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Walls Down - Essential Hospital Stories without Boundaries

Walls Down - Essential Hospital Stories without Boundaries

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Navigating Tracie's Brain


How Grady Health System Changed the Paradigm of Stroke Care

Brain Scan

Tracie Johnson Steadman is a poet. And right now, a hospital waiting room is her stage. “This poem is called ‘Authorized to Heal,’” Tracie says. She pauses for a moment, and then she chants.

He is read to heal your soul Take control Then create a mold Covered in his blood Oh so pure is it the cure..

Her voice, deep and throaty, loses any sign of hesitation. It lifts up, weaving words into melody as she implores you to let go, surrender to something else, someone else. Is it God or physician she’s referring to? It’s both, she says. The line, in trauma, becomes blurred.

On Oct. 8, 2011, Tracie awoke at 1 am, thinking she had to go to the bathroom. “When I tried to get out of the bed, I fell. I kept trying to get up, over and over again.”

“My husband, he picked me up and he sat me in the restroom. He asked me to raise my arms, he asked me to raise my legs, and he asked me to talk. By then, the look on his face, I could tell something was wrong.”

Looking in the mirror, Tracie saw her own twisted face. And she began to pray.

Three days earlier, she had received notice that her house was to be sold. It would follow the car and the job she’d held for 10 years. Her life, as she describes it, was full of clutter. And now, her brain was clogged as well.

Stroke can occur in one of two ways. A blood vessel in the brain can become blocked, cutting off the blood supply. Or, it can burst, spilling blood into the spaces surrounding brain cells. Tracie was suffering from the former – acute ischemic stroke. It is the most common form of stroke, accounting for about 87 percent of all cases. Deprived of the blood’s oxygen and vital nutrients, brain cells quickly begin to die. This deterioration can continue for days, leaving permanent damage, or it can kill almost instantaneously.

In the 1980s and early 1990s, stroke treatment was limited, with no real way to reduce the damage to the nervous system. Some considered it untreatable. But in 1991, the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health, began a clinical trial to test a drug called tissue plasminogen activator (tPA) on stroke. tPA is a clot-busting medicine doctors have used since the 1980s to restore blood flow in heart attack patients. There was hope it would work for ischemic stroke too.

Michael Frankel, MD, led the trial of tPA for stroke victims at Atlanta’s Grady Health System. “[Grady was] a leading site for the study, which really changed how we look at that disease,” says Frankel, who is now chief of neurology and director of the Marcus Stroke and Neuroscience Center at Grady. “And that's a disease that's really important to people in Georgia.”

“As the premier level I trauma center for this region, for all these people, in a growing population, an aging population, and a stroke-prone population, we had to be stroke-ready,” Frankel says.

Georgia is a part of the stroke belt, a region of the southeastern United States that sees a higher than average rate of stroke occurrence and mortality – in some cases, double that of other parts of the country. “As the premier level I trauma center for this region, for all these people, in a growing population, an aging population, and a stroke-prone population, we had to be stroke-ready,” Frankel says.

After five years of clinical trials, tPA proved to be an effective emergency treatment for acute ischemic stroke. The New England Journal of Medicine published the initial results, offering an early hint that the standards for stroke care were about to change. The following year, in June 1996, the U.S. Food and Drug Administration approved tPA for the emergency treatment of stroke. “This particular drug was going to be a lifesaving treatment for people … [it can] minimize the amount of damage by opening up that blocked artery quickly, restoring blood flow,” Frankel says.

As with any effort to improve health outcomes on a major scale, the difficult part was still to come. Before Frankel and others could effectively use tPA to save lives, they had to change the perception of stroke treatment among patients and providers. The drug had to be delivered quickly – within three hours of initial symptoms. But timing had never been a key factor in stroke care.

“The whole paradigm of how we looked at stroke had to be changed. It had to be treated the way that we treat trauma patients, which is why Grady was an ideal place to do this.”

“So how do we change the approach, the process of care, to rapidly recognize patients with stroke symptoms and rapidly treat them with a drug that's been shown to be effective?” Frankel asks. “The whole paradigm of how we looked at stroke had to be changed. It had to be treated the way that we treat trauma patients, which is why Grady was an ideal place to do this.”

The model of care Grady applied to all critical injuries in its level I trauma center was the right model for stroke victims as well. Frankel and his team built an infrastructure for staff to recognize stroke symptoms as quickly as possible. If stroke is suspected, they immediately x-ray the brain using a computerized tomography (CT) scan. Once they review the CT scan, they can determine if the patient is suffering from acute ischemic stroke and, if appropriate, deliver tPA. Grady paramedics aboard ambulances also learned to identify the symptoms and notify the hospital before arriving with stroke patients.

Brain sketch

That infrastructure was in place as Tracie’s ambulance sped through Atlanta toward Grady that October night. She describes her husband’s insistence that she go there despite her apprehension. “I didn’t want to go to Grady,” she recalls. But he was firm: “You’re going to Grady.” “He’s a Grady baby,” is her explanation. As she speaks, Brahms’ Lullaby begins to play throughout the hospital. Another Grady baby is born.

Johannes Brahms - Lullaby

Grady babies know. There is a trust and loyalty that exists among those who were pushed, squeezed, or prodded into life at Grady. It’s almost as if they remember the tender, loving hands that lifted them up, guiding their safe transport into this world. Something sticks with Grady babies, and as long as they have a choice, they won’t go anywhere else.

Many in the medical community agree. Grady is a distinguished teaching hospital and often seen as a premier destination for medical training. “I came to Grady when I was coming out of medical school,” says Frankel, who is also a neurology professor at Emory University School of Medicine. “I looked to Emory for training, and Grady, being [the] heart and soul of the training component of Emory's experience, was a huge attraction to me. I was impressed by the people that Emory was able to turn out and I knew that a big part of their experience was Grady … I knew that it would be the best experience possible. That's what I was looking for: a really optimal, clinical environment.”

As the teaching hospital for both Emory University School of Medicine and Morehouse School of Medicine, Grady has trained one-quarter of all physicians practicing medicine in Georgia.

Now, Frankel helps create that optimal clinical environment for the next generation of physicians. As the teaching hospital for both Emory University School of Medicine and Morehouse School of Medicine, Grady has trained one-quarter of all physicians practicing medicine in Georgia. “It's had a huge impact on public health throughout the state,” Frankel says. “I've trained hundreds of them since 1992 and stay in contact with most. I’m very proud of the relationships I've created over the years and proud of [my students’] clinical skills and their ability to take care of patients, largely because of the training that they had when they were at Grady.”

But the general public doesn’t always see the top-notch academic medical center that Grady is. Fulton County Commissioner Joan Garner describes her incredulity years ago, in Washington, DC, when a classmate decided to move to Atlanta to work as a Grady nurse. “Really?” she says was her response. Now, she shakes her head at that reaction, knowing Grady’s draw for the best and brightest in the medical field.

After taking office as commissioner in 2010, however, Garner took a tour of Grady. “I was really stunned and pleasantly surprised,” she says. “Throughout the years, what I read in the paper and what I saw on the news was totally different.” Those media reports reinforced a perception of Grady as primarily a destination for gunshot and car crash victims, not as a provider of choice for care in multiple specialties.

What’s more, Grady was emerging from a troubled recent past that included management and financial issues. Just three years before Garner took office, the hospital faced closure.

Grady has long served both Fulton and DeKalb counties (as well as numerous patients from across the region needing specialty services, such as trauma care). And it had been overseen by the politically appointed Fulton-DeKalb Hospital Authority. The two counties were responsible for contributing to Grady’s budget for indigent care, so the uninsured and underinsured would have somewhere to go. But as The New York Times reported in 2008, “The county commissions in Fulton and DeKalb have been reluctant to increase their contributions when the state has refused to do so, and when suburban counties will not contribute at all.” The Republican-run state legislature saw Grady as “someone else’s problem,” according to reports.

... Grady had amassed tens of millions in debt by 2007 and was on the verge of shutting its doors.

Without much public support, some administrative inefficiency, and a board that is said to have blurred the line between good business sense and politics, Grady had amassed tens of millions in debt by 2007 and was on the verge of shutting its doors.

“That place is in serious trouble,” former Georgia-Pacific Corporation Chair A.D. “Pete” Correll told Cousins Properties CEO Tom Bell. As the story goes, two prominent Atlanta businessmen met over drinks one night and tried to “solve the problems of the world” — one of those being Grady. Bell’s response: “You don't know the half of it.” As reported by Creative Loafing, an Atlanta-based alternative weekly newspaper, by the end of the night, Correll and Bell had decided to take action.

Soon after, the Fulton-DeKalb Hospital Authority and Metro Atlanta Chamber of Commerce formed the Greater Grady Task Force. Correll co-chaired the task force along with H.J. Russell & Company CEO Michael B. Russell. Bell was also a task force member. After studying Grady’s finances, structures, and operations, the task force recommended that the board create a new nonprofit corporation to run the hospital. As The New York Times reported, “The change would allow Grady to attract philanthropic dollars, expand … services and remove politics from its day-to-day operations, the task force predicted.”

Skeptics expressed fear that the hospital would abandon its essential mission to serve the underserved.

But while many saw the proposal as a true solution for Grady, some feared the community was going to lose its hospital. “I think it was the … perception that Grady was being taken away from Fulton County and DeKalb County and put in the hands of [business] executives,” recalls Commissioner Garner. “The perception was that they were not really interested in the well-being of the community.” Skeptics expressed fear that the hospital would abandon its essential mission to serve the underserved.

But amid the protests, sit-ins, and speeches, the task force persevered. In November 2007, the Fulton-DeKalb Hospital Authority voted unanimously to hand over day-to-day operational control of Grady Memorial Hospital to a nonprofit management corporation, the Grady Memorial Hospital Corporation.

Despite the naysayers, the governance change catalyzed a financial turnaround for the hospital while allowing it to remain dedicated to its mission. As the task force predicted, the transition quickly led to increased philanthropy, including a $200 million donation by the Robert W. Woodruff Foundation. Continued funding and improved efficiency and management have allowed Grady to begin to reinvest in itself.

“If Grady weren’t here, culturally it would have been devastating to the community. Health outcome-wise, it would have been devastating to the community,” Haupert says. “I think we’d see a lot of Grady’s patients being lost to care – not receiving the care they need or just dropping out of the health care system altogether.”

By the time current CEO John Haupert arrived in 2011, the hospital’s firmer financial footing permitted him to focus on broader transformation. Haupert was able to implement projects to improve outcomes, patient satisfaction, workforce engagement, and growth to help fund the mission – in addition to remaining financially sound. “If Grady weren’t here, culturally it would have been devastating to the community. Health outcome-wise, it would have been devastating to the community,” Haupert says. “I think we’d see a lot of Grady’s patients being lost to care – not receiving the care they need or just dropping out of the health care system altogether.” Frankel adds, “Financially, economically, socially, it would have been a major blow to the heart and soul of the southeastern United States. It would have had a ripple effect throughout the community that would have been nearly impossible to recover from.”

Grady Patient Photo

“We got here on time,” Tracie says. Her transport to Grady was quick that October night. And she was admitted to the Marcus Stroke and Neuroscience Center early enough to receive the clot-busting tPA stroke treatment. But it didn’t work.

Tracie had a blood clot in the left side of her brain, in the middle cerebral artery. The middle cerebral artery is the largest of the three major arteries that distribute blood to the brain. Research has shown this area of the brain to be the most commonly affected by stroke, as its size and direct blood flow provide an easy path for clots. While tPA had certainly improved stroke outcomes, it was known to be less effective with clots in this location. Raul Nogueira, MD, Tracie’s doctor and director of the center’s neuro-endovascular division, notes, “With that clot location, it's not unusual – about one in three to one in four of these patients will not respond to the intravenous blood clot buster.”

“We had 15 minutes to decide if we were going to let them go through my groin into my brain to get the clot out,” Tracie says.

In many hospitals, that would have been the end of treatment for Tracie. “If you don't respond to the tPA, [you usually] don't have any other option,” Nogueira says. But Grady is a cutting-edge research facility, and it did have other options – though slightly experimental. “We had 15 minutes to decide if we were going to let them go through my groin into my brain to get the clot out,” Tracie says. “That was a real difficult moment. But Dr. Nogueira, he had so much faith, and he was like, ‘I can save her.’ I believed that moment. I believed in my heart.” Nogueira, as doctors tend to do, smiles humbly in response. “The catheter-based therapy is still a work in progress,” he says. But Grady had given him the tools to succeed.

The Marcus Stroke and Neuroscience Center opened in 2010, but as Frankel (pictured here) notes, “It really was born from the work that we did early on in the 1990s. You have to build credibility and trust in an organization. And at an organization like Grady, [an] essential hospital that has limited resources, we had to really make sure that the decision to use those limited resources was wise.”

Frankel cites the years of success his team has had in developing new treatments, and Grady’s status as a coveted destination for physicians in training, as helping to build the case for a new stroke center. But an integral part of the unit’s worth lies beyond Grady, in the contributions it’s made to continuous quality improvement in stroke care nationwide.

