On television, nothing at a hospital is ever dull. Ambulances are always careening up to the emergency room door. Doctors are always screaming instructions at nurses. Life always hangs in the balance.
Of course, it's really like that only rarely. But at Children's Hospital, when an emergency arrives, life really does imitate television. My associate, Rob Graettinger, studied one recent trauma case that Children's handled. His report:
"At approximately 4 p.m. on March 9, 1981, 4-year-old Michele Pultz fell out of the front door of a van being driven by her father and was accidentally run over in the parking lot of Hampton Mall in Prince George's County.
"Suffering massive head, chest and abdominal injuries, she was rushed to Doctors' Hospital in Lanham, where she underwent preliminary treatment to stabilize her condition. Doctors there soon determined that she needed more specialized care. They arranged to have her transferred to Children's Hospital.
"Dr. Martin Eichelberger, director of the trauma service at Children's, was visiting with a patient when a red beeper/speaker fastened to his belt buzzed three times. Immediately afterward, the device announced that a trauma victim had just been brought to the emergency room.
"At Children's, the trauma service brings specialists from several sections of the hospital and forms them into a quick-response emergency medical team trained to deal with serious injuries.
"By the time Eichelberger arrived to deal with Michele Pultz, the emergency room was alive with activity. Surgeons, anesthesiologists, pediatricians, intensive care specialists and nurses converged on the 'code room,' a special section of the emergency corridor, immediately to the left of the emergency room entrance. In most cases, staff have only two minutes to reach the area before preoperative briefings begin.
"The code room contains all equipment necessary to resuscitate, diagnose and begin preliminary treatment of trauma victims. But when Michele Pultz arrived, Eichelberger said, 'we thought for a period of time that there was nothing that we were going to be able to do. Both sides of her lung had collapsed and she was showing signs of infection.'
"Normally, Eichelberger said, the staff has only a few minutes to decide whether a patient will be going to the intensive care unit (ICU), operating room or to radiology for more esoteric X-rays. But the seriousness of Michele's case made it apparent immediately that she would be going to the ICU.
"According to Michele's mother, Denise, when Dr. Eichelberger finally emerged from the code room, he gave the parents a concise description of Michele's medical situation and explained the necessary treatment.
"After that, Mrs. Pultz said, 'we would see him twice a day . . . He was always very clear.' The nursing and support staffs were equally helpful, she said. They wanted you 'to understand each aspect of the procedure.'
"While waiting outside the code room, Mrs. Pultz remembers being impressed with the staff's evident cooperation. 'It makes you feel better just sitting there,' she said. 'They would always help each other out to get ready for the next person coming in . . . They were so loving with each kid -- no matter what your problem was or who you were.'
"Michele was in intensive care for three weeks before transferring to a regular hospital room. She was discharged three months later. Although she had to undergo one more round of surgery, she can play today in a way no one dreamed possible nine months ago. According to her mother, 'she goes all day.'
"The care the hospital took to explain things to Michele's parents reflects its policy of bringing families into the rehabilitation process. At Children's, 'we don't just rehabilitate the youngster, we rehabilitate the whole family,' Eichelberger said.
"In many ways, the techniques used in Michele Pultz's case were developed on the battlefields of the 20th century.
"The most dramatic advances in treatment, Eichelberger said, occurred because of the rapid transportation systems developed in Vietnam. 'The helicopter accelerated our ability to triage,' or assign an appropriate priority level to the care of each patient, Eichelberger said. More effective trauma care at Children's, including arrival of trauma patients by helicopter, is 'one of the most positive things to come out of Vietnam,' he said.
"The tragedy of accidents with injuries is always magnified when the victim is a child. In cases where the accident is life-threatening, split-second decisions can have lifelong implications for the child and family.
"Children's is one hospital where split-second decision making is part of the 'trauma system.' In the case of Michele Pultz, the speed of the system helped avoid tragedy."