They come from highway accident scenes and nursing home beds, from factories and farm fields, from suburban homes, downtown sidewalks and small community hospitals.
But no matter where they come from, some of the nation's most critically ill and injured adult emergency patients end up in one place: the University of Michigan Health System's Emergency Department.
Starting today, the most critical emergency patients will go straight to a new unit designed just for them: the Massey Emergency Critical Care Center, or Massey EC3. Created to deliver optimal care from the moment of arrival through the first crucial hours of their health crisis, the new unit is one of the first of its kind in the country.
With five resuscitation/trauma bays and nine patient rooms, the EC3 gives teams of U-M doctors, nurses, respiratory therapists, pharmacists and others the room and technology they need to stabilize the patient, make an initial diagnosis, and begin to provide advanced care for health crises such as strokes, sepsis, hemorrhages, traumatic brain injury, cardiac arrest, overdoses and acute lung injury.
The new 7,800-square-foot unit was designed by architectural firm Niagara Murano and built by teams led by the George W. Auch Company. It uses an area of University Hospital that served children before the opening of Children's Emergency Services in the new home of U-M's C.S. Mott Children's Hospital.
The EC3 will help UMHS meet a growing demand for emergency critical care, which has risen 24 percent in five years. The number of adult patients admitted to U-M ICUs from the emergency department has risen 10 percent a year for at least the last five years, and the amount of time such patients wait for an intensive care unit bed has grown.
Through close partnerships between U-M emergency teams and teams in U-M's six specialized adult intensive care units, it will ensure patients a smoother transition to the next phase of care.
Just before its opening, the unit was named in honor of the Joyce and Don Massey Family Foundation, in recognition of a gift to support emergency care and research for traumatic brain injury.
"All of us in Emergency Medicine are grateful to all involved in planning and building this new unit, and to the Massey family, for getting us to this day," says Robert Neumar, M.D., Ph.D., chair of the U-M Medical School's Department of Emergency Medicine. "We're eager to begin this new era of emergency care at U-M."
The EC3 may mean some patients can get through an initial health crisis without needing an ICU bed at all. That's an important goal given the high demand for U-M ICU care and the ever-growing number of patients coming to U-M hospitals.
About one-third of all patients who come to a U-M emergency department get admitted to a U-M hospital bed. This includes thousands of patients transferred from other hospitals to U-M because of their critical illness or injury -- including those flown on U-M's Survival Flight helicopter and jet service.
"We take pride in our role as a key resource for all Michiganders, and residents of neighboring states and even Ontario, during medical emergencies," says T. Anthony Denton, acting chief executive officer of the U-M Hospitals and Health Centers. "With this new facility, we will enhance our ability to serve the most severely ill and injured among them."
Kyle Gunnerson, M.D., the U-M emergency physician and critical care specialist who leads the EC3, says, "The EC3 puts at our fingertips everything we need to provide exceptional care to every patient who needs the level of expertise our teams possess. This will raise the bar for emergency critical care."
Creating the future of emergency care
Designed with research in mind, the EC3 will make it easier for teams to test new diagnostics, devices, monitoring equipment and treatment strategies. Many of those ideas will come to the EC3 through the Michigan Center for Integrative Research in Critical Care (MCIRCC), which brings together more than 100 U-M scientists and clinicians with early-stage entrepreneurs and industry partners to develop and deploy critical care solutions.
U-M has many emergency research clinical trial efforts under way, and serves as the hub for multi-hospital clinical trial networks including the Neurological Emergencies Treatment Trial (NETT) network, Michigan StrokeNet, and the Pediatric Emergency Care Research Network (PECARN). The U-M Injury Center is one of only 11 funded by the Centers for Disease Control and Prevention.
Recently, a collaborative project between researchers in U-M's Pulmonary/Critical Care and Surgical Critical Care divisions, and Emergency Medicine, has resulted in UMHS becoming one of only 11 clinical centers funded by the National Institutes of Health for projects focusing on Prevention and Early Treatment of Acute Lung injury (PETAL).
Having the EC3 as an early critical care resource will help U-M attract funding for future research trials. And, by ensuring closer connections between emergency and intensive care staff, the EC3 will help ensure that patients who qualify for a study will be identified and enrolled, before hours slip by or they receive care that might make them ineligible.
The new facility will also serve as the training ground for a new breed of emergency critical care physicians. This rapidly growing discipline involves post-residency training merging the skill sets of critical care with emergency medicine, giving doctors expertise focused on the first hours after the onset of a major health emergency.
Special two-year fellowship programs now make emergency medicine-trained doctors eligible to be board certified in critical care by the American Board of Medical Specialties. UMHS has new emergency critical care fellowships, run through the departments of Anesthesiology and Internal Medicine in collaboration with Emergency Medicine. The EC3 will also be a training ground for other U-M critical care physicians-in-training and specialized emergency critical care nurses.
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