Welcome guys to Behind the Shield. My name is
James Gearing and this is episode 24. And my
guest this week is someone who kind of hits a
little closer to home. Dr. Joseph Ibrahim is
the Trauma Medical Director at ORMC, Orlando
Regional Medical Center, which was my primary
hospital in my old fire department and is my
primary trauma center even now. Now... We are
going to talk about the pulse shooting. That
is not the whole focus of this interview. Dr.
Ibrahim is an extremely interesting and intelligent
man, and we draw all kinds of things from his
brain. But touching on the pulse incident for
a moment, my old station, my old first U, we
could hit pulse with a rock. It was just within
the city of Orlando's limits, but we were the
next station over. And then the shooter's secondary
target that he was trying to decide if he was
going to hit that instead. was now my first due
Disney Springs in the Disney area. So that incident
hit home. Now, I was overseas. I was actually
in Portugal with family when it happened. So
I was really torn up to see both these areas
that I love affected that way. So back to Dr.
Ibrahim. He was one of the trauma team in that
incident. And we certainly want to talk about
that. That's an incident that... a lot of people
want to hear about and there were some great
lessons of things that went really really well
and some things that they changed after through
the first responders perspective and through
the er perspective but i also really started
delving into his mind about trauma in general
i mean outside of that we get the shootings we
get the stabbings we get you know the car car
accidents all kinds of trauma so we talk about
intubation in the field tourniquets needle decompression
all these things that we're taught and How often
they use? Are they effective? Would they be better
used more by the first responder out in the field?
Maybe even looking towards changing some of our
protocols to be a little bit more aggressive
in some of these areas. And another thing I wanted
to put in the intro was at the end, Dr. Ibrahim
recommended a movie, a documentary called Newtown.
And he said, have some tissues ready. And I'm
a bit of a kind of... cry like a three -year
-old girl if something really plucks on the old
heartstrings. And when the Sandy Hook shooting
happened, which is what this movie was about,
I had a son in kindergarten. So it tore me up
then and it really tore me up to see it. It doesn't
focus on the tragedy so much as the parents and
the kids' lives before the event and then how
they were affected after. And that really kind
of, not that I need reminding that much, but
even that shook me up again about how important
it is for us to train. in all areas but obviously
trauma is a huge one we all have schools in our
first year whether you're a volunteer fire department
or you're in you know manhattan we all have multiple
schools and daycares and sadly i mean it terrifies
me to think about this but this could happen
in any of our elementary middle high school colleges
um so being on top of our game you know with
with tourniquets with our with our trauma medical
knowledge um it's so so important because you
could be Sitting down with your crew having dinner
and the next thing being the middle of your worst
call you could ever imagine. So we touched on
that. We touched on setting the bar high and
keeping your training high and involving your
local ER staff to help train with the first responders.
Getting that chain of survival as tight as possible.
So I absolutely love this interview. You can
probably tell I've been prepping online. I think
this is an area that we don't delve into enough.
where we as paramedics or EMTs can set the ER
nurses and doctors up for success by what we
do pre -hospital. So it was amazing to hear Dr.
Ibrahim talk. I'm pretty sure we're probably
going to talk to him again in the future because
I had a million other questions when the interview
was done. Just to preface this, we did have a
little technical difficulties on my end. My computer
basically had a stroke. So then I overcorrected
some of the settings. So the first nine minutes
sound a little rough. They're still fine, but
they don't sound as clear as the previous podcast.
After about nine minutes, everything settles
down. I found where the error was. And then the
rest of the podcast should be crystal clear,
as I hope that most of ours are. So that being
said, phenomenal interview. I beg, beg you guys
again to go on iTunes. Take 60 seconds. Give
us a good rating. The higher our rating, the
more visible we are online through searches for
people that haven't heard about the podcast.
And if you haven't told everyone you know, please
do. Find a favorite episode, share it, say you
have to listen to this, whether it's sleep deprivation
or PTSD or mental toughness, whatever it is,
and let's try and spread this knowledge of these
amazing people that we have. So without further
ado, I introduce to you Dr. Joseph Ibrahim. Enjoy.
Alright, so welcome Dr. Joseph Ibrahim. First,
the very first question, am I saying your last
name correctly? Yes, sir. Perfect. Okay, fantastic.
