Raising the level of emergency care


Greenwich Hospital Ambulance
Greenwich Hospital works closely with emergency medical service first responders to deliver high-quality trauma services.


Picture this scenario: A bicyclist riding along a quiet road in Greenwich swerves to avoid a pothole, loses control and crashes. Within minutes, an ambulance arrives. The cyclist is conscious, but reports severe pain near his shoulder. The emergency medical technicians suspect a fractured collarbone and rush him to Greenwich Hospital’s Emergency Department (ED).

At the hospital, Christopher Davison, MD, medical director of Emergency Medicine, assesses the injuries and activates a trauma alert that mobilizes a team of experts.

“Once the patient arrives, the team is assembled and ready to stabilize the injuries,” said Dr. Davison. “Depending on the severity of the injuries, the patient might be treated in the Emergency Department and released, rushed into surgery, or admitted to the hospital for further evaluation and treatment.”

Trauma is one of several types of emergencies requiring immediate medical care. It can occur from vehicle accidents or collisions, falls, sports injuries and other incidents that result in broken bones, head injuries, severe wounds and other serious, potentially life-threatening injuries. Heart attacks, strokes, drug overdoses, poisonings and burns, while emergencies that need immediate attention, are not considered traumas.

Greenwich Hospital has the resources needed to treat a wide range of emergencies and traumatic injuries. The team includes Emergency Medicine physicians, surgeons, nurses, physician assistants, radiologists, anesthesiologists, pharmacists and support staff with specialized education and training. “We have instituted trauma-related protocols, processes and quality assurances to ensure we can deliver exceptional care to the community every day,” Dr. Davison said.


Athanassios Petrotos, MD, general surgeon and medical director of the trauma unit
Athanassios Petrotos, MD, general surgeon and medical director of the trauma unit, stands in the center core of the hospital's operating suite.


Overseeing those personnel and operations is Athanassios Petrotos, MD, medical director of the trauma unit and one of its general surgeons. Dr. Petrotos is a Yale Medicine physician and part of the Yale School of Medicine, Department of General Surgery, Trauma and Surgical Critical Care. “My role is to make sure all the appropriate steps are taken so that when an injured patient arrives in the Emergency Department, all injuries are identified and addressed immediately.”

In the most serious trauma cases, Emergency Medical Service (EMS) crews must make quick decisions based on saving the patient’s life. “Time is often of the essence, particularly if the patient is bleeding, having trouble breathing or has other unstable vital signs,” Dr. Petrotos said. “That’s why members of the trauma team can be gathered in the ED and ready to go within a half hour.”

Ann Marie McGrory, RN, is the executive director of Critical Care Services, including the trauma program. A critical care nurse for 30 years, McGrory oversees the program’s nursing operations and manages data to support the trauma program’s quality and patient safety. “We use the data to make sure we are meeting or surpassing standards of care for trauma patients,” she said.


Shelby Smith, RN
Shelby Smith, RN, brings years of experience as an Air Force medic and nurse to her role of Emergency Services director and trauma coordinator.


One of McGrory’s key colleagues is Shelby Smith, RN, director of Emergency Services and trauma coordinator, who brought her eight years of experience as a medic and nurse in the Air Force to Greenwich Hospital in 2019. “My military experience set me up to be organized, logical and proactive in the way things are done,” she said. “As the trauma coordinator, I’m the person who holds it all together, the glue. So when an alert is called, I jump right in alongside the rest of the team.”

Every morning, Smith checks the status of the previous day’s trauma patients. “We’ve created what we call a trauma room. In it, we have a glass board where we write the names of the team members and their roles and responsibilities,” she said. And when a new trauma alert is activated, she tracks the patient’s care and outcome. “If the patient is admitted to the hospital, I track them all the way through discharge,” she said.

Smith and McGrory take pride in reporting that 80 percent of the nurses in the program have taken certified trauma education courses. “When a trauma patient comes into the ED, nurses have to know their roles and responsibilities, right down to where they stand next to the gurney,” Smith said. “The education gives them another skill set.”

Many trauma patients are brought to the Emergency Department by a Greenwich Emergency Medical Service (GEMS) ambulance and trauma-trained crew. In addition to providing on-site care and transporting patients 24/7, “we are in constant communication with Greenwich Hospital’s ED in terms of what we do and how we do it,” said Colin Bassett, GEMS director of quality assurance. “We share data on trauma patients we take to the hospital.”

Because Greenwich Hospital also serves residents in neighboring Westchester County, NY, the Port Chester-Rye-Rye Brook Emergency Medical Service (PCRRBEMS) brings the majority of its trauma patients there, too.

“Many of the injuries we respond to are very time-sensitive regarding emergency care, so our proximity to Greenwich Hospital is a valuable benefit to us and our communities,” said Lt. Kenny Barton, a field paramedic and quality assurance coordinator at Port Chester EMS.

While each of the two EMS operations respond to as many as 6,000 calls per year, the most common traumatic injuries they encounter are from simple falls. “Falls can result in fractures to hips, wrists, shoulders, ankles and feet, as well as chest and head injuries,” Barton said.


Doctors and nurses on the trauma team quickly assess and treat patients
Doctors and nurses on the trauma team quickly assess and treat patients in the Emergency Department's specially equipped trauma room.


The high incidence of falls is why an important component of the hospital’s trauma program is a public education initiative managed by Kathy Carley-Spanier, RN, director of Community Health. “Our mission is to build healthy communities by providing educational outreach programs,” she said. For instance, Carley-Spanier is a regular at local health fairs that advocate bike safety.


Community Health nurse Diane DeMain, RN, provided bike safety
Community Health nurse Diane DeMain, RN, provided bike safety information at Greenwich Hospital's 2019 Teddy Bear Clinic for
children and their families.


“We teach children, and their parents, the importance of wearing helmets, road safety rules and using lights to increase visibility whenever they ride,” she said.

Carley-Spanier also runs fall prevention programs, at which physicians and physical therapists talk about following safety measures at home. Elderly residents, who are especially prone to falls, are encouraged to use handrails, good lighting and non-slip supportive footwear. “A tai chi instructor teaches balance and strength exercises at various support groups,” she said.

Hospitals nationwide are officially designated as trauma centers by the American College of Surgeons (ACS). A Level I trauma center can provide immediate and total care for most any type of injury or emergency; a Level II center covers Emergency Medicine, General Surgery and specialties such as Orthopedics and Neurology; a Level III center provides most of the same services as a Level II, but must demonstrate a certain volume of trauma patients over several years. Level II and III centers can transfer patients they are unable to care for to a Level I center.

While Greenwich Hospital has for years provided trauma care that meets ACS Level III criteria, it is now in the process of becoming officially designated. This involves documenting its evidence-based, data-proven trauma care protocols and outcomes, maintaining specific and properly trained medical staff, and having public prevention and education programs.

The Level III designation will benefit the public by ensuring that Greenwich Hospital provides a high level of care. “We’ve always had the capabilities to take care of trauma patients,” Smith said. “Now we’re just confirming that our evidence-based practices, standards and continuum of care meet the ACS’ stringent criteria.”

“Local residents can feel confident that they will receive comprehensive care for traumatic injuries,” added Dr. Davison. “Just having these trauma services and resources available improves the level of care for all patients, which is pretty awesome.”