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Trauma czar acts as lynchpin of care when patients clinging to life

BAGRAM AIRFIELD, Afghanistan (AFNS) -- With the whirl of activity rushing around her and the advice of nearly 20 specialists being presented, it’s the job of Maj. (Dr.) Valerie Sams to decide the medical treatment to go forward with that could ultimately decide whether the patient lives or dies.

As the 455th Expeditionary Medical Group trauma czar, her job is unique. The first responsibility is to coordinate all the care a patient will need for the variety of treatments. She also makes the final decision after hearing the advice of every specialty available to them, even when it is the hardest one to make.

“As the trauma director for the Craig Joint Theater Hospital and medical director for the intensive care unit, I oversee the entire trauma patient’s medical care,” Sams explained. “I have my ER (emergency room) team, my resuscitation team, and five doctors who do inpatient medicine. We all come together and make a plan which will be best for the patient.”

However, sometimes getting to that solution is a difficult one. With a multitude of medical backgrounds being brought together, finding a unified path for care takes a unified effort.

“At the hospital, we do not control the specialties that we receive each rotation,” Sams said. “I know it is a lot to ask to have a physician step outside their comfort zone in medicine, and almost be a resident again. That is a hard thing for a doctor, but our team has done a wonderful job.”

While Sams is not the highest in rank, her decision on how to treat a patient is the final word. Each of the 12 to 15 doctors in the rounds have practices that line up with their experience, and which procedure works best for them. For example, if a problem presents itself, a gastroenterologist might choose to use a scope first, while a surgeon may have had success with exploratory surgery in the same situation.

“There are always some frustrations because everyone here is an expert and we all want to provide the best medicine for our patients,” said Maj. (Dr.) Brock Miller, a 455th EMDG gastroenterologist. “We all have experiences where we have been successful and those are what we lean on. But someone has to make the final say, and that is the trauma czar. It’s not an easy job and Dr. Sams takes it very seriously.”

Even at the end of a long day, the trauma czar still does not get to go home. Her office in the hospital doubles as her sleeping quarters, meaning that no matter what happens in the deployed theater of operations, she is less than 30 seconds away from the ER.

“Sometimes I will get a knock on my door in the middle of the night and it is a nurse filling me in on something going on,” said the trauma czar. “This position needs to be immediately available to the teams. Sometimes I will go days on end without leaving the hospital and have to remind myself to step outside, take a walk, and get some fresh air.”

With so much going on at any single time in the hospital, it is the trauma czar’s leadership that can guide a team to accomplish unbelievable tasks.

“When the condition of a British national became critical, it was the trauma czar that made the call across the ocean to bring out a specialty team to try and save his life,” said Lt. Col. (Dr.) Robert Stankewitz, a 455th EMDG staff physician. “Everybody wants to get the patient the best possible treatment. She was very cool under pressure and because of that, we were able to get him home to see his family one last time.”

That intimate knowledge of patients and their treatments are critical to the role of the trauma czar. Knowing the progression of their care and when they are ready for release or evacuation, makes Sams’ job a constant balancing act that requires a lot of focus.

“She is the most involved on all the patients in the hospital. She has to be,” Miller said. “She is very, very dedicated to the job and the patients.”

Throughout the time spent at the hospital, a patient may experience a variety of treatments and transitions, but one thing will always remain constant. The trauma czar will be watching over them, acting as the lynchpin that brings decades of experience together to provide them with the best care available.