When severely injured patients at the University of Maryland Shock Trauma Center needed rides between floors, there was only one way to fit all the life-saving staff and equipment in the cramped elevators.
"I used to crawl in bed with the patient," said Melissa Reece, nurse manager of the trauma operating rooms. "I'm glad I don't have to do that anymore."
New elevators offer more than enough room. Reece and the 673 others who work in what may be the nation's busiest trauma center can spread out a little now that a 140,000-square-foot, $160 million tower officially opened on Lombard Street. Dignitaries were slated to cut the ribbon Friday, though three-quarters of the space already is in service.
The trauma hospital, part of the University of Maryland Medical Center, opened in 1989, designed to handle 3,500 patients a year. But it has served more than 8,000 in each of the past several years. These are many of the state's worst victims of car accidents and falls, and to a lesser extent, violence.
The new and redesigned spaces accommodate the most sophisticated equipment and processes that speed the flow of care, according to those who work there. Dozens of doctors, nurses and other staff, as well as patients, contributed ideas. Planning began five years ago.
"We didn't need to be talked into this because the demand was so high," said Jeffrey A. Rivest, president and CEO of the medical center. "We definitely had our eye on the money, but we had no doubt about the need."
Trauma care has evolved into a specialty, like other areas of medicine. The Trauma Center Association of America reports there are more than 600 trauma centers embedded within the nation's nearly 6,000 hospitals. They serve some 678,000 injured patients annually and support other hospitals in their regions.
And despite advances in care, trauma is the fourth leading cause of death nationally, accounting for about 170,000 a year, and is a leading cause of disability, according to the association.
Shock Trauma has the highest designation for such a center, called a Primary Adult Resource Center, because it has availability of specialized medical staff and equipment at all times. It's the only such center in Maryland and the only center in the country that operates as a stand-alone facility.
Johns Hopkins Hospital, Hopkins Children's Center, Hopkins Bayview Medical Center, Sinai Hospital and a handful of other hospitals around the state also serve trauma patients in their emergency departments.
The injured cannot take themselves to Shock Trauma, though they can go to the UM Medical Center's emergency department. More than two-thirds of Shock Trauma's patients arrive by ambulance or helicopter from the scene, and the rest are transferred from other hospitals that don't believe they are equipped for a particular case.
The roof can now accommodate four helicopters at a time, including the president's Marine One. Because of security, the hospital can't say under what circumstance the president would be taken there, but officials are prepared.
A statewide emergency management system makes the trauma center designations and manages where patients are transported.
Dr. Richard Alcorta, state EMS medical director, said Shock Trauma's expansion benefits the entire state because the center can now accept more of the most complex patients from the field and from other emergency departments, and can even potentially train more emergency medical responders.
For example, he said, sometimes it's better for patients taken to rural hospitals to be flown to Shock Trauma for immediate surgery instead of waiting for a surgical team to arrive there. Other times, trauma doctors elsewhere may not have the proper expertise for a patient, or a doctor in another emergency department may need to call Shock Trauma for guidance.
"By expansion of their capacity, we're able to see a significant increase in referrals they can accept," Alcorta said. "We were realizing there were times when the inn was full."
As health care needs in the state continue to grow, other hospitals have also made investments, including Johns Hopkins Hospital, which opened a $1.1 billion set of towers in April 2012.
Mercy Medical Center opened its new $400 million hospital in December 2010. Others who have started or finished improvements in recent years include Saint Agnes Hospital, Harford Memorial Hospital, Johns Hopkins Bayview Medical Center, Carroll Hospital Center, Anne Arundel Medical Center, Baltimore Washington Medical Center and MedStar Franklin Square Hospital, according to the Maryland Health Care Commission.
For its expansion, Shock Trauma for the first time sought contributions from the public. It received $35 million, including $1 million gifts from the late Tom Clancy and his wife, Alexandra, Willard Hackerman, Edward St. John, George Doetsch Jr., Frank and Janet Kelly, and the University of Maryland Medical System and School of Medicine's leadership team. Another $50 million came from the state and $2 million from the federal government. The University of Maryland Medical System funded the rest with cash and debt.
Major improvements include 10 new operating rooms that allow patients to be moved more quickly from the intake area, called the Trauma Resuscitation Unit, which can handle up to 26 people at once.
The resuscitation area often became a bottleneck because there were not enough inpatient beds or operating rooms, said Karen Doyle, the center's vice president of nursing and operations. The extra operating rooms also mean more surgeries during the day and not overnight, which could be stressful for the staff and uncomfortable for the patients — 96 percent of whom survive their injuries.
A technologically advanced training center for the staff and members of the military who partner with the hospital will simulate conditions at the hospital or on the battlefield, Doyle said.
For patients, the changes include private waiting rooms away from the hustle and bustle where families can learn from staff about the conditions of their loved ones. Patient rooms also include extra space for furniture for family and friends, windows for natural light, and lifts for getting out of bed.
Other small changes include a new private hallway to transport patients out of view of the general public and a roof-top healing garden.
A pneumatic tube system was installed to speed labs, medications and units of blood around the facility.
Dr. Deb Stein, chief of trauma, said some of these additions may seem like "silly little things," but they will mean a lot.
"We wanted an environment that worked for patients and worked for the staff," Stein said.
All the improvements will contribute to treating the "disease of trauma," said Dr. Thomas M. Scalea, Shock Trauma's physician-in-chief, who has been in charge for nearly 17 years. The center is named for his predecessor, the center's first physician-in-chief, Dr. R Adams Cowley, who gave rise to time-oriented treatment in emergency medicine called the "golden hour."
"Everyone wants to do a good job," Scalea said of his staff. "They haven't asked for it to be easy and they haven't asked for it to be slow. They've asked for resources so we could excel."
Space: 140,000 square feet of new construction, including 64 new private ICU patient rooms and 10 new operating rooms
Cost: $160 million, including $1 million donations from the late Tom Clancy and his wife, Alexandra, Willard Hackerman, Edward St. John, George Doetsch Jr., Frank and Janet Kelly, and the University of Maryland Medical System and School of Medicine's leadership team
Construction: 35 months of construction led by Whiting-Turner, including 1,750 workers and 874,000 man hours.