As Frankel explains, once Grady was able to fundamentally change its own stroke care – treating it as extremely time-sensitive, trauma care – “Other hospitals were very interested in the paradigm that we created.” But spreading new clinical processes across numerous hospitals takes resources, so Grady had to find some.

In 2001, Congress directed the Centers for Disease Control and Prevention (CDC) to establish state-based registries to measure and track acute stroke care to improve the quality of that care. The Paul Coverdell National Acute Stroke Registry is named in memory of former Sen. Paul Coverdell (R-GA), who died of a stroke in 2000 while serving in Congress.

With Grady’s help, Georgia was selected as one of four states to receive initial funding from this registry, and thus created the Georgia Coverdell Acute Stroke Registry. “Then we started working with hospitals to basically teach what we had done at Grady to change the paradigm of stroke treatment,” Frankel says. “Rapid recognition, rapid treatment, improve the quality of care, improve outcomes.”

Dr. Frankel

By 2005, having worked for years to improve stroke care, Grady became one of the first essential hospitals to receive Joint Commission certification as a primary stroke center. The Joint Commission helps set the national standards for quality in health care. And by sharing its practices via the stroke registry, Grady has helped many other hospitals meet these standards as well. Frankel notes that Georgia has far more Joint Commission–certified primary stroke centers than neighboring states due to their participation in the registry. “We're very proud of the fact that we disseminated this concept throughout the state. What better way to improve public health than to get hospitals ready for a disease that requires everyone to be on the same page? We've got a huge generation of baby boomers that are entering those stroke prone years – the 50s, 60s, and 70s. It's very important for us to be as ready as possible.”

All of this work – the innovation, the infrastructure, the clinical research, the education – helped build the case for funding the Marcus Stroke and Neuroscience Center. “Here's what we've done, here's what we're capable of, here's where we can go if we're supported,” Frankel says, describing his conversations with Grady leadership. “It really was a multiyear conversation, but it had to be a grassroots effort. It had to have a foundation, not just an idea.”

It also had to be layered into larger conversations about Grady’s future, which had been highly uncertain for many years. “Timing is everything,” Frankel says. “It wasn't the first time I had gone to a CEO and said, ‘Here's what I'd like to be able to do.’ This time, though, the CEO felt like the timing was right.” The CEO was Michael A. Young, who led Grady’s turnaround before handing over the reins to Haupert.

By 2013, three years after the stroke center opened, The Joint Commission hailed Grady as a benchmark and national model for stroke care. Grady also became the first essential hospital to be certified as a comprehensive stroke center. This advanced certification recognizes the significant differences in resources, staff, and training necessary to treat complex stroke cases. With it, the Joint Commission aims to develop formal referral networks to guide the most complicated cases to the centers best equipped to provide the specialized care they need.

Grady has also continued to help grow the stroke registry. By 2013, 64 systems with 66 hospitals were contributing information to the registry, covering close to 80 percent of the annual acute stroke admissions in Georgia, or about 8,000 to 10,000 patients a year. In addition to helping spread best practices, the registry allows for continuous quality improvement by aggregating data about the process of stroke care. As Frankel describes, providers can periodically review data on stroke treatment throughout the state, pinpoint problem areas, introduce changes, and then re-measure. “It’s all about process improvement and quality improvement,” he says. “Now that those hospitals are participating regularly, we have a wonderful group of interested individuals and stroke coordinators at hospitals that didn't exist before. That didn't happen until we had a proven therapy that forever changed the field of treatment.”

Grady was only a handful of years removed from near-closure, but it was already showing that potential that drove Atlanta’s business leaders to act to save it. “The business community, political community in Atlanta, really get what Grady is about and the role Grady plays,” Haupert says. “They all understand that if there’s not a Grady-type institution that’s a level I trauma center, major burn center, level III neonatal center, that it’s hard to attract new businesses to the community. It’s hard to [attract] major sports playoffs and major conventions if that type of care is not within the community.”

The world Tracie entered that October night was, in Nogueira’s words, futuristic. Her decision to let Nogueira insert a catheter into her groin and then maneuver it through her body and into her brain had led her to the stroke center’s angiogram suite. There, she would spend six hours – awake, watching, listening. What she saw around her was open space. The room is large, and instead of any fixed furniture or equipment, large mechanical arms rise in arcs out of the walls, the floor, the ceiling. One leans over the head of the bed, others reach up and out from the side of the room into the middle, holding flat screens of monitors. There, Nogueira could see the catheter as he moved it up Tracie’s body, toward her brain.

By building the world’s first angiogram suite within a neuro–intensive care unit (ICU), Grady bridged a longtime gap in care. “Far too long have we seen the way patients are taken care of in hospitals where segments of the hospital are separated,” Frankel says. The unit also has its own 64-slice spiral CT scanner. “That was a design principle that we felt would create a leap forward in the quality of care,” Frankel says. It saves transport time, which is a part of that paradigm shift. The idea that time is of the essence in stroke care, that stroke is trauma care.

Grady cross trains staff to work in both the ICU and angiogram suite, which improves patients’ continuity of care. Also unique is the way nurses monitor their patients. At decentralized stations, nurses can monitor two patients at a time, watching through large glass windows from a desk placed directly in between. Behind them, and inside each room, natural light gently spills in to the unit, creating a soft glow. As Frankel explains during a tour of the unit, “Intensive care units can be very depressing environments. People are very sick. When someone has a neurological injury, access to light is actually part of the therapeutic plan.”

In the wee hours of that October morning, it was this angiogram suite that provided the tools Nogueira needed to save the life that Tracie had known.

In the wee hours of that October morning, it was this angiogram suite that provided the tools Nogueira needed to save the life that Tracie had known. Would she have died? Nogueira can’t say. “I’m not sure she had a stroke that could have taken her life,” he says, but he believes she would have lived the rest of her life with a major disability. “Tracie had an unusual situation – she had a stroke at a relatively young age. That comes with some good aspects and bad aspects … if you don't succeed in the treatment, you're going to have a young [woman] with a high degree of disability.” For Tracie, that meant potentially severe disability in her right arm, face, and speech.

The catheter-based therapy is a neuro-endovascular approach. The surgeon navigates the arteries from the inside, just as in a heart catheterization, except this time all the way to the brain. Grady’s neuro-ICU is what makes that approach possible.

