Inside A Level I Trauma Center For Kids: Riley’s Incredible Ability to Save Lives

The bicycle wreck happened in an instant. Her tiny 6-year-old body flipped over the handlebars, her head hit the cement, a pool of blood on the sidewalk.

The horrific car crash took place in the wee hours of a dark morning. A family coming home from vacation, the truck coming out of nowhere. A 13-year-old writhing in pain in the ditch, his pelvis crushed.

The lawn mower fall was devastating. A toddler riding on his grandpa’s lap on a beautiful, sunny spring day. He slipped, his legs trapped under the blades, an injury too tragic to describe.

Unthinkable trauma to children. More than 1,600 children each year come to Riley Hospital for Children at IU Health, the victim of trauma of the worst kind.

Riley is the only hospital in the state verified as a Level I Pediatric Trauma Center by the American College of Surgeons. It is the only hospital in the state where the sickest of the sick children of Indiana are treated.

It is where -- within 15 minutes -- a team of world-renowned emergency physicians and specialized surgeons, nurses and social workers, critical care doctors and chaplains are at the bedside of the patient. In most cases that team is there before the patient even arrives.

It’s where children get the pint-sized care they need, the specialized care crafted just for them.

Cory D. Showalter, MD, has watched as pediatric surgeons comfort a child before surgery.

“They know how to deal with kids. You can’t get that at a place that sees one kid every other month,” says Dr. Showalter, medical director of pediatric emergency medicine at Riley. “We have lots of tricks to help kids through these situations.”

In the most severe cases of trauma, for example, a mom can make a child feel better than any amount of morphine.

When a child is crying, the trauma staff knows how to tell whether it’s due to pain or because of their fear of a room full of strangers, says Dawn Daniels, program manager of injury prevention and trauma services at Riley.

“And their tummy always hurts no matter what the problem is,” she says. “We are very good at figuring that out and getting the child exactly what they need.”

The trauma team only deals with children and, so, they know children – extremely well.

“We have the ability to identify a sick child,” says Dr. Showalter. “We are all very well rehearsed on what’s the vital signs. We can tell a child who is getting sicker and sicker.”

But good medical care isn’t the only key to recovery and survival, says Dr. Showalter.

“The consequences of the case depend on you being able to connect with a child and a family,” he says.

And that is Riley’s calling card.

A Look Inside A Level I Pediatric Trauma Center

• Riley, which has been verified since 1993, is one of fewer than 30 pediatric Level I trauma centers in the nation.
• All in-house specialists are pediatric board certified.
• Fifty percent of trauma patients come directly from the scene to Riley. The other 50 percent are transferred from another hospital.
• 24 hours a day, seven days a week, patients can get into an operating room in 15 minutes or less. There are operating teams, anesthesiologists, pediatric surgeons, critical care doctors and emergency medicine physicians all in house round the clock.
• Among the most common trauma injuries Riley treats are vehicle crashes and falls. Other trauma includes: loss of limbs, gunshot wounds, head injuries, pelvic fractures, broken necks, crushing injuries, broken spines, dog bites, lawn mower injuries, trampoline accidents, sports injuries.

• The Level I Trauma team may also be activated for “time is of the essence” cases. For example, a child found down under the age of 2 would be admitted as a high-level trauma. A button battery ingestion would also be admitted due to need for surgery. It can be a matter of minutes before that battery burns a hole in the esophagus, Dr. Showalter says.
• There are four specialized trauma bays.
• Within 30 minutes or less, a CT scan, MRI and interventional radiologists are in place, if needed.
• Communication. The trauma team gets on the phone with the transferring emergency department to discuss the case before the patient ever arrives. CT scans, X-rays and other images are sent digitally. If needed, a patient may land via LifeLine on the roof of Riley and go straight to the operating room. “It all saves critical minutes,” says Daniels.
• Prevention is key. Part of being a Level I trauma center is having programs in place to educate on preventing injury. At Riley, there are multiple programs, including bike helmet safety, car seat training and helping mothers addicted to opioids learn how to prevent injury to their child. “You still want them to climb trees and play on monkey bars,” says Daniels. “You still want them to be kids.”

-- By Dana Benbow, Senior Journalist at IU Health.
 Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow.