 Good evening everyone, we're live tonight from the Maryland Shock Trauma Center in downtown Baltimore. This is the institution that pioneered the idea of the golden hour in emergency medicine and in the 50 years since then the helicopters have gotten bigger and faster surgical techniques have improved and now the focus is shifting to what else can be done to improve survival in accident cases and other types of serious injuries. The focus is on what individuals can do before the paramedics even get there. It's a program called Stop the Bleed. We're going to have a demonstration coming up with some techniques you need to know about. There'll be no blood, maybe a little bit of plastic, but stay tuned for that in a few minutes. Also tonight we're taking your questions by email the email address live questions at mpt.org. Joining us now is Dr. Thomas Scalia, who is the physician-in-chief at Shock Trauma for almost 27 years. Tell me about the patients that you see here. What types of situations are coming in? That's evolved some over the years. If you ask me about our current profile, about a third are vehicular crashes, defined that as you know in all ways. About 35 or 40% are actually older people that have fallen and about 25% are people that have been injured with interpersonal violence, largely ballistics, largely gunshot wounds, and then a little bit of industrial and recreational injuries. If you watch the evening news around Baltimore, you frequently hear Shock Trauma in the context of a shooting victim being transported here to have their life saved. How many people, what are the trends that you see in that? We're seeing this year probably seven or eight hundred, I would guess, gunshot wounds, another several hundred, three hundred people stabbed. So it's a lot. It's a substantial number, well over a thousand people a year that are injured by what we call penetrating trauma. You were telling me about a 12-year-old patient of yours that you saw recently with penetrating trauma from an assault weapon. Indeed, certainly one of the things that has gotten a lot of attention appropriately so is the real spike in injuries, particularly gunshot wounds to young people, to children. And the last numbers I saw, there were 10 deaths so far this year and another 50 or 60 non-fatal shootings in kids, which is a noticeable difference for us relative to the last few years. And even when you're able to save somebody's life, frequently they don't walk out the door as the same person they came in. Well, it's a complicated set of circumstances, particularly young people, older people as well. There's a huge emotional toll to being injured and being injured violently evokes a whole set of issues that require longer term often therapy. And even though we save almost everybody that comes here, that doesn't mean that they don't have sequelae of their injuries, physical sequelae. And so we certainly do our best to try to be as holistic as possible. We try to treat the body. We try to treat the psyche. We try to treat the mind. But it can be a problem. No question. You've also tried to venture outside the hospital in terms of violence prevention. What have you tried? What have the results been? Well, we had the first hospital-based violence intervention program 2006, if I remember correctly. And it is one of the few to date that has randomized prospective data that says it actually changes behavior. And so it was very discouraging for many years. We were unable to get it funded. I'm happy to say we now have obtained funding, and we are trying to amplify that up to make that as evident as possible. The new area where we're really concentrating is we just opened as of May 1st, so not even a month ago, the University of Maryland Baltimore Violence Prevention Center. And we have our new executive director, Dr. Nadine Finnegan-Kar, and we're just getting going. But the idea is to make this community-based prevention, what we'd like to do is not have to fix them after they get here, but prevent them from ever coming here. Now, that's a tall order and is a set of issues that is going to take a generation to really affect. We have to sort of dig in and make the long-term commitment to getting that done. That's not a quick fix. Reminder viewers, do you have a question for Dr. Scalia or broadly about shock trauma? Send us an email livequestionsatmpt.org. I mentioned at the beginning it was Dr. Cowley's concept of the golden hour. How radical was that 50 or 60 years ago, and has it really spread beyond Baltimore? Oh, absolutely. This is a well-established concept. Injury is the quintessential time-sensitive disease, and it's a disease. And so the clock starts ticking at the time of injury, not at the time of hospital arrival. So what you need is a system, right? You need a system to deliver the right patient to the right place in the right amount of time. That slogan that we use was also the slogan adopted by the U.S. military in Iraq and Afghanistan. Right person, right place, right amount of time. And so whether you believe that the golden hour is 60 minutes or sometimes for terribly injured patients, it may be six minutes, the clock is ticking. And our job is to get the patient to care, define that as you like. It's different days and for different people, but get the patient to the right care as fast as we can. And the right care may not be a shock trauma. There's a whole system around the state. It's not just you guys and your helicopters. No, it's a very sophisticated system. It's five EMS zones, a helicopter in each zone, a regional trauma center in each zone, four trauma centers in the city. So it's a big system. We stand at the top of that system being the principal adult resource center for the state and the Neurotrauma Center for the state of Maryland. But certainly if every injured patient came here, we'd be crowded beyond belief. It's the right person that needs to come here, not every person. You mentioned the military's approach to trauma care. You train military doctors here. Yeah, we started that in 2001. And we have been proud to be the Air Force training site for whatever that makes it, 22 years. We will be the Air Force training site as long as the Air Force wants to stay or at least as long as I'm here and hopefully long after I'm gone. And I think there is great synergy between us and the military. We taught them a number of lessons from the experiences we garnered in the 90s when crack cocaine came to the United States and there was literally war on the streets of America. They have brought back many important lessons from the war, including new ways of using blood and plasma. And so it goes back and forth and in my mind then everybody wins. If you were named Bob says how do you process all the trauma that you witness psychologically and emotionally and not just you. If people saw the video from the resuscitation unit they're going to be 20 people in there. Yeah, it's a great question. If I can't do that I'm not very good at my job. I would be pretty ineffectual and I think when I'm on right I don't have the luxury of grief. I have to put that in a different place because the radio is going to go off, the phone's going to ring and the next person that comes in deserves my A-game not me going oh I'm sad. And so I think each of us has a way of doing that of putting the feelings in a different place and then each of us has our way of dealing with them when we get to not be clinically active anymore. My way is to go to the gym. You teach. We Dr. Henry coming up, Professor of Medicine, when you're talking to students of surgery and trauma care and preparing them for the emotional aspect of what they're going to see, how do you set it up for them? Well this isn't for everybody and I think people need to make at least a certain level of decision in medical school or in residency and some people want to be outpatient doctors and that's great because we need a whole bunch of outpatient doctors and some people want to be very directed in their practice, have a little niche and become an expert at a small area. We need those people. We are the doctors and the nurses for the sick people and to a large extent it doesn't matter how you're sick. If you're really sick, we're your guys and we're happy to swing in and help. We talked during the pandemic by Zoom of course and at the time things were really different because nobody was driving anywhere. I imagine the number of crash victims was declining and you moved into a different role. We did. We really reinvented ourselves. It says shock on the building before it says trauma so it's about the care of critically ill or and or injured patients and what we did is we became the center for respiratory failure from COVID. We set up a 32 bed biocontainment unit we called it and we offered the highest level of support for respiratory failure. We put almost 90 people on heart lung bypass ECMO as we call it for respiratory failure with a survival over 70%. It's a sort of a staggering set of results and you know the men and the women of the shock trauma center led that fight in every discipline. Doctors, nurses, respiratory therapists, techs, everybody really leaned in and said here we are. We're gonna we're gonna save lives. It doesn't matter why you're sick. Last question. You were practicing medicine in New York City 27 years ago when this job opened up. What brought you to Baltimore? The job. I never intended to leave New York City. I was going to live and die there and when this opportunity became possible I hesitated about four milliseconds and said yes this is this is the analogy is like playing center field for the Yankees or the Orioles depending on your your current geography right it's um this is the best job in trauma care in the world and I would say it's the best job in academic medicine in the United States for sure. So when this became a possibility I I was all in and I still am. It's always an honor to talk to you. We appreciate the time. Your health segments are a co-production of Maryland public television and the University of Maryland Medical System.