As of 2013, the catheter-based therapy was still a work in progress, with Grady continuing to participate in clinical trials. To Nogueira, the fact that he could offer it to Tracie in 2011 is significant, and demonstrates why he came to Grady in the first place. He talks about the opportunity to bring the latest research and therapies to a community much in need of these treatments. He calls it “incredible.” “To treat everybody, without respect for socioeconomic status, with the same type of therapy. At the end of the day, you're dealing with human lives,” Nogueira says. “This is a special place where a lot of the other factors don't really matter.”

So there Tracie lay, awake for the six-hour procedure, because “in acute stroke, general anesthesia comes with setbacks,” Nogueira says. Research indicates that patients tend to have better outcomes under lesser sedation, possibly due to the increased time it takes to start the procedure under general anesthesia, as well as the drop in blood pressure it causes.

“I just began to pray, and I began to look at each person and pray,” Tracie says. As she prayed, she thought about her life, what she had to change. And she vowed to make those changes – if she still could tomorrow. She doesn’t hesitate when describing that moment. “I know God didn't wake me up out of my sleep to leave me on [that] operating table.”

She was right. “Once they finished, they said, ‘Mrs. Steadman, can you move your arm?’” She waggles her fingers now as she recalls her response. “I was able to move my arm,” she says. Nogueira remembers the moment too. “It was really rewarding to see that right after the treatment, she had almost like an immediate response,” he says. “As soon as [we] opened the blood vessel and lightened up the sedation a little bit, [we] started to see her moving.”

“You know, we all go through things in our life, [but] when I come in this room, it brightens my day. These people, they keep me alive,” Tracie says, motioning to the room behind us. We are in the stroke center’s family waiting room, where Tracie is now employed.

Tracie spent two days at Grady recovering from her stroke. Just like with any trauma patient, her life had been startlingly interrupted. An unexpected blood clot in the brain isn’t that different from a sudden car crash or a tornado. It freezes your life for a moment. Everything else falls away and you focus on survival. But for Tracie, survival meant more than just being able to move again. It meant keeping the promise of change she made during that six-hour freeze-frame of her life.

But she couldn’t do it alone. “I got the best care here,” she says. “The nurses, everybody was just so nice, just made sure that I was comfortable. There was a guy that even held my hand in surgery. I will never forget him.” The care Tracie received at Grady made an indelible impression, and she wanted the hospital to know it. So she called and said as much. Impressions being reciprocal, several months later, Grady called Tracie.

Many essential hospitals struggle to get the public to see them as more than just a haven for the uninsured. “For so long, [essential] hospitals looked at themselves as the provider of last resort,” CEO Haupert says. “But we are making sure that we are the provider of choice for all people and differentiating ourselves clinically.” He cites the stroke center as an example of the work Grady does “that no one else in this market is doing. When you think of the essential nature of what we do, there are things we provide [that go] above and beyond.”

In 2010, the hospital launched “Atlanta Can’t Live Without Grady,” a comprehensive media campaign to change the conversation about Grady. The Atlanta Journal-Constitution reported, “Patient care and satisfaction are up … Grady has fewer hospital-acquired infections. Waits for medicine at the pharmacy have been reduced, in some cases by hours. Waits for an MRI, which in the past could be six months for an outpatient, are now typically less than a week.” The campaign was necessary to ensure everyone — lawmakers, business leaders, and the public — knew Grady was making good on its promise.

Highlighting the new Marcus Stroke and Neuroscience Center was part of that campaign, and Grady wanted Tracie to participate. Without quite realizing everything that entailed, but overjoyed to represent the hospital, Tracie readily agreed. “So [now] I'm on a MARTA bus, I'm on a billboard, I'm on channel 2,” she says, shaking her head in disbelief. “When I went to see my first billboard, I looked at that billboard and I said, ‘Lord, I want to look like that on the inside.’ Because I had so much clutter in my life, I had so much stuff going on, seeing that picture, it was like a reflection of [what] I wanted to be. I just looked so free.”

microphone

So she worked to become what that billboard represented to her: order, calm, and ultimately, inspiration. Again, she turned to Grady. “Let me call back and see if they're hiring,” she says, recalling how she found her first job in several years. “And they hired me — in this room that we're in now, in the family waiting room.” There, as families wait for their loved ones, she encourages them. “I embrace them. I make sure they're comfortable. I recite poetry. Whatever they need.”

It isn’t surprising that Grady chose to hire Tracie. Like so many essential hospitals, Grady is part of its community, through and through. Outside, it is a well-recognized part of the downtown Atlanta skyline. It even lends its name to local traffic reporters covering “the Grady Curve,” where Atlanta’s looping Downtown Connector swings wide around the building.

Essential hospitals are some of the largest employers in their communities, and Grady is no exception. Not only does this drive local jobs and economies, but it also creates immediate empathy between patient and provider.

Inside, Grady mirrors the community it serves. Nurses who were once Grady babies. Administrators who sought treatment in Grady’s cancer center. The staff are the patients. Essential hospitals are some of the largest employers in their communities, and Grady is no exception. Not only does this drive local jobs and economies, but it also creates immediate empathy between patient and provider. It’s good for the patients. It’s good for the staff.

“At first I couldn't talk about [the] experience,” Tracie says of her stroke. “But when I started working here and I became a part of this unit, my heart began to go out to the people that come in here. They're hurting, and they're in pain, and they're believing … for their loved one to live. Whatever I can give them, to make it easier for them ... When they hear my story, it may be a totally different situation, but when they hear my story, they're inspired.” Adds Frankel, “She's had the experience, she knows what it's like, and I think that that comforts people in a way that no doctor ever could.”

For Nogueira, seeing Tracie at work is a reward and sometimes, a necessary inspiration. “She's so full of life and energy,” he says. “Sometimes you have good days, sometimes you have bad days, and when you see somebody like her doing so well, it's very rewarding and gives us more energy to keep doing what we are doing.”

And here again, the relationship reciprocates. “I had an appointment [with Dr. Nogueira] during the time I was coming to interview for this position,” Tracie explains. “He takes pride in what he does. He has faith and he believes in what he’s doing. I wanted that type of passion in my job.” Inspired by Nogueira to land her job, Tracie continues to be invigorated by those around her at Grady. “Everybody is like family, and they began to encourage me and it was just like building me up from everything that was taken and destroyed inside me from all that stress. It just built me back up, coming here.”

The poetry she had been writing for years and now reciting to stroke families became a book – 31 Days of Live Inspiration. And her stage in the stroke center’s family waiting room became churches and shelters and conferences and workshops across the country, where she can be found reciting poetry, sharing her experience as a stroke survivor, and helping people understand the symptoms of stroke. And yet, like the doctor who inspired her, she remains ever humble, ever grateful, for the chance.