Alright, so you are a trauma medical director
at ORMC and I'm obviously going to go into the
trauma side and some of the events that we've
had in Orlando recently. But can you start by
telling us about your upbringing? You were born
in Tennessee, is that correct? Correct. I was
born in Nashville, but grew up in the mountains
in East Tennessee. Okay. And tell me about your
childhood unit. What was your family like? So
my father was a general surgeon in a very small
town. My mother was a nurse anesthetist, had
two sisters. Again, very, very small town, single
traffic light town growing up. My father and
mother divorced at a fairly young age when I
was around 12, but I was always around medicine.
I was fortunate enough in high school to have
opportunities to shadow people in medical environments.
Even to the point I got to go to the operating
room as a senior in high school and really get
some up -close experience since my mother worked
in the OR. It was always around medicine from
that point on. I did research in undergraduate
where I got to do animal research, operating
on hearts, doing cutting -edge stuff with satellite
cells and things like that, where it was just
myself and Dr. Gao, who was a research genius
doing cutting -edge things way before satellite
cell implantation became well -known. It was
just a very great environment for me, very fortunate.
all the way up and then got to work in medical
or in college i worked in medical records in
the hospital then worked as an ekg tech and got
to work in various environments that made it
just kept me around the hospital all the time
so just very very fortunate all the way around
when it comes to that okay and just educate me
for a moment satellite cell what exactly is that
so those are the cells that are not differentiated
so they're at the basement basically basement
membrane of our muscles before they develop into
skeletal cells. So they've not differentiated
yet. So what we would do is take those and basically
cause a heart attack in these animals and then
inject these cells before they differentiate
with the theory that the environment that they're
in, being surrounded by other cardiac muscle,
they would differentiate into cardiac muscle
and actually contract. And to the point that
he actually did some patient trials in china
and things like that and it was really cutting
edge for for a 20 year old to be able to be on
the front lines of doing those kind of things
absolutely and is that the same kind of philosophy
as stem cell Yeah, same thing. Okay. No, no,
no, you're fine. Yeah, I've researched a lot
of that, more on the musculoskeletal injury side.
I just had a meniscus repair a while ago, and
I'm intrigued to see if it progresses to the
point where it might even regenerate the meniscus.
I'd certainly get that done if that was the case.
Sure. All right, so just touching back with your
parents, and the reason I want to touch on this
is I myself am a first -generation immigrant
from the UK, and your parents were not born in
the US as well, is that correct? My father was
born in Cairo. I'm first generation from his
side. My mother was from the States. She grew
up in a very, very rural area in western Kentucky,
so much so that they didn't have running water
until 1985. everything was from a well so yeah
so two different sides of life for sure yeah
and how did an Egyptian meet a young lady in
Kentucky they were uh she was in nursing or anesthesia
school in Nashville where he was doing his general
surgery residency okay so doctor nurse relationship
correct yeah all right brilliant um so all right
so you you were exposed to medicine what made
you choose trauma specifically Well, you know,
initially starting out I was torn between family
medicine and surgery. I know that sounds like
two different ends of the spectrum, but I wanted
to be able to take care of whatever came through
the door. You know, whether it be heart attack,
whether it be an aortic rupture, whatever, whether
it be a gunshot wound. And, you know, as I went
through my training, you know, it became more
and more apparent that surgery would be the better
avenue to take for that. And then through my
surgical training, you know, I liked basically
all facets of that. I loved all of my surgical
training. When I came down to Orlando to do my
critical care, I actually did that more so thinking
I wanted to be able to follow my patients and
take care of them wherever they were in the hospital,
whether it be a regular floor, whether it be
the ICU, whatever. So I really initially did
the ICU training and the critical care more so
to be able to keep with my general surgical patients,
really not thinking I would just... be as involved
with trauma as I have become. But when I came
and did my fellowship, I just became enthralled
with it. I loved every aspect of it. You know,
taking care of the total patient, you know, being
able to operate on anything from the head and
neck all the way down to, you know, leg injuries
and obviously the chest and the abdomen. So,
you know, one of the last few true general surgeons
because everything's become so specialized these
days. I really believe trauma surgeons and pediatric
surgeons are the last surgeons that can really
take care of whatever comes through the door.
Yeah, I'm guilty of kind of holding some areas
of medicine's feet to the coals with respect
to chronic medicine and trying to... You've got
to lean people back towards looking at their
nutrition and their exercise levels as opposed
to turning initially to long -term chronic meds.
