How an Innovative Trauma Team is Saving Lives in the Real World

New North Texas pre-hospital trauma team saves man’s life on its first field call.

The lifesaving onsite amputation of a construction worker’s leg in Frisco by a team of experienced ER and trauma physicians demonstrates the value of pre-hospital trauma care in North Texas. Medical City Plano received its Level I Trauma Center designation from the Texas Department of State Health Services in May 2017. Newer yet is the team that was assembled for just such a real-world incident in a joint effort between Medical City Plano, Medical City Frisco and local EMS and firefighters. Known as the Pre-Hospitalization Amputation Team, it was called on for the first time during the Frisco construction accident when it saved the life of a man who had become caught in a commercial trencher, his right leg completely trapped in its chain-saw-like teeth.

PHAT Channel 4

The team had been put together just six months earlier at the request of Collin County firefighters. They had identified a need for the service due to the increasing number of ongoing construction sites in the area and the potential for injuries the sites present.

Firefighters arrived on the scene within five minutes but were unable to free the man’s leg. They called Mark Gamber, DO, an emergency room physician at Medical City Plano, who put in a call to trauma surgeon Al West, MD. The two doctors were helicoptered to the site with their Pre-Hospitalization Amputation Kit.

Dr. West, who performed the operation, said that there was no choice but to amputate above the knee. After the 10-minute procedure, the patient was stabilized and transported in the helicopter to Medical City Plano. For the latest update on his condition, read the full story on DallasNews.

For Dr. West, this was his first experience with field surgery.

“In the civilian world, it’s pretty uncommon to go out and do something like this,” he said.

Trauma is a team sport.

Having the team in place shaved at least an hour off the time it would normally have taken to treat the patient. Dr. West said it was very likely he would have bled to death while he waited.

“The real takeaway is the preparation by the local fire departments and the MCP trauma service for just such an emergency,” he said. “Process improvement is what good trauma care is built on. Trauma is a ‘team sport’ and I am incredibly proud of the team of professionals we have put together here.”

Learn how to stop the bleed in any trauma situation.

Roughly 10,000 Texans are killed each year from injuries, according to the Texas Department of Health and Human Services. The National Trauma Institute lists traumatic injuries as the leading cause of death in persons aged 1 to 46 years old.

Trauma injuries can take many forms, from construction accidents to ground level or high falls to mass shooting incidents. Knowing how to stop bleeding in someone who is critically injured is a valuable skill that could save the life of someone you love. Visit Stop the Bleed for more information.

For fast, emergency service in any crisis situation, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free, 24/7 Ask-A-Nurse hotline.

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Seizures and Fainting: How to Know When to Go To the ER

If you’ve ever seen someone faint or have a seizure, you know that it can happen suddenly and without warning. It can also be very frightening for everyone involved. Both reactions are the body’s way of telling us that something is wrong. Diagnosing the source of the seizure or fainting spell is something that should be left to a medical professional, as there are many different conditions that can cause these reactions. Here’s what you need to know about seizures and fainting and when to go to the ER.

Common conditions that cause seizures.

A seizure happens when there is a sudden, abnormal change in the brain’s electrical activity.

“Seizures can be caused by a variety of conditions that directly and indirectly affect our brains,” said Aamr Herekar, MD, a neurologist at Medical City Fort Worth. These include:

  • Brain tumors
  • Brain hemorrhages
  • Developmental malformations of the brain
  • Stroke
  • High fever in children, which can cause febrile seizures
  • Very low sodium levels (hyponatremia)
  • Very low or very high blood sugars
  • Genetic disorders
  • Some medications/drugs

“But by far, the most common causes of seizures are unknown,” Dr. Herekar said.

Epilepsy is a seizure disorder that affects about 3.4 million Americans. According to the Epilepsy Foundation, 6 out of 10 people with epilepsy have no diagnosable cause for their condition.

About 3% of people with epilepsy have photosensitive epilepsy, which means their seizures can be triggered by exposure to flashing lights at certain intensities or certain visual patterns. This type of epilepsy is more common in children and adolescents and episodes can decrease with age.


How to recognize seizures.

According to Dr. Herekar, seizures can be easy or hard to recognize, depending on which part of the brain is seizing. The person may or may not lose consciousness. The seizure may involve the whole body, repeated jerking of a single limb or simply hand rubbing or picking at clothing.

However, there are common elements to look for that can help you identify a seizure.

“Most seizures include staring, decreased responsiveness and lip smacking movements, Dr. Herekar said.”

When to get medical help for seizures.

When someone is having a seizure, Dr. Herekar says that the best thing you can do is to place them away from harm. For example, keep them away from sharp objects and make sure that they don’t choke on anything by laying them on their side. Don’t put anything in their mouth or hold them down.

Dr. Herekar recommends calling 911 for seizures that:

  • Last beyond one minute
  • Begin to happen more frequently (occur back-to-back)

You should always inform your doctor of any seizures or other unusual medical symptoms regardless of how severe they are.

Common conditions that cause fainting (including seizures).

When someone faints, they lose consciousness due to a sudden decrease of blood to the brain.

Dale Yoo, MD, a cardio electrophysiologist at Medical City McKinney, says that an episode of fainting can be a sign of a seizure disorder.

“That would always be abnormal and needs medical attention,” he said.

Conditions that can lead to fainting include:

  • Seizure disorders (including epilepsy)
  • Electrolyte abnormalities in the heart or brain
  • Dehydration
  • Low or high potassium or magnesium levels
  • Other heart issues, including:

“If fainting is caused by a low heart rate, a pacemaker is the only thing that will correct it,” Dr. Yoo said. “On the other hand, your brain may tell your heart to take a five-second break or your heart does it on its own. It goes on lunch break but you need that five seconds of blood pressure in order to stay awake — otherwise you pass out.”

When to get medical help for fainting.

A fainting episode normally lasts a few seconds to several minutes. Always let your doctor know about any episodes of fainting and seek immediate help for all medical emergencies. When in doubt, call 911 or head to the nearest ER.

If you feel faint:

  • Lie down or sit down.
  • If sitting, place head between knees.
  • Avoid getting up too quickly.

If someone else faints:

  • Position the person face-up.
    • If there are no injuries and the person is breathing, raise their legs above their heart level (about 12 inches) if possible.
    • Loosen belts, collars and other constrictive clothing.
  • If the person doesn’t regain consciousness within one minute, call 911.
  • Check for breathing and begin CPR if necessary.

For expert emergency care in any situation, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free, 24/7 Ask a Nurse hotline.

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What You Need to Know About Hospital-Based Emergency Departments

You’ve probably noticed the abundance of walk-in medical clinics and ERs that have recently popped up all over North Texas. There seems to be one on every corner. While they may share convenient locations and extended hours, there are differences that you should be aware of before checking in. Choices include urgent care centers, freestanding emergency rooms and hospital-based emergency departments (HBEDs), also called off-campus ERs.

What are hospital-based emergency departments (HBEDs)?       

Hospital-based emergency departments are off-campus ERs that are affiliated with hospitals — as opposed to freestanding ERs, which have no hospital affiliation. In short, HBEDs are an extension of a hospital’s emergency room. How you will know: Look at the name of the ER to tell if it is affiliated with a larger health system or hospital. The name may contain the name of the health system or indicate that the ER is a department of the hospital.

Medical City hospital-based emergency departmentsAdvantages of hospital-based emergency departments include:

  • Board-certified physicians and specially trained staff: Patients are seen by board-certified and board-eligible emergency medicine physicians and emergency RNs. Often, they are the same physicians, nurses and other healthcare providers who practice at the primary ER location in the hospital.
  • Full-service care: HBEDs are equipped to handle true medical emergencies such as life-threatening illnesses and injuries expertly and efficiently and with many of the same resources and personnel of a hospital ER, including laboratory techs, radiology/imaging CT and X-ray techs, patient access registrars, pharmacists, executive RN administrators and paramedics/ED techs.
  • Pediatric expertise and training: Some HBEDs, such as those affiliated with Medical City Healthcare, feature specialized pediatric treatment rooms and nurses trained in pediatric care and certified in Emergency Nursing Pediatrics or Pediatric Advanced Life Support.
  • Insurance acceptance: Because HBEDs operate as a department of a hospital, you can be sure that they accept the same insurance plans and adhere to all state and federal regulatory compliance requirements for acute care hospitals.
  • Shorter wait times: Often, there is little or no wait time in an off-campus ER.
  • Seamless transition of care: If patients need a higher level of care that can only be provided by a hospital, transferring from an HBED to its main hospital or a hospital within its network is seamless. It can also be less expensive than transferring from a freestanding ER because you won’t be charged multiple facility fees.
  • 24/7/365 service: HBEDs are always open, just like hospital ERs.
  • Recognized by Medicare and Medicaid: Unlike freestanding ERs, HBEDs are recognized by the Center for Medicare and Medicaid Services (CMS) as emergency departments.

What’s the difference between hospital-based emergency departments and urgent care centers?

Urgent care centers, such as CareNow, offer extended hours and treatment for minor illnesses and injuries, family medicine, flu shots and other immunizations, annual check-ups and sports physicals. They can be a great option when your family doctor isn’t available or when you don’t have time to wait for an appointment.

Hospital-based emergency departments, just like their in-hospital emergency room counterparts, provide a higher level of emergency, lifesaving care 24/7 for more serious illnesses and injuries. Read In Case Of Emergency — ER vs. Urgent Care for a more comprehensive list of conditions treated by both.

Always call 911 for potentially life-threatening situations.

For fast, emergency help when you need it most, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free 24-hour Ask-A-Nurse hotline.

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How to Survive and What to Do in an Emergency Trauma Situation

If you’re ever faced with an emergency trauma situation that has the potential for serious injuries, such as a natural disaster (fire, flood or tornado), a manmade attack such as the Las Vegas concert tragedy or even a motor vehicle accident, the folks behind Stop the Bleed want to empower you to think of yourself as an immediate responder as opposed to a bystander.

According to the National Trauma Institute, traumatic injuries are the No. 1 cause of death for people ages 1 to 46 years old. In 2014, the CDC reported that nearly 27 million people were treated for injuries in an ER and 2.5 million were hospitalized.

Launched by the White House in 2015, Stop the Bleed is Homeland Security’s national awareness campaign to encourage the public to become trained, equipped and empowered to help in a bleeding emergency before professional help arrives. The key is to remain calm, avoid panicking and rely on your training.

But first things first. See RUN. HIDE. FIGHT.®, a video produced by the Houston Mayor’s Office of Public Safety and Homeland Security and recommended by the FBI for learning how to respond to an active shooter situation. The takeaway is to think ahead and take immediate action to get to safety.

First aid for emergency trauma injuries.

Once you are safe, check to see if you are injured. Then check those around you. No matter how quickly first responders arrive, people directly or indirectly involved in an incident will always have a head start on providing first aid.

Traumatic bleeding.

“A person can die from blood loss within minutes during an emergency trauma situation,” said Mike Mixson, Trauma Services Director at Medical City McKinney. “But if a bystander is familiar with how to control the bleeding until first responders arrive, they can save a person’s life.”

“The people who are going to be able to render aid are the ones that are there,” agreed Jennifer Turner, Trauma Program Manager at Medical City Lewisville. “The first thing you want to identify is where the injured person is bleeding from.”

Turner has taught first aid classes through the hospital, featuring Stop the Bleed techniques and hands-only CPR. She was recently interviewed by NBC5 for her expertise on emergency first aid.

Jennifer Turner
How to stop the bleed.

Stop the Bleed training includes the following steps:

  • Move yourself and the injured person to safety
  • Call 911
  • Apply firm, steady pressure with hands
  • Apply a dressing and press firmly (pressure dressing)
  • If bleeding doesn’t stop, apply one or more tourniquets as needed

“We teach members of the community how to pack a wound,” Turner said. “So after you’ve identified where the bleeding wound is, you’re going to take a piece of gauze or clothing and start packing it inside the wound. Once you’ve wrapped your extra material around the wound, you want to apply pressure until first responders arrive.”

“Tourniquets can only be applied to arms and legs,” Turner said. They will stop the bleeding. Pressure dressings can be done to other areas.”

Medical City McKinney recently donated 75 Stop the Bleed kits to Anna High School for their first disaster drill. Kits contain pressure dressing, gauze, shears, a tourniquet and a simple guide on how to stop the bleed. Find more information at

Members of the hospital’s trauma team plan to instruct teachers on how to quickly stop life-threatening blood loss due to injury at a follow-up teacher in-service day.

Lifesaving CPR.

If a teen or adult suddenly collapses and isn’t breathing, start hands-only CPR. It’s recommended by the American Heart Association for adults and can double or even triple the chance of survival.

“Studies have shown that compression alone can help save a life,” said Turner. We’ll teach you the right way to do chest compressions.”

Matt Bush, MD, an emergency medicine physician at Medical City Dallas, teaches the two simple steps that can save a life.

Medical City hospitals also teach infant CPR classes.

Tia Raymond, MD, a pediatric cardiologist at Medical City Children’s Hospital, demonstrates how to properly perform chest compressions on an infant.

For expert care in an emergency trauma situation, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City Healthcare ER near you or call our free 24/7 Ask-A-Nurse hotline.

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How to Stop Texting While Driving (And Why People Do It)

The law against texting while driving in Texas (complete with fines of $99 to $200) went into effect in Sept 2017. But do we really need a law to prevent us from doing what we know is potentially deadly? In 2016, the Texas Department of Transportation reported that 455 people were killed in crashes involving distracted driving in Texas. Distracted driving has been called the “new drunk driving” because people who text while driving are:

  • As impaired as if they’d consumed 4 beers
  • 23% more likely to cause a crash

Melanie Leonard, RN, Trauma Program Manager at Medical City North Hills, encourages people to commit to not driving distracted and to “put texting aside and arrive alive.”

According to Matt Carrick, MD, Trauma Medical Director at Medical City Plano, the average driver who sends a text glances at their phone for 5 seconds, during which time the car, at 55 mph, will travel the length of a football field.

So why are people still texting while driving?

A survey commissioned by AT&T® found that at least 7 in 10 people use their smartphones while driving. Although texting and emailing top the list of activities, the survey revealed that people are also using social media, Web surfing, video chatting and taking selfies … while driving.

Among those who text while driving, survey respondents said they:

  • Want to stay connected to family, friends and work (43%)
  • Do it “out of habit” (Nearly 33%)
  • Can multitask, even while driving (Nearly 33%)
  • Have FOMO, or fear of missing out on something important (28%)
  • Can text while driving without affecting their driving performance (25%)
  • Believe others expect them to respond to texts “right away” (25%)
  • Feel a “sense of satisfaction” when they read or respond to a text (17%)
  • Feel “anxious” if they don’t respond right away (14%)
  • Are “addicted to texting” (6%)

Addicted to tech.

Ninety-eight percent of those who admitted to texting while driving said they know it’s dangerous but they do it anyway, using many of the reasons above to rationalize their behavior. According to experts, this is a classic sign of addiction. Compulsively checking your phone and reading and responding to texts, tweets, emails and posts causes an increase in dopamine, a chemical released by our brains that makes us feel happy.

In addition to the risks of texting while driving, being too plugged in can take a toll on your physical and mental health. In his article “Is Too Much Tech Making You Sick?,” Roger Butler, MD, a psychiatrist at Medical City Green Oaks Hospital and Medical City McKinney, says that the drawbacks of the digital age can include depression, social awkwardness (especially for children), back and neck problems, headaches, eye strain and sleeping disorders.

To find out if you have a digital addiction, take the Digital Distraction Test created by The Center for Internet and Technology Addiction, the organization that conducted AT&T’s survey.

Breaking the habit: How to stop texting while driving.

Let’s say that you’re one step ahead of the texting while driving ban. You already drive with your phone out of reach or you’ve downloaded an app that helps you avoid distractions while driving, such as AT&T’s Drive Mode®. Great job. But now you’ve got to fill that smartphone-sized empty space and try to get to where you’re going without lapsing into boredom-induced road rage. Here are a few ideas.

  • Listen to a podcast

Podcasts are episodic digital audio files that are available to download from the Internet for free or via subscription. There are podcast titles for every taste, including politics, pop culture, romance, mystery, celebrity gossip, true crime sports and more. Check out TIME magazine’s 50 Best Podcasts of 2017.

  • Listen to audio books

No time for reading? Download an old classic or the latest bestseller and enjoy having someone read it to you while you get from A to B. Find a list of free audio book websites here.