Coming home from a speaking engagement in California, Tracie’s car breaks down. “Here I am, lugging my bags to get on the bus. I'm tired, I’ve been on a plane all night. [And] I look up and see my picture.” With her phone dead, Tracie nabs a nearby police officer and asks him to snap it for her. Staring at the larger than life image of Tracie covering a wall in Atlanta’s bohemian Little Five Points district, the office responds, “You know what, I thought that was an actor.” “No,” Tracie says, “I'm a stroke survivor. I'm a stroke thriver.”

My Personal Stars you are the stars in my life. You had no idea, before that day. I failed to nurture myself. I was full of pain and distress. At the darkest hour of the nighty ou shined on me All of you as a team you played a part in the change in me.

When Disaster Strikes

Essential hospitals are first responders, delivering critical care to communities in crisis.

Summer 2014

Ebola Outbreak

When the Ebola virus that plagued West Africa began to spread, hospitals including Grady Health System and Bellevue Hospital Center handled the transport and care of some of the first patients to be treated in the United States.

Truman Medical Centers (TMC) went to the source of the outbreak when the World Health Organization tapped TMC’s Corporate Director of Infection Prevention/Control Tom Button, RN, to join a six-person consulting team. The group traveled to West Africa to share knowledge and expertise in containing an outbreak.

Ebolda News
watch

News video of U.S. physician with Ebola

August 2013

Wildfires in the West

The staff of St. Luke’s Health System shed their own fear and fatigue to tirelessly care for patients as wildfires blazed in much of the western United States in August 2013. Staff from areas that weren’t evacuated even offered up their homes to those who had to vacate.

April 15, 2013

Boston Marathon Bombing

Boston Medical Center (BMC) and UMass Memorial Health Care staff worked furiously to stabilize patients onsite after two pressure cooker bombs exploded near the finish line of the Boston Marathon, killing three and wounding 264 runners, family members, and spectators. BMC’s trauma center also accepted 23 patients with multiple shrapnel wounds, missing limbs, and psychological shock. Nine of those patients became amputees, but all of them survived.

“Regardless of where you were that day, you were profoundly affected by the events that took place,” said Amy Peterson, BMC emergency department nurse. Peterson is also a member of Team BMC, a group of 107 staff who ran the next Boston Marathon in tribute to the survivors.

October 22—November 2, 2012

Hurricane Sandy

Several members of America’s Essential Hospitals, including NuHealth, New York City Health and Hospitals Corporation, and Stony Brook University Medical Center, demonstrated their deep community commitment by continuing to provide emergency care under extreme circumstances when the deadly and destructive storm hit the East Coast in October 2012.

“Thirty-eight of our own staff lost housing, while others needed child care, food, and a variety of support, even as they continued to care for patients ... One individual, unable to come by car, walked miles from Freeport to East Meadow to care for her patients,” noted former NuHealth Executive Vice President for Medical Affairs and Medical Director Steven Walerstein, MD.

January 12, 2010

Haiti Earthquake

UF Health, the Los Angeles County Department of Health Services, and The Ohio State University Wexner Medical Center were among the members of America’s Essential Hospitals to provide critical care in Haiti after a 7.0 magnitude earthquake struck near the country’s capital, causing massive casualties and destroying the country’s fragile medical infrastructure.

Jackson Health System in Miami also received patients injured in the earthquake. Among them were a two-month-old baby buried beneath rubble for four days, who was then reunited with her parents, and an Arizona State University graduate student volunteering in Haiti, who now ice-climbs with her prosthetic leg.

August 1, 2007

Interstate-35 West
Bridge Collapse

Hennepin County Medical Center cared for 31 victims — 8 of whom arrived in critical condition — when the bridge along I-35 West in Minneapolis collapsed into the Mississippi River during evening rush hour. Hennepin’s emergency medical services also provided leadership in paramedic response to the site. “After August 1, 2007, we truly realized the value and significance of the time and resources we devoted to being prepared for emergencies,” said then CEO Lynn Abrahamsen when Hennepin County Medical Center was honored for its response.

News Video for i-35 bridge collapse
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News video for I-35 bridge collapse

December 14—15, 2006

Seattle Windstorm

Harborview Medical Center quickly mobilized to treat more than 65 patients for carbon monoxide poisoning after an unprecedented windstorm produced record-breaking wind gusts of 69 miles per hour in the Pacific Northwest. The storm knocked out power to an estimated 4 million people in 15 counties, and some sought refuge from the cold by using charcoal grills or generators inside their homes, causing the illness.

August 23—31, 2005

Hurricane Katrina

Memorial Hospital at Gulfport was the only comprehensive medical center between the Gulf Coast and Jackson, Mississippi, to remain fully operational when the devastating storm hit the coast. The area was slammed again on Sept. 18, when Hurricane Rita worsened flooding and disrupted electrical service in the area. Association members nationwide helped with funding, staff, and supplies as the Gulf Coast dug out from under the destruction.

A couple of months later, Diane Gallagher, director of community and corporate relations for Memorial Hospital at Gulfport, described the scene to the Mississippi Business Journal. “I walked down by the railroad tracks and saw that as the wind started dying down, people were coming out of the trees and water walking towards us. People were walking from all directions coming here. It was chilling to see so many people in the emergency department who were cold, wet and cut. That was our first clue as to the real damage outside of this building...”

September 11, 2001

Terrorist Attacks (and 1993
World Trade Center Bombing)

New York City Health and Hospitals Corporation (HHC) staff mobilized to heroically treat and transport victims after coordinated terrorist attacks destroyed the World Trade Center’s twin towers, killing nearly 3,000 people and injuring many more. HHC staff previously dealt with disaster at the same site on Feb. 26, 1993, when a truck bombing at the north tower killed 6 people and injured more than 1,000. In 2014, HHC continues to provide care for those suffering from the 9/11 events.

America’s Essential Hospitals recall 9/11
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Members of America’s Essential Hospitals recall 9/11

April 20, 1999

Columbine (and 2012 Aurora)
SHOOTINGS

Denver Health staff delivered lifesaving care when two high school students shot and killed 15 people and wounded many others at Columbine High School in Littleton, Colorado. Denver Health also responded when a similar tragedy struck on July 20, 2012. It was among the hospitals that received victims of a mass shooting in an Aurora, Colorado movie theater that killed 12 people and wounded 58.

Christopher Colwell, MD, director of emergency medical services at Denver Health, was on hand during both tragedies. “You're not sure how they're going to arrive to you, so you prepare for the worst,” he told CNN during the Aurora shooting. That preparation came in part from lessons learned during Columbine.