But trauma obviously is one of those areas of
medicine that you cannot fix with herbs and potions.
There's a certain point where if you snap your
femur in half, you're obviously going to need
to see a trauma surgeon. So I think it's definitely
one of the purest areas of medicine still as
well. I agree. But to your point, doing those
things up front, Taking care of your body, taking
care of your health and doing all those proper
things do have a significant impact. If you are
in a traumatic situation or traumatically injured,
they do significantly impact your outcome, I
believe. Yeah. No doubt. Yeah, I agree. We had
CrossFit. CrossFit, I think he's quite a champion,
but a high -level athlete and also a firefighter,
Matt Chan, on the show a few weeks ago. And very,
very muscular, very, very fit. And he had a mountain
biking accident where the... the front part of
his saddle went in and ruptured not the actual
femoral artery, but one of the initial branches
that comes right off it. And his surgeons told
him exactly that. It was still compartmentalized.
I don't think it broke the skin, so it kept everything
in place. But had he not been as in shape as
he was, he absolutely would have bled to death.
Oh, my goodness, yeah. It's amazing. Very interesting.
All right, well, speaking of that, so you yourself
obviously appear to be in good shape. So what
do you do for sports and exercise? I do a lot
of just running and swimming. I've actually started
swimming more and more just as I get older because
it's easier on the joints. I used to do taekwondo
a pretty fair amount with my family. We took
five years of that, did jiu -jitsu for three
or four years. Really enjoyed that, but figured
some of these younger guys doing jiu -jitsu didn't
care if I had my shoulder in place or not. Oh,
really? I could have very good out of that and
do something that could conserve my career. But
swimming and running and a little bit of weights
and just watching your diet, I think all those
things come into play. I think it's a good balance
to do all those things that you need to do. Getting
rest is something that none of us do, right?
in medicine i mean ems guys fire guys we're no
better rest is probably the one area of our lives
that we don't do very well yeah yeah that's one
of the big pushes that i have on on this show
and actually it's something i'm going to be pushing
forward in the fire service is for some reason
the standard week has been 56 hour weeks of which
these men and women are up you know as you know
the areas around ormc they're not exactly quiet
areas so they're getting their asses kicked for
24 hours and then wondering why they're sleep
-deprived, wondering why we're seeing some of
these mental issues manifesting, and I think
that sleep is a huge part of that. Absolutely.
Okay, so you touched on what brought you to Orlando,
so can you elaborate on that? Sure, so I came
back here for my fellowship in 2006 to 2007,
and then I actually did my fellowship a little
differently. I took it after my third year of
general surgery training. Again, had a wonderful
experience here, loved it here, but I still had
commitments back in East Tennessee. So went back
to East Tennessee and finished my last two years
of general surgery. They asked that I stay on
staff there, which I did for a couple of years
at a level one trauma center as an assistant
professor with East Tennessee State University.
Enjoyed it very much, but again, wanted to build
what I had seen here. Obviously, you can only
build it to... a certain extent, you know, I
can't bring the volume when it comes to trauma,
you know, trauma that has its own volume. So,
you know, in a sense, I kind of got bored, so
to speak. And fortunately, Dr. Michael Cheatham,
who's my chairman, my boss, but he's also a mentor
in every part of my life, to be honest with you,
he would call me pretty regularly once or twice
a year. Hey, are you interested in coming back?
We'd love to have you back. I kept kind of putting
it off, putting it off. And in 2011, I was just
at a point in my career up there that I just
kind of really didn't enjoy getting up and going
to work, which was unusual for me. And so my
family at that time agreed to come down and check
things out. And we did. And financially, it didn't
really make sense, but it's where we felt led.
And it has been just a great. Great experience
and opportunity that I'm so blessed that we took
advantage of. Yeah, it's certainly a good city
to go to if you want to see trauma. I worked
at Rescue 70 just down the road, so Orange and
Oak Ridge. And yeah, I mean, we brought you all
kinds of, you know, horrendous cases. All right.
So touching on that, something I want to educate
myself and my fellow EMTs and medics out there.
So can you first tell me what makes RMC a level
one trauma center? And then specifically after
that, why and when we call a trauma alert? You
know, what what kind of ball is rolling after
that point? Because obviously, I know we have
criteria and we initiate it. But it'd be good
to hear from your side, you know, what happens
and. And, you know, why that impacts the patient.
Sure. So a level one center has to have certain
capabilities and people ready and available 24
-7. So we have an in -house trauma surgeon. We
all stay here four or five nights a month. We're
actually sleeping in the hospital or trying to
sleep. Rarely do we sleep. But in addition, we
have neurosurgical capabilities, orthopedic,
interventional, radiology, which is so key to
a lot of things we do. all those on the ready
and available within 30 minutes. We also have
ORs available at any moment, and that's proven
itself over and over again to be so crucial.
In addition, what people always ask, especially
recently in Florida, level one versus level two.
So level one and level twos are, in theory, supposed
to be able to provide the same level of care.
The difference is a little bit on the timing,
as I just kind of alluded to. But then the other
thing that sets a level one apart from a level
two is the research component. So let me talk
a little bit about that. So what you guys don't
really see a lot of is the research side that
all nine of the trauma surgeons are involved
with. And what that means is we're doing constant
quality assessment of what's going on with our
patient outcomes. And in addition, what that
allows us to do is do cutting edge techniques.
For instance, we were just talking in here about
my kind of pet, the REBOA catheter you may have
heard about, the resuscitative endovascular balloon
that we actually insert in the trauma bay. And
actually, the Department of Defense is looking
at using this in the field with military. But
it's basically a catheter with a balloon on the
end that we can insert through the femoral artery
and occlude the aorta as opposed to doing the
old -fashioned opening the chest. finding the
aorta, putting a clamp on it, and then rushing
up to the OR. We put this catheter in, and within
four to five minutes, we've occluded the aorta,
and the patient stabilizes almost immediately.
It's just been amazing. And with that comes our
ability to be involved in multi -center trials.
We're currently involved with the American Association
for the Surgery of Trauma, national trial with
multiple centers, and we're the third biggest
user in the country with that, along with Baltimore
and Houston. So that, I think, sets us apart.
uh, level one from a level two. And then the
other part is a level one is that you're responsible
for doing community outreach. Uh, what that involves
is you need to take what's your biggest, biggest
admission issue, which for here in central Florida,
our trauma center and most trauma centers across
the country, it's a ground level falls, which
I know you guys get called on all the time. Yes.
Uh, so whether it be a nursing home, whether
it be a house, you know, had a lady fall down
her stairs the other night, you know, and we're
finally realizing that, that's not something
to take lightly, that people can have significant
injuries from that. So what we do here, our trauma
program manager, Susan Ona, who is outstanding,
she's done some outreach to some of our senior
centers and things like that to tell them about
little things like wearing the proper shoes to
eliminating transitions in doorways as those
that are commonplace for people to fall and things
like that. And then we're also involved with
the initiative of best foot forward you may have
heard of it's an initiative and a program here
in florida to make people aware about one of
our biggest problems or one of the things we're
number one in the country for and that's auto
versus pedestrian and you know people commonly
think well it's orlando it's the tourists and
things like that well the research would show
otherwise it's actually our own people oh really
oh yeah it's actually not the largest percentage
are people from the central florida area not
So, you know, they've done things, you know,
making sure people try to identify the crosswalks
to making sure you're paying attention to the
walking signs and things like that. So we're
also heavily involved with that as well. So that,
you know, those are some of the things that set
us apart from the level two center that you won't
see with them. Okay. Yeah, just touching on that.
One thing I observed coming from England is.
You know, they'll be able to turn on, make a
right turn on the red. If people don't stop in
the crosswalks, you think of something like OBT,
which is what, eight lanes, I think, across.
You know, you've got big vans, SUVs, whatever
it is, and they're blocking the vision. It terrifies
me because these people are flying through these
reds to make a right. And all it takes is someone
pushing a stroller, you know, and then the next
thing you've got, you know, a dead kid. So I
think educating the drivers is a huge part of
trying to reduce those injuries too. Oh, absolutely.
That's another key part of that initiative. It's
not just the pedestrian paying attention, but
you're absolutely right. It's the drivers looking
for the crosswalk because it's so easy, as you
pointed out on those turns like that, that people
don't even look. They just, oh, no cars are coming
and turning. And you're right. Somebody's in
the crosswalk and there they are. It doesn't
matter that they're in the crosswalk or not.
