital."
Champion was formerly associate clinical director of the Maryland Institute for Emergency Medicine, known in both the Washington and Baltimore areas as the Shock Trauma Unit.
The Baltimore unit is a separate facility, attached by corridors to the University of Maryland Hospital. While it draws upon specialists within the university hospital, it does not share facilities or basic personnel.
The new program at the Washington Hospital Center, by contrast, is totally dependent upon existing hospital facilities and staff, enabling the hospital to launch the program with virtually no new costs.
Since the new service went into operation on Washington's birthday, less than a month ago, it has already admitted 23 patients. Only one of them has died.
Nine of the patients arrived at the hospital by helicopter, as do the vast majority of patients at the Maryland State Police medivac helicopters that service the Baltimore unit, and four arrived by U.S. Park Police helicopter.
The use of helicopters, said Champion, a staunch advocate of regional cooperation in the field of emergency medical services, puts the new program within "a three or four-minute flight of any point on the (Capital) Beltway."
The patient brought into the unit Wednesday afternoon turned out to be a 26-year-old Washington man shot in the side with a .38 caliber revolver.
Although he was brought into the special two-bed admitting area used only for the most critically injured and those in shock - the patients whom the program is intended to aid - it turned out he did not need the special care.
He was still conscious while the team worked on him, attaching the leads to machines to monitor his heart and braething and assessing his general condition. He was not in shock, his vital signs were stable, and he was soon transferred to the hospital's general surgery service, rather than to the shock trauma service.
In another case, a patient was picked up by a D.C. Fire Department ambulance Wednesday morning "because he was feeling a bit dizzy and weak," according to Champion.
"By the time he got here he had vomited a little bit of blood and he had no pulse and no blood pressure," Champion said. "He had a code yellow response. It took us about 15 minutes to resusciate him to a normal pulse and blood pressure, identify that he had massive" internal bleeding "and get him up to the operating room.
"He (had) no history of trauma, and he is a nontrauma patient that benefited from this service. He would normally have died in an ordinary emergency room setting. He would have had a code blue type resuscitation for a cardiac arrest, and sometimes internal hemorrhage with no available history hust goes unnoticed.
"The system is set up so he got a massive transfusion of uncross-matched blood and everything a trauma patient would have gotten.
"It's taken us eight months to set up the system and train the personnel" to provide this service, said Champion.
The Baltimore unit is geared exclusively toward caring for trauma and shock patients, but the new Washington service takes a variety of patients who can benefit from the type of treatment normally given only trauma patients. Those include any patient in shock following an injury or blood loss, any patient brought in by helicopter, any patient with burns over more than 20 per cent of the body or with gunshot wounds and any patient suspected of bleeding internally.