January 17, 1994

Northridge Earthquake

Among broken equipment and a flooded building, quick-thinking staff at Olive View-UCLA Medical Center provided emergency care to more than 80 patients in the aftermath of the 6.7 magnitude earthquake.

August 16—28, 1992

Hurricane Andrew

Jackson Health System and Broward Health hospitals mobilized resources to treat patients when the destructive storm hit South Florida in August 1992. The category 5 storm – only the third to hit the United States in recorded history – caused massive power outages and billions of dollars in damage to the state.

April 1992

los angeles riots

LAC+USC Medical Center staff worked around the clock to treat victims of widespread riots in Los Angeles. The riots were sparked by the April 29, 1992 acquittal of three white police officers on trial for the videotaped beating of African American Rodney King. The riots were the worst in America since the 1960s.

August 2, 1985

Delta Air Lines Flight 191

Parkland Memorial Hospital treated most of the 31 survivors of Delta Air Lines Flight 191, which crashed in a field near Dallas-Fort Worth International Airport. The plane was downed by a microburst, which is an intense downdraft within a thunderstorm. A motorist on the ground and 132 people on board died in the crash.

Essential hospitals' disaster response continues much further into the past. But it was only in 1981 that America's Essential Hospitals was formed (then called the National Association of Public Hospitals), thus creating a support system and historical archive for these vital organizations.


A World Without

Have you ever thought about where that ambulance is going? The one that stopped traffic as it sped through your lane, siren wailing? Have you ever wondered where that ambulance would take you if you had a stroke? A heart attack? A fall? Who would come help if you broke your ankle on a hike in the mountains? Read More >

Each day, we face potential harm from fires, car accidents, complicated pregnancies. We need level I trauma centers, which provide the highest level of care, should we face this type of severe injury. Essential hospitals are often the only level I trauma center in their region. They provide 38 percent of the nation’s inpatient burn care. They also provide some of the most comprehensive neonatal care, emergency response, and even emergency transport to locations far beyond their immediate communities.

So, what if essential hospitals didn’t exist?

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9Burn
Centers
California

There are only nine burn centers in California verified by the American Burn Association. Five of them are essential hospitals: Santa Clara Valley Medical Center, the University of California (UC) Davis, UC Irvine, UC San Diego, and LAC+USC Medical Center in Los Angeles [pictured below]. Each of these centers averages more than 200 admissions for burn care each year. Other acute care hospitals average just 3. Without these essential hospitals’ burn centers, more than 1,000 people each year would be left without reliable access to this critical care – losing, in the process, a real chance to thrive again.

Burn Center Patient Burn Center Doctor Burn Center Patient
950,000Square Miles
washington

Airlift Northwest [pictured below], part of essential hospital system UW Medicine in Seattle, transports roughly 3,200 patients per year from four states — Washington, Alaska, Montana, and Idaho. These patients need a range of care, including neonatal, pediatric, trauma, medical, and surgical. Harborview Medical Center, part of UW Medicine, is the only level I trauma center for all four of these states, covering more than 950,000 square miles, or roughly one-quarter of the United States.

Helicopter Airlift Northwest
7.2 millionPeople
US Map

Without essential hospitals, other hospitals across the country would need to find room in their emergency departments for more than 7.2 million additional people each year.

data chart
600 Infants
texas

More than 150 babies each year are transferred from other hospitals in South Texas to University Health System (UHS) in San Antonio for neonatal intensive care unit (NICU) care [pictured below]. This NICU treats roughly 600 infants annually, and UHS has the only dedicated ground transportation in the region to transfer critically ill infants.

 South Texas to University Health System Infants
150,000 miles
ohio

Cleveland Metro Life Flight transports approximately 3,000 patients per year across approximately 150,000 miles. Metro Life Flight is the only air transport connected to the region’s only level I trauma center, located at The MetroHealth System. If this essential hospital system didn’t exist, Metro Life Flight helicopters would have nowhere to land with their trauma patients.

Metro Life Flight Helicopter Interior Metro Life Flight Helicopter
45,000 babies
tennessee

The neonatal intensive care unit (NICU) at Regional One Medical Center in Memphis [pictured below] has treated more than 45,000 premature babies successfully, since opening in 1968. Without Regional One, those thousands of babies may not have survived beyond birth. Also, roughly one-quarter of the babies delivered here each year are high-risk births. The obstetrics program at Regional One receives 1,500 referrals each year due to pregnancy complications.

Regional One Medical Center infant in care
400 staff
mississippi

Memorial Hospital at Gulfport in Mississippi housed more than 200 people in a makeshift village immediately after Hurricane Katrina hit in August 2005. The first 8 to 10 days after Katrina, Memorial was the only hospital open and admitting patients in Gulfport, Hancock County, and west Harrison County. During the weeks following, the hospital’s emergency department saw nearly triple its regular traffic. Roughly 400 hospital staff members also lost their homes, but all staff put patients and the hospital as their top priority.

Hurricane Katrina catastrophe team
450 premature
infants
west virginia

WVU Healthcare has one of just four neonatal intensive care units (NICUs) [pictured below] in the whole state of West Virginia — a population of 1.8 million. On average, 450 premature infants are admitted to WVU’s NICU each year. These babies can remain in the NICU for more than 300 days. People would need to drive 2 hours and 18 minutes without traffic to get their babies to the next closest NICU.

WVU Healthcare Children
3 burn
centers
florida

There are only three burn centers in Florida verified by the American Burn Association. All three are essential hospitals: Tampa General Hospital, UF Health Shands Hospital [pictured below], and Jackson Health System. Jackson is the only one in South Florida and sees more than 2,000 patients annually. Without these three comprehensive burn care centers, everyone in Florida would need to be transported out of state to be treated.

UF Health Shands Hospital burn patient
1,200People
New York

In October 2012, Hurricane Sandy devastated much of the East Coast. In Long Island, New York [pictured below], four area hospitals were forced to close their doors from the damage. That meant a surge of patients for essential hospital NuHealth System. Without NuHealth, the roughly 1,200 people the hospital cared for during the storm would have had to somehow find care elsewhere — or none at all.

Long Island Coast destroyed
225,276People
massachusettes

Boston Medical Center [staff pictured below] and Cambridge Health Alliance, essential hospitals in the city of Boston, treated 225,276 people in their emergency departments (EDs) in 2012. Without these essential hospitals, roughly one-third of the city’s population would need to find another ED.

Boston Medical Center Staff

Born Early:
When Life Begins
in the NICU

Inside the neonatal intensive care unit (NICU), a hospital’s smallest, most fragile patients fight for their lives. Members of America’s Essential Hospitals run some of the most advanced NICUs in the country. And they’ve let us inside.