The car doesn't see them. Yeah. Now, I want to
touch on what you said about the balloon for
the aorta. Is that for trauma anywhere in the
body or specifically an aortic rupture? It's
anywhere in the body. So basically, well, I should
say anywhere below the diaphragm. If it's above
the diaphragm, then we really probably shouldn't
use it. But it's something that's used initially.
In the trauma bay, the biggest benefit, I think,
has been the area of pelvis fractures, which,
again, we see a lot of, especially with our autoverse
pedestrian community, but also with motorcycle
crashes and things like that. People have open
pelvis fractures, have significant bleeding.
As we know, historically, that's a very difficult
and treacherous area to try and control bleeding.
And in most cases, we end up going to interventional
radiology for embolization of those. And this
has just really kind of bridged that gap between
putting a binder on and they're still hypotensive
to getting them to the radiology suite so they
can get embolized. Because historically, that
time period between putting the binder and sitting
in the trauma bay and getting to interventional
radiology, you're constantly giving blood products
and things like that. And obviously, still the
patient is at risk because they have ongoing
hemorrhage. But this has significantly impacted
that. And we've seen great benefits here just
in the 20 some cases we've had. Wow. And you
said thinking about the military using it, is
this something you foresee first responders using
one day as well? I do. Actually, you know, UK
has used it some as have Australia first responders.
But there's, you know, obviously they're set
up, which, you know, is a little different. And
in Australia, they actually have positions on
the flights with them. But their flight teams
are actually using it in a few cases that have
been reported. Right. Yeah, I think that's one
of the most frustrating things about being a
medic is you hit that educational ceiling. And
I'd love to see us, you know, create yet another
level that we can progress to, we can educate
to, to provide an even higher level of care before
we get to the hospital. Right. And I think, you
know, this catheter, they really keep streamlining
it and changing it so that it's really extremely
user friendly. and making it more and more of
a safer profile to be used in that kind of setting.
Right. Brilliant. Now, touching on trauma out
in the field for a moment as well, backboarding
has always been an absolute bane to a lot of
first responders. We see that obviously it doesn't
seem to immobilize very well. I'm told that there's
no research even supporting its use. Many, many
fire departments are getting away from it now.
As a trauma surgeon, obviously you see this and
you see... you know, the cervical and spinal
damage. What's your view on backboarding and
should it go away ultimately? Right. Well, first
of all, I just want to say thanks to all the
first responders. You know, I have to tell you
one quick story if you have just a second. So
my experience with first responders, when I was
a resident, I was driving one Sunday afternoon
and came upon a two -vehicle crash, and I was
the first one there. so two people unresponsive
and a cop was there and I told him who I was
a surgical resident we get out and two people
were basically in respiratory arrest and anyway,
he didn't know what to do and Try to get in the
car finally get in one of the doors. They're
all kind of smashed in and get in one side I'm
trying to hold the airway and hold their neck
up to your point So trying to get some air any
way I can into these people And I was trying
to figure out how could I get him out of the
car? It was just me and You know, just thinking
about our first responders and how just they're
quick they are. It's just amazing to me. And
so I remember this very large paramedic walking
up, and I said, I've got two people unresponsive,
blah, blah, blah. And I said, I can't get the
door open. And he, I mean, in stride, without
even thinking, we're in East Tennessee, finds
a big rock by the side of the road and smashes
the window in the back, and we get the people
out, I mean, just within seconds. And I was like,
and that was brilliant. How did I not think of
something like that? But anyway, my hat's off
to them because they're just they're just amazing
how quick thinking they are and doing the things
they do. I'm spoiled that we get to do all the
things in a nice setting. You know, patients
on a bed, they've got great lighting. You guys
are on the on the ground in the dark. So my hat's
off. But back to your question about the boards.
You know, I think. You're right. I think things
will change over time. Right now, I think I still
have to speak. The standard would be to keep
them on the board. And I think it's just more
honestly to protect us. If something were to
happen, did you do this? The standard. And I
think that's still the standard. Will that? And
I agree with you. I mean, we see people all the
time. In fact, I was in the yard the other night.
