HOUSTON flood followup

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Ben Taub staff escapes the worst on holiday

Workers keep fingers crossed as hospital fails to overflow


Copyright 2001 Houston Chronicle


The crisis administrators had feared would overwhelm Ben Taub Hospital's emergency center Wednesday didn't happen.

But patient volume appeared to be picking up about 9 p.m. at the city's only functioning Level I trauma center, said Dr. Christian Eckman.

A patient with a fractured pelvis had taken the last available bed in the surgical intensive-care unit about 4:30 p.m., making the situation tenuous for additional critical patients, said Dr. Asher Hirshberg, attending surgeon on duty.

"We can't not take them," said Hirshberg, also an associate professor of surgery at Baylor College of Medicine. "We'll manage somehow."

A few intensive-care beds had become available by about 9:15 p.m. when an auto accident victim arrived, Eckman said.

"We have people move out of beds all the time," Eckman said. "We're constantly reassessing."

By late afternoon, the emergency center already had treated a patient with a gunshot wound to the head, another who had fallen out of a tree and was hit by a falling limb, two injured motorcyclists and a patient ejected from a car.

About 7 p.m., another patient with a gunshot wound was dead on arrival.

Officials had feared the Independence Day holiday could lead to a spate of injuries that would swamp the hospital. The patient flow was steady throughout the day and was expected to increase, said Dr. Michelle Schmidt, the attending physician in the emergency center Wednesday.

"Everybody's bracing for the evening, after it gets dark," she said.

The root of the problem is a nursing shortage that has worsened since the June 9 flood that closed Memorial Hermann Hospital and hobbled several others.

Ben Taub, unaffected by flooding, has had to pick up the slack. But there are limits to what it can do, said Dr. Ken Mattox, the chief of staff there.

"What this has shown is that when one of us falters, the health infrastructure of the city is in jeopardy," he said. "This is a wake-up call that gives us the opportunity to get the best minds in town to address the question. What do we desire? Do we want four Level I trauma centers?"

A Level I trauma center has the highest rating possible and can, among other things, handle emergencies requiring surgery within an hour.

Mattox said the competition for nurses won't lessen anytime soon. And Ben Taub, which is run by the Harris County Hospital District, pays considerably less than private hospitals and agencies.

"This community needs to address this issue," Mattox said. "What do we want for our health-care safety net? That's a societal decision. Our job is to take care of the patients who come through the door."

Patients who come to Ben Taub's emergency center go first to the triage area where a nurse assesses their condition. Critical patients are sent immediately to one of five "shock rooms," where a team of physicians, nurses and X-ray technicians begins treatment and tests. From there, the patients may go to intensive care or surgery.

Two operating rooms and 22 intensive-care beds were available Wednesday. The nursing shortage has caused the hospital to close eight ICU beds.

Patients with a potentially serious condition are moved to the holding area, divided into a surgical side and a medicine side. Those who are not seriously ill are seen in one of 12 examining rooms in an area called the "team hallway."

Each side in the holding area has space for about 25 beds, but may at times have as many as 40 patients, some of whom are placed in chairs, staff members said.

"Sometimes they'll be squeezed in here so tight, you can't walk between stretchers," said Sabrina Kamman, who has worked at Ben Taub for five months. Kamman worked as a staff nurse at other hospitals for 13 years.

"Here, you do truly feel like you're making a difference," said Kamman, 34, of Richmond.

Ben Taub emergency center nurses work 12-hour shifts, three or four days a week. It's common, however, to put in 50- or 60-hour weeks, Kamman said.

Although the emergency center was not overflowing with patients Wednesday, it may be today.

"We dread coming in the morning after a holiday," said Julia DeVore, a nurse. "The place is wall to wall C-collars and backboards," she said, referring to devices used to protect a patient's spine and neck.

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