Inside New England’s Busiest Trauma Center

MedFlight paramedics wheel the patient into the trauma bay. He is awake and lucid, his right leg elevated on ice packs. Blood seeps through the bandages below his knee. No case is ever the same at Boston Medical Center’s Trauma Unit, and today is no different. Paramedics allow the patient, a former emergency medical technician, to brief the staff.

He clears his throat. “Alright folks, is everybody ready?!” Lying on the trauma stretcher, he barks out the specifics of the incident (a fall from a 30-foot ladder), his suspected injuries (open tibia fracture and pain in the sacral region of his spine) and his detailed medical history (including a recent hip surgery). Everyone listens carefully to him and then to the paramedics, who provided pain medications en route, before snapping into action.

Tracey Dechert, MD, trauma and critical care surgeon, and Thea James, MD, emergency medicine physician, and a handful of nurses and emergency and surgical residents work swiftly to make clinical decisions. Orthopaedic Surgery is called, Radiology prepares to take images of his chest and pelvis, technologists are informed to keep a CT scanner open.


Staff from BMC’s trauma team review a pelvic x-ray of a patient suffering from multiple injuries after a fall from a ladder. BMC’s Level 1 Trauma Program has earned a reputation as one of the country’s finest.

Falls are the second most common cause of trauma seen at BMC, which admits more than 2,200 trauma patients per year. Collaborating closely with the emergency department, the trauma team (staffed around the clock), rapidly triages, admits and follows patients with complex multi-system injuries though their hospital stay.

“The trauma service is like primary care for critical injuries. We decide what referrals need to be done to what specialty services and in what priority they will occur. We’re like the quarterback on a football team,” explains Joseph Blansfield, RN, MS, NP, trauma program manger.

Founded 36 years ago at Boston City Hospital, BMC’s Level I Trauma Program has earned a reputation as one of the country’s finest. The hospital triages and treats the majority of the city’s most critical injuries, including victims of motor vehicle crashes, head injuries, stabbings and shootings.

BMC, in partnership with Boston University School of Medicine, conducts cutting-edge research on trauma interventions focusing on wound repair and healing, gene regulation after injury and mechanical ventilator impact on traumatic brain injury. Residents and attending physicians share interesting case studies with other teaching hospitals during monthly trauma video teleconferences.

As trauma cases continue to rise, the team is also deeply committed to injury prevention. Twelve unique programs provide outreach to trauma patients, family members and at-risk community residents. Advocacy ranges from violence prevention and intervention initiatives to seatbelt and helmet programs.

Back in trauma bay 2, Dr. Dechert and Dr. James observe the patient’s x-rays. His chest is clear but he will need further imaging for his spine. Dr. Dechert and her team shuttle the patient to a nearby CT scanner. Neurosurgery is called for a consult. Beyond his obvious leg injury, a burst fracture of his 12th thoracic vertebrae is found. Radiology takes the patient for more images of his right leg. His injuries are serious and he is admitted to a monitored bed to be followed by the Surgical Critical Care Service while he awaits surgery for both his leg and spine.

In the hours that have passed, the trauma team has consulted on four other patients in the emergency department. Some critical, others less so. Being a Friday night, more cases are sure to follow. It’s all in a day’s work for Dr. Dechert and her team.

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