The person was on the on a longboard laying on
their side, all curled up. So in one of the rooms,
I was like, well, that's probably not doing much
good right now other than creating potential
bed sores or pressure wounds in that area. So
I think long term, we're going to come up with
something different for that. What that's going
to be, I wish I knew. But right now, I would
still have to advocate for using boards this
time just because we don't have... any way to
say for sure what is the best right now yeah
and i think that's the most accepted if you were
if something were to happen to somebody did you
do the standard and i think that's kind of what
the standard is as of right now but do i think
that's going to change i do yeah yeah it's it's
it's like i said when when you realize there's
no real research behind it and you see these
people slipping around all over these boards
um i think our our medical directors now have
allowed us to be more intelligent with the way
we uh kind of analyze the injuries and then allow
us to put the patient in more of a position of
comfort especially some of these elderly people
with with the terrible spinal curves that you
lay them on a board and they're in agony so sure
yep absolutely absolutely you know you know the
issues come into play when you have people with
distracting injuries right they have a terrible
femur fracture they have terrible you know other
injuries and they can't really tell you yeah
my back hurts maybe it's a little more subtle
and then you miss something subtle they end up
having something that was potentially dangerous
that you know that's always a tough call so that
those are the areas that i think we just have
to get some more information on right understood
okay so i guess we'll move forward now to a very
uh very poignant event in in our city's history
so june 12th of last year um correct me if i'm
wrong this is kind of per the research i've done
online you got a phone call middle of the night
is that correct yes it was around 2 a .m Okay,
so tell me about that day, if you wouldn't mind.
Sure. So I had been on call the night before,
the Friday night, and that night was relatively
busy, as you know what that's like down here.
We had the shooting at a local concert area where
the young lady from The Voice got shot by a stalker.
So we thought that was going to be our biggest
thing that weekend. So 2 a .m., I was in bed.
Obviously, I'm on backup call. Chad Smith was
on call. And around 2 .15, he calls me and says,
hey, there's a shooting in a club, and they think
we're going to have 20 victims or so. I'm going
to need you to come in. I'm like, I'll be right
there. So I jumped up and threw on my scrubs,
and I live really close. And within 10, 15 minutes.
And so, you know, when I walked in, we still
didn't have the significant police presence.
We weren't on lockdown yet. It seemed like a
typical quiet outside night to me from the side
I came in, you know, all the way until I got
to the trauma bay. And once I opened the double
doors on the far end of the trauma bay, and it
was obviously something we had never, I'd never
encountered before. We had patients in every
bay, patients perpendicular to the typical situation.
A lot of people just kind of running around.
It was just full. Patients kind of screaming
and yelling. It just was obvious that this was
a much different situation we'd ever experienced.
I looked up and I saw Dr. Smith. at the far end
of the trauma base. So I said, well, I'll start
on the near end and kind of meet him in the middle.
We'll just start triaging. And first one I came
to, the gentleman had a very large wound to his
chest and abdomen and looked to be fatal and
started to evaluate him. And Dr. Smith came up
to me and he said, no, no, Joey, I've already
triaged him. There's nothing we can do. He's
just, I told him just give him morphine. And
so that's something, you know, maybe in the military
setting you might have some experience with,
but in the civilian setting, again, you're experienced
with. We don't do that, right? We do everything
for every patient. So I just kind of had this
blank stare at him for a second and then realized
he was exactly right. This was a true triage
situation. And so then, you know, going to the
next one, you know, and just remember assessing
different patients. sending the next one up for
surgery, sending our fourth -year resident up
with him to get things started. And then it wasn't
very long after that Dr. Cheatham came into the
trauma bay, and Chad had called him also, and
I informed him that we had sent one up to the
OR, could he go cover that case, and then I would
bring the next one up. So I took... After assessing
three or four patients, I then took one of them
upstairs and did my first exploratory laparotomy.
It's just a different mindset that you quickly
have to go into. I remember I had a third -year
resident with me, and we took care of the abdominal
wounds. We didn't close really any abdomens that
night because, again, damage control. You take
care of whatever's bleeding or leaking or whatever,
and you put a temporary dressing on, something
we call a wound back. and we get them out of
the OR. And we didn't close anybody short of
one surgeon closed one abdomen that night. It
was a pediatric surgeon. But that's kind of the
damage control mentality. You get whatever is
life -threatening taken care of, and then you
move on to the next one. And I remember he had
several wounds going down his left arm, and the
resident looked at me and said, do we need to
do an arteriogram and evaluate his arm? I said,
no, we're going to wrap it with a beta. Betadine
soaked gauze. And if it bleeds, we'll put a tourniquet.
