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HOUSE CALL WITH DR. SANJAY GUPTA

Treating the Atlanta Bus Crash Trauma Victims

Aired March 3, 2007 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


T.J. HOLMES, CNN ANCHOR: Well, treating the trauma victims. We've got an in-depth look with CNN chief medical correspondent Dr. Sanjay Gupta now.
BETTY NGUYEN, CNN ANCHOR: That's right. He is live at Grady Memorial Hospital, right here in Atlanta, for a special edition of HOUSE CALL.

Good morning, Sanjay.

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Good morning, guys.

T.J. and Betty, thank you so much.

We're going to pick up the story right where you guys left off.

Welcome to a special live edition of HOUSE CALL. I'm Dr. Sanjay Gupta.

As you mentioned, we are live here Atlanta's Grady Hospital, where patients are here, still being treated for injuries from a tragic bus crash yesterday. In fact, take a look here.

That was the scene 24 hours ago. Paramedics on the scene rushing patients to several local hospitals. Here at Grady Hospital, the largest trauma hospital in the area, 19 patients were brought here within minutes. And that's going to be critical. I'm going to talk about that here in a second.

(on camera): Right behind me here are the ambulance bay. That was sort of the hub for the victims of that horrible highway accident. There's also helipads above them, going to give you a sense of how a trauma hospital works. The story continues to develop today.

Now I am a neurosurgeon. I'm also a reporter for CNN. I am not going to divulge any patient physician confidentiality, but I am going to give you a unique first person look of what happens in a city, and what happens at a hospital when this kind of disaster strikes.

First of all, it starts with the EMT. It starts with the paramedics. They arrived at the scene. They arrived there within minutes. And that is so important to try and get those patients care as quickly as possible.

What happens then as doctors as standing by here in the ambulance bay, waiting to take care of those patients. Here at Grady Hospital, they have trauma surgeons available on site all the time. Oftentimes, they'll call in neurosurgeons, they'll call in orthopedic surgeons, they'll call in specialists to keep going.

Trauma surgeons are always on stand by. And OR is always on stand by. There are 10 to 20 units of "O" negative blood, which can be given to anyone who is close at hand.

Now this is because there may not be time to check the blood type. Things move very fast in a situation like this. You may not be able to check their blood type. You've got to get these patients cared for as quickly as possible. Often times, CAT scans are used as well.

The triage, the priority of patients all happening very quickly. But of course, the care for some of these patients will continue for much, much longer.

Now I want to give you some of the headlines from just last night here. I got an update from the trauma surgeon. We have 19 patients that were brought here yesterday. Four remain in the hospital today. One is stable, one is serious, and two are still in critical condition.

And Dr. Jeff Salomone is our guest. He's joining me here now. He's in the hospital. Get a quick microphone here as well. Come on up here, Dr. Salomone. You're one of the trauma surgeons here at Grady Hospital.

JEFF SALOMONE, DR., TRAUMA SURGEON: That's right.

GUPTA: And I want to get a sense, first of all, how did you find out about this yesterday? Did you get a page or?

SALOMONE: On the news. I woke up yesterday morning, and the -- my colleagues who were here at the hospital were already involved in caring for the patients.

I was the surgeon assigned to cover the trauma yesterday. And so as soon as I got here, we began to -- they were in the process of organizing care for the patients.

We had 19 patients who were spread over the emergency room. Two had gone to the operating room already. And we were able to find a quiet area of the hospital to move all the walking wounded patients to, and begin to assess them, and organize care.

GUPTA: Well, you were just in the hospital. You just walked out from there.

SALOMONE: That's correct.

GUPTA: How are these patients doing?

SALOMONE: The two that are critical remain critical. The one that is serious has done well overnight, but he still has a very bad liver injury. And it's going to be several days before we have a good handle that he's not going to need an operation. And then the one remaining patient of the least injured is doing OK, but not quite ready for discharge yet. GUPTA: Fifteen patients have left the hospital now.

SALOMONE: That's correct.

GUPTA: Where do they go? Where are they leaving to?

SALOMONE: Well, yesterday, the Atlanta community pulled together in a tremendous effort. One of the local hotels offered rooms. A number of local hotels offered rooms.