That’s Jacob. You’ll meet him soon. Through Jacob, we met his doctor, Rangasamy Ramanathan, MD. Together, they showed us what’s possible when a NICU performs at its best. It is a delicate balance of heart and science, and it exists more often than not in essential hospitals.

The Lion Inside

LAC+USC Medical Center, Los Angeles, California

Jacob is 4 (he told me in Chinese). We just met, on Facetime. He isn’t quite ready to let me in. Fair enough. He’s holding a set of drumsticks, so I ask about music. He starts beating the sticks together. His mom, Cat, reaches for his small Chinese drum. He begins to play.

First slowly, then faster. The beat takes off, building toward a crescendo, then abruptly stops, about face, and heads down a different road. This one slower, but just as rhythmic.

No one taught Jacob how to drum. He learned by watching his dad – and YouTube. He also likes to perform Chinese lion dancing with his dad. He runs across the room and picks up a giant Chinese lion head and peeks out through its mouth. “Hi Sandy,” he says.

Jacob in Hospital

Unit 4: Jacob's First Home

LAC+USC Medical Center, Los Angeles, California

Jacob was born at 27 weeks and weighed 14 ounces – only 2 ounces more than a soda can. Cat has only one kidney, which makes pregnancy difficult. He wasn’t getting enough blood and had stopped growing. “I was scared,” Cat admits.

“I just kept praying and praying. But he’s a fighter, a strong little boy. I’m blessed,” she says with a smile.

Jacob was one of the smallest babies ever born at LAC+USC Medical Center. When Cat arrived there for an emergency Cesarean section, his heart rate was dropping and her kidney function was failing.

“There wasn’t much blood going from the placenta to the fetus. We thought that if the pregnancy continued, he could die,” says Ramanathan, who is medical director of the LAC+USC NICU.

Ramanathan – Dr. Ram – moved from India to the United States in 1981 because he was tired of watching so many babies die in India without being able to help them. He read the research coming out of other countries. He saw that with the right care, these babies could live.

He arrived at LAC+USC Medical Center for training in 1984. He left in 1986, then returned for good in 1988. “Most of the people who started with me are still here,” he adds. He notes the changes in neonatology in the past 20-plus years.

“With advances in technology and everything else, you have a fighting chance. That’s what makes me get up and come to work every day.”

Essential hospitals have led many of these advances. For example, LAC+USC is one of the few hospitals in California that provides follow-up care until age 6, including all specialty and well-child care, for babies born less than 3.3 pounds. “We are their pediatrician,” Ramanathan says.


Dr. Ramanathan

Here to Fight

LAC+USC Medical Center, Los Angeles, California

LAC+USC is part of the Los Angeles County Department of Health Services, the second-largest public health care system in the nation.

In the Treetop...

University Health System (UHS), San Antonio, Texas

Miles away from LA County, we enter a NICU in San Antonio that comes as close to a dreamy, gentle nursery as any hospital could. Light spills in from the outside, and each baby rests among the branches in this painted treehouse.

It’s quiet in here, and Medical Director Steven Seidner, MD, talks softly, as here and there a baby stirs. The treehouse’s pinwheel design encircles each baby’s unit in its own arc. It creates a private, quiet space, so the stirring of one doesn’t disrupt another.

Why are we here – so far from Jacob and Dr. Ram?

Because essential hospitals across the country are saving babies just like Jacob. And they all do something unique to add to that fighting chance.

The treehouse, for example, is a major transport destination for critically ill newborns in South Texas. It is the only NICU with its own dedicated ground transportation for newborns. Each year, more than 150 babies are brought here to heal and grow in the treehouse.

Skin to Skin

Santa Clara Valley Medical Center, San Jose, California

Santa Clara’s NICU is dedicated to continuous quality improvement. Since 2011, Santa Clara has been studying the micronutrient composition of breastmilk to get a clearer understanding of its benefits.

Santa Clara NICE Mother and newborn

In Northern California, we find a unique focus on the parents and families of NICU babies in Santa Clara Valley Medical Center, which has set the standards for this specialized care since 1972.

Feeling her way around the tubes and wires, a mother cradles her baby close, pressing skin to skin. In this NICU, a mother’s touch is seen as necessity, as important as any test or treatment.

Breastfeeding, as well, is a central element of NICU care – for the health of mother and child. For preemies in particular, the benefits of human milk can be vital to survival. That’s why the medical center works closely with the San Jose Mother’s Milk Bank. Because not all mothers can breastfeed their babies, the NICU ensures its fragile patients receive this fundamental nourishment.

My Family

LAC+USC Medical Center, Los Angeles, California

Jacob often returns to the hospital where he spent those first weeks of his life. He receives all of his primary and specialty care through the hospital and its premature clinic. But really, he’s just visiting family.

Swept into the arms of his primary NICU nurse and now, godmother, Jacob grins. “The doctors … the nurses … they never gave up hope on my son,” Cat says. “I will never, ever forget about them. They’re part of my family.”

And the feeling is mutual.

“We treat every baby in our NICU as our own baby, our own family member,” Ramanathan says.

It’s a concept he applies to his staff, as well. “I spend more time in the NICU with my staff than at home. We trust each other.” That trust is apparent when a new baby joins their family. “Everybody knows what to do,” Ramanathan says. “I don’t have to tell them, they know.”

Sheldon B. Korones Newborn Center Nurse and Infant

Trusting Hands

Regional Medical Center, Memphis, Tennessee

More than 45,000 babies have passed successfully through the Sheldon B. Korones Newborn Center, part of the Regional Medical Center, one of the oldest NICUs in the country. And more than 1,300 babies each year rely on this team for survival.

At rare times, however, Ramanathan isn’t sure what to do, which is the hardest part for him. “If you do all the tests and still don’t come out with [an] answer … [to] why a baby is not doing well, that’s when you get frustrated,” he says.

“We can only test so much and there are so many things that are unknown.”
It is then that his colleagues become even more crucial.

“You have to be humble,” he explains. “Being able to accept ideas and suggestions from your colleagues and team members is the most important thing. Not only will it help you personally, but [it will help] all the patients you care for. … Everyone has equal value. Anyone can come to me with an idea.”

Please Stay with Me

UF Health Shands Children’s Hospital, Gainesville, Florida

The Shands Children’s Hospital NICU sees babies so small, “the total amount of blood in their bodies is three to four tablespoons,” says chief of neonatology David Burchfield, MD. Some patients even come to Shands from other level III NICUs where doctors have tried everything else, to no avail.