  • Talk to your kids

When you’re the chauffeur, it’s only fair that the kids put down their phones, too. Make this your catch-up time — sometimes it’s easier to talk in the car than among all the distractions at home. You can also play car games if you’re on a long trip. Check out Pinterest for a list of games such as license plate bingo, eye spy and road trip scavenger hunt plus the ultimate road trip playlist.

  • Listen to a movie or soundtrack

If you’re bored by your radio’s choices, listen to your favorite movie (just don’t watch it) or the music from the latest Broadway hit. A current favorite: the original Broadway cast recording of “Hamilton,” available on Amazon and included with a Prime membership.

Texting while not driving.

If you’re wondering whether it’s okay to text while stopped in traffic or at a light, the answer is yes. However, drivers are cautioned to pay attention so they won’t stop the flow of traffic.

For fast, emergency help when you need it most, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free 24-hour Ask-A-Nurse hotline.

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Revised 3/8/2018

Does the Latest Exercise Worry Have You Spinning?

A recent wave of articles based on a 2017 report published in the American Journal of Medicine (AJM) has exercisers — especially those who take indoor cycling classes — concerned that over-exercising will lead to muscle meltdown. Clinically, the condition known as rhabdomyolysis, or “rhabdo,” occurs when muscle tissue begins to die, leaking a protein called myoglobin into the bloodstream. Small amounts of myoglobin can be filtered out by the kidneys, but the protein breaks down into substances that can damage kidney cells and too much will shut them down.

Exercise-induced rhabdo among weekend warriors is rare. In the past, it’s been more often associated with soldiers, firefighters, college athletes such as the eight Texas Women’s University volleyball players who were hospitalized with rhabdomyolysis in 2016 and others whose professions or training can be especially physically demanding. The AJM report is based on three spinners out of a study group of 46 who got rhabdo from indoor cycling; 42 of them became injured during their first class.

Causes of rhabdomyolysis.

Rhabdo can be caused by a variety of issues that lead to muscle death or damage, including:

  • Trauma, burns or crush injuries
  • Severe dehydration
  • Severe exertion, as from Spinning®, SoulCycle®, P90X®, CrossFit® and marathon running
  • Drug use, including cocaine, amphetamines, statins (cholesterol medications), heroin or PCP
  • Extremes in body temperature
  • Low phosphate levels
  • Seizures or muscle tremors
  • Lengthy surgical procedures
  • Genetic muscle diseases

None of the articles suggest that you should stop doing high-intensity exercise, as it can provide a variety of health benefits. But you should learn to recognize the symptoms of rhabdo, because the earlier treatment is started, the better.

Symptoms of rhabdomyolysis.

Here are symptoms of rhabdo to look for:

  • Uncommon pain, stiffness, swelling, tenderness or weakness in muscle groups overexerted
  • Dark red or brown urine
  • Decreased urine output
  • Nausea or vomiting

These symptoms can also be present:

  • General weakness, fatigue or joint pain
  • Unintentional, rapid weight gain, which can signal a dangerous buildup of fluids

Treatment for rhabdomyolysis.

If you think you or an exercise buddy might have rhabdo, call 911 or head straight to the nearest ER. Time is critical in preventing kidney failure.

Treatment for rhabdo can include:

  • Mild cases involve giving patients fluids to rehydrate and flush out toxins
  • More severe cases may involve
    • Dialysis in the case of kidney shut-down
    • Drainage to relieve pressure on swollen limbs (compartment syndrome)

Spinning-Instructor-FB.jpgHow to prevent rhabdomyolysis.

As the AJM report noted, exercise-induced rhabdo almost always affects people — even fit ones — trying an aggressive new activity for the first time and overdoing it. Here’s how to make sure it doesn’t happen to you.

  • Slowly work up to a new, high-intensity exercise that you’ve never done before or that targets muscle groups you’re not used to working
    • This means, in a tough workout class, knowing when to slow down or stop even if the instructor is urging you on
  • Tell the instructor that you’re new to this type of exercise
  • Stay well-hydrated before, during and after
  • Avoid taking nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen and naproxen sodium) after an intense workout, as they can be damaging to kidneys and worsen a case of rhabdomyolysis

If your latest exercise routine has you spinning out of control, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free 24-hour Ask a Nurse hotline.

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