BETTY NGUYEN, CNN ANCHOR: Obviously, we're having some technical difficulties with the audio there in Sanjay's live report. We're going to work on that and try to bring him back to you as soon as we get that worked out.

But in the meantime, let me tell you some more information because there are still puzzling questions this morning concerning the Atlanta bus crash that killed members of an Ohio college baseball team.

Atlanta police don't think driver fatigue was a factor in that, but they still don't know exactly why that bus plunged off of an overpass early yesterday morning.

Now federal investigators are expected to get their first look at the bus this morning. And that is going to be so key in determining exactly what happened.

They'll also be searching for clues in the bus' computer system. Four students and two adults were killed in that crash. The bus was carrying the Bluffton University baseball team from Ohio down to Florida. 29 people were injured. And some of them, seriously.

So the question on everyone's mind -- how did this happen? Well, police say the bus driver may have been confused by how the lanes were divided. Here's a look -- an animation of possibly how this occurred. CNN's Don Lemon actually shows us how it happened.

(BEGIN VIDEO CLIP)

DON LEMON, CNN CORRESPONDENT: This is I-75 where it happened. You can see that's the HOV lane. One way is the HOV exit only lane to the right here. And then to the left is the HOV lane continuing south on I-75.

He came up this ramp, went through the stop sign that you see right here. And then once he got here, it appears he realized -- from the skid marks, he realizes from here that he's on the exit ramp and not continuing on the interstate. Tries to take a sharp turn this way but couldn't do it in time.

And as you can see from the marks here on the wall, it appears the bus scraped up against this wall. He sheared the top of the fence and then went over the side.

There's another barricade there that carries some sort of piping from one side of the interstate to the other. He even went over that, and then back onto I-75 southbound.

(END VIDEO CLIP)

NGUYEN: So that's an idea of how this occurred. Obviously, an investigation is underway and will determine exactly how and what happened.

But let's you get back now to CNN's Sanjay Gupta at Grady Memorial Hospital, as we learn more about those victims, those 19 who were taken to that hospital and treated yesterday. Sanjay?

GUPTA: Yes, thanks, Betty. Sorry about those audio difficulties. I'm here with Dr. Jeff Solomon, who was the trauma surgeon actually in the hospital yesterday.

First of all, they were having trouble hearing before, Dr. Salomone. So how did you first find out about this?

SALOMONE: I heard about this on the news. When I woke up first thing yesterday morning, I heard about the bus crash. I hadn't been paged, so I wasn't sure about the severity of injuries.

But as soon as I got to the hospital, we realized that there were a number of patients. The two critical had already been transported up to the operating room. And so we had 17 other individuals that needed to be assessed and cared for.

GUPTA: You just were in the hospital. You were just taking care of some of these patients. What can you tell us? What updates?

SALOMONE: What I can tell you is that the two critical patients who had surgery yesterday remain in critical condition. They've been fairly stable overnight. The young man who has a liver injury is seriously injured. He's remained stable overnight. And the one of the walking wounded who was not discharged yesterday still has some leg problems and is going to need to work with physical therapy before he's discharged from the hospital

GUPTA: There were 19 patients brought here yesterday.

SALOMONE: Yes.

GUPTA: Even -- no matter how big a trauma center you are, that's a lot of patients. How does it work? What's the triage? How do you decide who's going to be cared for when?

SALOMONE: There's a physician posted in the triage area of the hospital to begin to assess looking for life threatening injuries. And patients are sorted by severity of injury.

After the initial three, the remaining 16 had minor appearing injuries. So they were corralled in a quiet area of the hospital so we could organize nursing care, radiology services, identify in a systematic fashion who needed what tests, and get that process very quickly. And the hospital worked incredibly efficiently yesterday. GUPTA: You know, in addition to the physical injuries, I mean, this was such a horrific thing probably for people mentally, just to be able to deal with it. Do these patients get some sort of counseling as well?

SALOMONE: Well, there are -- there were a number of social workers and counselors. There were volunteers from psychological services from the police department, who were down here yesterday.

But remember, in the first acute hour or so, we're making sure they don't have life threatening injuries.

GUPTA: Saving their lives.

SALOMONE: Right. Making sure there's nothing we have to do. And then the mental health comes secondly.

GUPTA: All right.

SALOMONE: I think, in keeping everyone together, it allowed them to provide support for each other.