But he's probably going to lose that arm. But
we've got to move on. That's not going to kill
him. And she looked up at me the same way I looked
at Chad. Like, what are you talking about? And
then she quickly realized, same, just like I
did, you're exactly right. We've got 20, 30 more
patients down there that need us. So that, again,
is something that's very, very different from
our training. that now we actually do incorporate
into our training, but nothing that a typical
civilian training incorporates. So I finished
that case, went down, and saw several more, and
helped some of the residents get patients to
the ICU and things like that, and then took my
next patient up to the OR for the next ex -lab,
and took care of that patient. Again, didn't
close them. I think on my third one taken up,
We got a page saying code silver, which meant
that there was concern that a gunman was in the
ER. So I was up in the OR area at this time and
turned the corner and there were two heavily
armed police officers outside the OR I was going
into. So you have two feelings. You're like,
all right, I'm safe. But then at the same time,
you're thinking my whole team is still down there
in the trauma bay. Right. what's going on down
there. And again, the same resident was with
me and I just told her, look, let's just take
care of this patient. We'll figure it out. So
we took care of that patient and everything was
on lockdown at that point, meaning we were basically
stuck in the OR area. So I began going room to
room to see, you know, if somebody needed an
extra hand and went in one room where Dr. Havron
was working with Dr. Patel, our vascular surgeon.
The patient had a very bad subclavian artery
injury and knew they were going to be busy for
a while, but they said they were good. So I went
to the next room, and there was one of our other
fourth -year residents, Dr. Bada. He was prepping
out the leg, and he said, hey, the vascular surgeon
is going to come help me explore this femoral
artery wound. I said, well, no, he's got his
hands full two doors down. I'll just start scrubbing.
I'll help you with this. We can do this. So I
scrubbed in with him. We took care of that patient.
You know, again, going back to that the trauma
training, you know, you might, you know, even
though I'm not a vascular surgeon, we are very
well trained in taking care of vascular injuries.
So that that's, again, one of the reasons I went
into this. But, you know, it was just patient
after patient. And then. Once we finished that
case, the code silver had been lifted. They figured
out that they were just hearing the gunfire from
three blocks down because, as you know, Pulse
is very close to our facility. Extremely close.
Yeah, so when they breached the wall or whatever
and they had to shoot out, the shooting sounded
like it was in our ambulance bay. At that point,
they were, again, we were not on lockdown anymore.
I went back down and helped evaluate some more.
I think I did one more exploratory laparotomy
after that and then began, you know, seeing some
of the lesser injured patients. And all that
went on and on until around 730, at which time,
you know, is a testament to our facility. I mean,
everybody involved, you know, environmental services.
We had orthopedics guys helping us take off tourniquets
and evaluate people. I mean, it was. Our critical
care medicine guys were running the ICUs and
recovery room. And it was just, again, a total
team effort. But, you know, at that point, we
had one, I think, one pulse victim still in the
trauma bay, which is pretty amazing. We've gotten
everybody into beds and things like that. And
so at that point, the day teams were kind of
responding that maybe didn't hear the mass call
in the night. And which that was a blessing,
too. You know, if everybody would have shown
up at once, we all would have been dog tired.
So as it was, we had some fresh, fresh eyes,
brains and legs coming in, which was good. Yeah.
So we I remember we sat down in the trauma bay
and laid out all the patient lists because we
had we had around 60 patients that were in the
hospital already on the trauma team. So we kind
of divvied up, OK, who's going to round on what?
And then we also needed to go back through all
of these, the pulse victims and make sure all
their injuries, because we took care of the most
life -threatening injuries, but there may have
been some lesser injuries that we missed. So
we needed to go back through and reevaluate.
We call our tertiary evaluation. So we did that.
Just another resident, one of the senior level
residents and I went and made sure we saw every
single patient. And after doing that, We all
met back up and just kind of continued. I started
meeting with our hospital incident command. Dr.
Cheatham and I would alternate, which that's
a system that was put in place to have all the
department heads be able to talk to each other
directly to determine what things you need. For
instance, for us, we were in great need of chest
tubes and wound vacs, as I mentioned. That hospital
incident command allowed me to look directly
at the supply guy sitting next to me and say,
hey, I need this and this and this. He made one
phone call and we were fully stocked. Just amazing.
