Medical technology cheats death

More people are surviving severe trauma as medical technology improves.
BALTIMORE (AP) -- It's nine o'clock on a Saturday night when a 15-year-old boy with a bullet in his leg is rolled onto a gurney into the R Adams Cowley Shock Trauma Center. More than 20 minutes have passed since he was shot in a drive-by.
On this night, the boy is lucky. His lone wound is fairly straightforward, and he's in place where dedicated lifesavers wield some of medicine's most advanced tools.
At Cowley -- and other trauma centers across the nation -- leaping improvements in emergency medical technology are helping doctors save lives that, a few years ago, would almost certainly have been lost.
Most valuable
Most valuable are devices that swiftly offer detailed looks under the skin, be they portable ultrasound machines or thermometer-like oral probes that detect internal stomach bleeding.
For Dr. Thomas Scalea, Shock Trauma's chief physician, the more nimble and clearer-eyed inventions represent as radical a progression as the jump a century ago from horse-and-buggy to automobile.
"When I first got here [seven years ago] I'd sometimes say, 'Oh, that person's going to die.' Now, my expectation of who's going to die is very much different," Scalea says.
Since Scalea arrived at Shock Trauma, technology has transformed nearly every corner of the emergency room, most impressively in ultrasound and CT scan machines.
With blunt force injuries, which occur during auto accidents and falls and account for most trauma cases, a patient often has minor, if any, external bleeding; all the while, he or she could be bleeding to death internally.
Instead of inserting a catheter in the abdomen to blindly test for internal bleeding or using a 500-pound ultrasound machine that needs three people to maneuver and operate -- the old methods -- a 6-pound, brick-sized portable ultrasound can now detect bleeding in about 15 seconds.
Bigger machine
It takes all of about 20 seconds for a bigger, stationary machine that travels a patient's length -- it's called a helical CT scan -- to provide doctors with a crisp, three-dimensional digital view of every part of the internal landscape, from the brain to the smallest artery.
The new "16-slice" CT machine, which looks like a large white doughnut, rotates around a patient stretched out on a narrow table, capturing 16 images for every half-second cycle.
With the older CT scan, it often took more than an hour to see the result.
Doctors say it won't be long before they're wearing tiny ultrasound scanners around their necks, much as they now wear stethoscopes.
Death rates drop
Nationally, improvements in emergency care have over the past 40 or so years helped lower the death rate for assault victims by nearly 70 percent to between 15,000-20,000 annually, according to a study by the University of Massachusetts at Amherst and Harvard University.
At Shock Trauma, which belongs to the University of Maryland Medical System, the mortality rate is now about 3 percent -- half what it was 10 years ago -- even as the number of patients doubled to 7,000 annually.
Information sources
Other new inventions are allowing doctors to better marshal information in the emergency room.
Shock Trauma has four Computers on Wheels -- flat-screen computers set on height-adjustable rolling carts, a tiny brass-colored bell tied to the front of each COW so even staffers in the heat of an emergency can hear them coming.
Instead of walking from department to department, doctors and nurses can pause during a procedure and search the COWs for every piece of information stored on every patient in Shock Trauma -- digital X-rays, CT scans, pharmacological information, even surgical techniques listed on Web pages at medical schools.
Dr. Amy Sisley, a Shock Trauma surgeon, is already looking forward to the benefits of advances in wireless communications.
"Pretty soon," she says, "I'll be able to pull up a patient's information, from CT scans to pharmacology, all on my pager."