GUPTA: Dr. Jeff Salomone, keep up the good work. I know you have a busy day ahead of you still. Good luck with those patients as well. Thank you very much.

The deadly bus crash here in Atlanta isn't the only tragedy to hit the South over the last couple of days. The survivors of a tornado that roared through an Alabama school, crushing and killing students as well. And how do you treat the sick and injured when your own hospital is blown away? It's amazing. We're going to take you live to the scene.

And later, we're going to have our "Ask Dr. Gupta" segment. I'm going to answer your questions on these medical crisis situations this week. Stay with HOUSECALL. We're back in just two minutes.

(COMMERCIAL BREAK)

GUPTA: The details of a tornado that hit a high school in Enterprise, Alabama, are still unfolding this morning. We want to take you quickly now to CNN's Miles O'Brien, who's on the scene.

Miles, you've been reporting about this for some time now. I'm most curious to try to get an update on the injured. What's the latest information, Miles?

MILES O'BRIEN, CNN CORRESPONDENT: Yes, you know, Sanjay, we've been reporting, frankly, a lot about the deaths here, the eight students, 10th, 11th, 12th graders, who died in that interior hallway.

We haven't said so much about the injuries. There were about 120 people injured in all in this part of the world, Coffey County, the greater Enterprise area. About 100 of them showed up at the door a half mile away at the Enterprise Medical Center. Now this is a facility. You're talking about how taxing it would be to have 19 or 20 people come into Grady in Atlanta. Imagine 100 people walking into the doors of this facility, which has all of 135 beds

I talked to the chief nurse there this morning. And she was so heartened by the fact that they had what they call a Code Gray. Of course, you know, if you watch ER, you know what a Code Blue is. That has something to do with a patient who has a heart problem.

Code Gray at this hospital means tornado. And you have to get the patients out of their rooms and into the hallways. So they're in the process of doing that, they hear about the tornado hitting. And all of a sudden, people just started showing up.

Doctors, nurses, they never even had to put a call out. Among the people that they treated it this young man, Dylan Lewis. Why don't you step in here, Dylan? Dylan is a -- you're a junior, right? And you were, of course, in that terrible hallway where things collapsed. I'm curious, when you went into that hospital, what was the scene like there?

DYLAN LEWIS, INJURED IN STORM: I was one of the first people there luckily. One of the teachers, John Logan, I was right beside his classroom. And whenever everything fell down, he was standing up, from what I hear. And he was in critical condition. And I heard he got released yesterday.

But whenever I was in my room, they pulled him right -- like stopped him right in front of my room. At first, it didn't click because I was, you know, heavily medicated, completely out of it. And at first I thought it was one of the dead, A.J. Jackson, you know, because I didn't have my - I lost my glasses in the rubble and everything.

I mean, he - they had a neck brace, everything. Everything was wrapped up. Everyone was saying he was dead. And it looked like it. And I mean, he was in such bad shape.

O'BRIEN: Give us a sense. Now you've broken your collar bone. Those are the typical sorts of injuries that people suffered, right? I mean, among your friends, how are people hurt?

LEWIS: Most of my friends are OK. Most everyone else, you know, they -- a few broken bones here and there. Most is just scratches, a few concussions here and there.

But I have had some friends, Jake Crawford, for one. He was on the same hallway within talking distance, too. He even mentioned something to me whenever we were in the hallway. From what I hear, his spleen ruptured and sliced liver and all that. I don't know if it's true. This is just what I heard. He's in pretty bad shape.

O'BRIEN: Yes.

LEWIS: I mean... O'BRIEN: Well, we wish you well as continue to mend here, not just physically, but obviously emotionally. I know you lost some friends there. We wish you and your town well. Dylan Lewis, junior there.

Sanjay, this morning, there is still somebody in intensive care at the Enterprise Medical Center. There were a few people who came in, about three, whose condition was serious enough that they felt that they couldn't treat them. And these were people, as they said, that appeared to have some sort of head injuries.

And as you well know, that requires specific kind of attention not necessarily available in a facility of this size here in a town of 20,000.

So you know, once again, when you start coming -- when you come to these terrible scenes of tragedy, what you see is, in addition to the terrible sadness, a tremendous response. And that's what happened at that hospital, Sanjay.