Finding answers is crucial for building trust with a baby’s family – as is finding common ground.

When they see their baby for the first time, families are often devastated. Wires running everywhere. Skin so fragile you can see the veins. Sometimes, bleeding.

“They don’t want to touch the baby, those first few days,” Ramanathan says. And he knows the feeling – his own daughter was born prematurely. Thirty years ago, when she was born, he couldn’t conceive of the thriving young woman she has become. “Knowing all of the things that could go wrong,” he recalls, was a constant battle in his mind. Worrying about her survival, her quality of life. And back then, he reminds us, the NICU technology was not that great.

So he shares his story with families. “I tell them, ‘I know what you’re going through, so please stay with me. We’ll work together to help your baby.’”

Shands Children’s Hospital NICU infant pateint

The Cuddler

UC San Diego Medical Center, San Diego, California

Together, families and staff provide NICU babies that crucial combination of science and love. As doctors and nurses run IVs, check vitals, and provide treatment, parents offer comfort with intimate reminders of life in the womb – a mother’s voice, a familiar song.

But even the most devoted parents have to step away from the NICU at times. And while each minute away can seem like an eternity, some hospitals are lifting that burden.

Meet retired building inspector Roger Whistler. He is one of the 6,000-plus volunteers at UC San Diego Health System.

He’s a cuddler. He helps hold, rock, feed, and change the NICU babies.

In doing so, he frees staff to care for other patients and eases parents’ minds, who just want to know their babies are loved.

Over the past two decades, thousands of newborns have cuddled in his arms, finding comfort and peace in his embrace.

Shhhhh...

The MetroHealth System, Cleveland, Ohio

The MetroHealth System sees a significant number of babies with very low birthweight – 20 percent weigh less than 3.3 pounds. The average birthweight of a full-term newborn is more than double that, at 7.5 pounds. But this essential hospital ranks in the top hospitals nationally in survival rate for these tiniest babies.

The babies that come into the NICU face great challenges. And every moment of ease, every ounce of love they receive adds to their survival.

Treating NICU babies as his own is Dr. Ram’s way of creating those moments. And just like any proud parent, he knows that success is only achieved when his babies no longer need him.

When a thriving 4-year old like Jacob comes bounding into the NICU. When that strong, healthy child bears no resemblance to the helpless baby Ramanathan once knew. On that day, he says, his work is done. “The rest is yours,” he tells families.

“I am just lucky to be here,” he says, “to help your baby make it through this crisis … [and] I am so thankful that I was given the opportunity to do that … [because it] has made an impact in my own life.”

Jacob's Luck

LAC+USC Medical Center, Los Angeles, California

Jacob has warmed to me. He showed me his bike and rode it around the house. He told me he likes to sing and launched into a near-flawless version of the ABCs. His recovery has exceeded Ramanathan’s expectations.

Jacob had to overcome three substantial hurdles in the NICU: immature lungs, an open blood vessel that allows for abnormal blood flow, and the risk of double blindness. And now? His glasses are the only visible sign of these crises.

So why, I ask, has he done so well? His parents, says Dr. Ram.

“[They] are unbelievably loving to him.” Love and attention to detail can dictate the course of a NICU baby’s life after discharge.

“His parents go out of their way to interact with him, to talk to him and be part of his everyday life. They bring [him] to the clinic, they follow all of the instructions … That’s what happened to Jacob. He is lucky.”

Dr. Ram and Jacob

Why We're Taking the Walls Down

In health care, we often talk about what goes on inside the hospital walls. We talk about getting outside those walls and into the community. In or out, the walls are still there. There’s a barrier, a separation in our communication that, in reality, doesn’t exist.

In an essential hospital, life flows in and out. It’s fluid. Part of a community’s central grid, the hospital comes alive and reaches out, into schools, shelters, and the streets that run through them. Finding people where they are and bringing them what they need. Maybe it’s food. Maybe it’s medicine. Maybe it’s inspiration or education.

At the same time, the community is drawn in. For lifesaving emergency care. For hands-on clinical training. For innovative, cutting-edge treatment not available elsewhere. For support. There are no walls. There’s only motion, back and forth, in and out, and beyond.

By taking the walls down, we can talk about the people who move fluidly around this space. The moms and dads, sisters, brothers. The babies. The doctors and nurses, students and teachers, the leaders. We can talk about what they do, what they think. We can delight in their joy, dig deep in their despair, and learn from their experience.

This issue of Walls Down focuses on one aspect of essential hospitals – the specialized, lifesaving services they provide, such as trauma care, neonatal intensive care, and disaster response.

We have always needed these services. Natural disasters are not new. Collisions, fires, and clashes are inherent in our world. But for many years, there was no training to provide emergency care. It wasn’t until the 1960s, when increased urban violence and drug use filled emergency departments with critical injuries, that medicine changed. The inner-city, public hospitals that cared for those patients, essential hospitals such as LAC+USC, San Francisco General Hospital (SFGH), and Cook County in Chicago, became the agents of that change.

As the teaching hospitals for local medical schools, they were the perfect first training ground for emergency medicine students. SFGH and Cook County also opened the country’s first hospital-based units specifically for these services. And in the 1970s, formal guidelines and designations for trauma centers were established. Training, processes, and equipment continue to evolve, and as you’ll see in these stories, essential hospitals remain the leading innovators of this care.

We’ve chosen to focus on lifesaving services because they take us back to the roots of essential hospitals. This aspect of their character touches all of us. Travel into the shadows and back out through the experience of an artist, a mother, a preemie, a neurosurgeon, a first responder. When the walls are down, we can see the emotion and the reality, the human and the technical, the existence and the absence. We can see the flow, in and out, through us all.

Sandy Laycox and Maya Linson

From the CEO of America's Essential Hospitals

We all need essential hospitals. Look around and you’ll see that essential hospitals are there, in the background of our lives. I was born at an essential hospital, and I’ve overseen two of them.

The people inside essential hospitals – patients and providers – are at the heart of our work at America’s Essential Hospitals. Their health and success are our end goal. But often in our work, we must focus on the more technical aspects of health – data, legislation, research, and regulation. And the people – the spirit and emotion behind the numbers – sometimes fade from view.

Walls Down is a publication that shares essential hospital stories by putting the people who live those stories up front. Those people are you, they are me, they are all of us. Through this perspective, we can make connections – to each other, to our communities, and to the meaning behind the day-to-day details of our work.

I encourage you to get to know these people. Through their stories, you will see what we all face. And you will learn how certain hospitals remain essential to us all.

Bruce Siegel, MD, MPH
President and CEO
America’s Essential Hospitals