GUPTA: Miles, thank you. It is amazing to think about that many patients coming to a hospital that is not necessarily a level 1 trauma center. It really does take a community.

And also, Miles, as you were talking, it kind of gave me a sense as a neurosurgeon, the sorts of injuries that you might see in this. You have the sort of injuries from the tornado itself. But then you have a lot of debris sort of moving through the area. You have bodies moving through the area. You get sort of these primary injuries and then secondary injuries.

Miles, there might be some people out there who are injured, may not even know it as of yet as well. So we'll keep checking in with you, Miles. Thank you so much.

And now to Americus, Georgia, where a tornado ripped through the town's only hospital. CNN's Allan Chernoff is live there. Allan, I mean, it's amazing, the hospital itself was sort in the storm center. You had a unique look inside the hospital. What did you see in there?

ALLAN CHERNOFF, CNN CORRESPONDENT: That's right, Sanjay. You see the exterior here, and severe damage. Not only the windows destroyed, but of course, parts of the roof ripped off. The insulation, and inside just debris everywhere.

To the right, what you're look at here, that's a new portion of the hospital, but the most severe damage here to the older wing of the hospital built in the 1950s.

But inside, as I was saying, there's debris everywhere. It seems that it's really just almost in the state that it cannot be salvaged.

The engineers have been looking through this wing of the hospital. And they're still trying to decide whether it is structurally sound, but really severe damage.

And fortunately, no one, believe it or not, no one was killed here. About 60 patients were actually in the hospital with staff when the storm hit. And the staff here just did an incredible job in getting everyone away from the windows and into the center. And fortunately, people made it out alive.

GUPTA: Amazing. And I guess the basic supply there in the hospital as well is trying to protect yourself from a tornado. Allan, as you're there, do you have any idea of what kind of an impact this is going to have, the loss of the hospital, is going to have on the community as a whole?

CHERNOFF: Yes. Well, we actually have the chief executive officer of Sumter Regional, David Seagraves with us. And David, tell me, how is this -- very briefly, how is this affecting the community? What are you going to do going forward?

DAVID SEAGRAVES, CEO, SUMTER REGIONAL HOSPITAL: Well, at this point in time, we are working with other area organizations to provide for emergency treatment of individuals who have been affected by the storm here.

CHERNOFF: Four regional hospitals in the area?

SEAGRAVES: There are several facilities in cities who are near Americus. And we have made arrangements for physicians to travel there and for patients to seek services there.

CHERNOFF: OK, David Seagraves, thank you. And I do know that they do hope to at least get the emergency room up and running here as quickly as possible. That's their number one priority. Sanjay?

GUPTA: Allan, that has to be the key, obviously, getting those patients taken care of. Thank you so much. We'll be checking back with you.

You at home, I want you to imagine something for a second, because we've been talking about this a lot. You're working late. You hear a tornado. You see the roof of your office building literally being lifted off by the wind. What would you do? What would you do?

Well, if you're Dr. Michael Busman, you run two miles to the nearest hospital to help others. But you find when you get there is a huge shock. Dr. Busman and the story coming up live, next.

(COMMERCIAL BREAK)

GUPTA: Welcome back to this live edition of HOUSECALL. I'll be answering your questions on the tragic events of this week in just a few moments. A lot of people have questions about how does a trauma center take care of patients in a situation like this.

But first, we're joined by Dr. Michael Busman. He's a physician in Americus, Georgia. He was working -- get this -- he was working late in his office near the hospital when the tornado hit.

It's sort of remarkable. People have been hearing your story. Tell us what -- you were just working on your computer, and what happened? What did you see?

MICHAEL BUSMAN, DR., FAMILY PHYSICIAN: Yes, I was at my office, which is about a quarter mile from here, just doing some paperwork and working on the computer, when I heard some loud noises, kind of like a freight train. And I heard some winds. And I knew a tornado was coming.

So I got away from the office -- well, my personal office, because it was near a window, and went to the center of the building. And just heard a lot of racketing and blowing. And the roof got blown off of the building.

And about 20 feet away from me, it was a big office building, my part, most of the roof was on. But nearby was blown. And everything was racketing and blowing around. And I heard glass flying everywhere, and just everything flying. A lot of banging. And I was trying to get to the center of the building, you know, just hoping that it wouldn't come down on me.

So it was pretty scary. I don't know how long it lasted, but it seemed like quite a while, but it was probably just a few minutes. But it seemed like about 10.

GUPTA: Yes, I can imagine. Sounds like a freight train going by. So your next priority as a doctor, you want to try and get to the hospital. So I understand you actually drove to the hospital.

Let me ask you a question about that. As you're driving there, what's going through your mind? What sort of injuries do you think are going to occur after a tornado?

BUSMAN: You never know. I mean, the biggest thing was trying to get there. Even though it was only a quarter mile away, everything, power lines were down, roofs were off. I mean, there was debris all over the road. You couldn't -- I mean, it probably took a half hour to go a quarter of a mile in the car. Just debris all over the place, power lines.

And I guess the power was out. So we wouldn't have to worry about getting electrocuted.

But it was just - it was tough getting there. We had to jump curbs and drive over lawns and curbs and, you know, curbs and everything. And just injuries-wise, you never know. Anything can happen.

GUPTA: Yes.

BUSMAN: I mean, there was a car that got lifted with two people in it, got lifted about 30 - I don't know - 30 yards in the air and just pretty much lifted across the road.

GUPTA: Unbelievable.

BUSMAN: And then in the parking lot, cars were turned over upside down, right side up, on top of each other, crushed by trees. I mean, anything could happen. Of course, houses got totally demolished. GUPTA: Well, Dr. Busman, I mean, it's amazing stories. I wish you the best down there. I know you're trying to take care of patients. We don't want to keep you too long. We appreciate your time this morning. Dr. Michael Busman, an amazing story.

Many people have had questions from me about the role of first responders, the types of injuries we doctors tend to see in these types of disasters. Today, I really want to take some time to answer as many questions as we can after a quick check, though, of this week's other top medical headlines and a quick break.

(BEGIN VIDEO CLIP)

JUDY FORTIN, CNN CORRESPONDENT (voice-over): Have you had your breakfast today? Researchers say eating whole grain cereal can be good for your heart. According to the study participants, those who ate whole grain cereals two to six times per week were 22 percent less likely to develop heart failure.

A new study says women who engage in strenuous exercise for more than five hours a week reduced their risk of invasive breast cancer by 20 percent, compared to those who exercise less than 30 minutes a week. The researchers say the reduction may be due to less weight gain and changes in metabolism brought about by exercise.

HPV is the most common sexually transmitted infection in the United States. Now a new report says it's most prevalent in young people right after they start having sex. The infection was prevalent in nearly 45 percent of women, aged 20 to 24, and 26.8 percent among U.S. females overall. The report says about 90 percent of infections clear up within two years.

Judy Fortin, CNN, Atlanta.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSECALL live edition. We're here at the hub of Grady Memorial Hospital. 19 of those patients from that tragic bus accident were brought here yesterday. 15 have now been let go from the hospital. One is still in serious condition, one in stable condition, and two in critical condition.

Remarkable stories. I was just hearing from Dr. Michael Busman in Americus just a little bit ago about a hospital that was destroyed as part oft that tornado as well. It reminded me of Charity Hospital in New Orleans. Same sort of problem where you were stuck without power, without electricity, without food, very little water for days on end for patients. It is remarkable.

One of the questions -- we've been sort of teasing your questions all hour. I wanted to get some responses back to you. One of the questions we get over and over again is how important, how critical is it for EMTs to be a part -- integrated into the system of trauma care?

It's an obvious answer. EMTs are sort of the first line here at some of the disasters that we hear like the bus crash. I want to point out something good. The EMTs, the paramedics were actually on the scene within five minutes after that bus crash yesterday. Why is that so critical? Because you want to try and care for these patients as quickly as possible.

Several different moving parts come into place here. You had the EMTs. They're immediately assessing these patients, talking to the doctors already on the radio, giving them a sense of what the blood pressure is, what the heart rate is, do they have their airways protected? What are they going to need when they actually arrive here, go through those doors, straight into the emergency room?

Well, if they're going to need a CAT Scan, if they're going to need to go straight to the operating room. There is a service - there is an elevator right off the emergency room here at Grady Hospital. Takes you straight to the operating room six floors up. And things move very quickly.

That was one of the questions that came up over and over again. We'll have much more just after this quick break.

(COMMERCIAL BREAK)

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