Our hospital, again, the environment's amazing
in that they do that pretty regularly. If we're
full for other reasons or if the ER's backed
up, things like that, our chief operating officer
has gotten into a habit of calling incident command
just for everybody to come together and make
solutions. And so when we had to do that on that
evening, it wasn't something totally new, right?
Again, that's, I think, key to the success of
that. But yeah, it was something, I mean, that
went on, to be honest with you, you know, that
was a very long day. I was actually on call that
Sunday and took care of an incarcerated hernia,
appendectomy, and I helped with an ovarian abscess
over at Winnie Palmer. The main thing that we
wanted to get out was that while we had this
tragic event occur and we had to deal with a
lot of the patients from that and victims from
that, we were back open to the rest of our community
within a few hours. again a testament to the
to the system yeah i'm gonna have to say from
from the outside looking in i was actually in
portugal and and there's a strange irony to the
whole thing my my station like i said was right
down the road i mean you could hit pulse with
a rock from the edge of my first shoe in orange
county and then when i moved to reedy creek uh
omar matin the the shooter i guess he had two
targets pulse was one and disney springs with
the other and that's where i protect now so it
was a kind of weird twist that i wasn't physically
able to be there but potentially it could have
been you know me on that scene as well um but
i was so impressed with with that i mean just
just the overall scene i mean i'm sure it wasn't
perfect in every single element with you know
the first responders and some miscommunication
but overall the the event itself the way they
they killed him um you know when he came out
you know guns blazing like in the movies versus
most what incidents that are pretty uh pretty
stable all the way through to you guys and how
you dealt with with this incredible influx of
patients from the outside looking in it looked
absolutely amazing you know the whole scene went
the way it did right no it's you know it went
better than any any drill we've done you know
you always do your drills and you know your biggest
you're your own best or worst critic and I remember
you know thinking oh we can do this better that
better we we finished this event and we had our
debriefings and such and we were like i mean
obviously there were a few things here and there
like you're mentioning but overall yeah from
from ems and police all the way through we couldn't
have been more satisfied with it honestly yeah
now one thing i was going to ask you as well
so did you absorb every single um patient they
want any sense of chance or any of the area level
one trauma centers uh no so We got all the critical
ones. Eleven, I believe, did go to Florida Hospital.
And while it's not a trauma center, I think they
were pretty minimally wounded, so they felt like
they could go to the closest center and get care.
Right. Some showed up a couple days later at
some of our smaller centers like Dr. Phillips
and things like that with minor wounds as well.
But all the major injuries were brought directly
here. Okay. All right. So I guess the next question
is, I mean, it sounds like everything went phenomenally
well, but I mean, one of the whole points of
the show and this interview is for us to learn,
us to grow. So firstly, you guys specifically
as trauma surgeons and in the ER, what were some
of the lessons you learned from that particular
incident? And if anything, what did you change
after that? Sure. So some of the things that
we've encompassed into our training and our...
for mass casualty training is that and we actually
incorporate into our regular traumas now if somebody
needs to go to the operating room truly emergently
you know like right that second then we can actually
go up to the or you know and they will open the
or around us as opposed to calling and saying
hey call us when you have the room ready we get
the patient to the room and then the room gets
ready around us right and that That way, we bring
ER staff with us until we make that transition
or that pass off to the anesthesia team and the
OR team. That just cuts down on some of the time
needed. In a mass casualty situation, that gives
you more bed availability in your trauma bay.
That was something that night. We're calling
up and telling our front desk person, hey, we
need to come up. They said, okay, give us 10,
15 minutes. I said, no, you don't understand.
We're coming right now. You can open the room
around us. You know, it took some talking, you
know, and making them understand, hey, we need
to make more beds available. We've got to do
this. And they're like, OK. I mean, it didn't
take very much talking, but we found that that
was much more beneficial. And then the other
thing, when we went on lockdown, as I mentioned,
some of the surgeons that were called in, additional
surgeons that were called in, they could not
get to the trauma bay. So instead, they had to
go directly to the operating room and we would
shuttle patients up to them. As a result, we
found that that is a little more efficient in
a mass casualty situation. So now, and that's
very much like what the military training and
exercises do. They have people that are in the
ORs waiting, and they have people that are triaging,
and they send them their way once they evaluate
them and figure out their injuries. And that,
especially when you have a close unit like ours,
I mean, there are nine of us, and we work together
very well. We've known each other, at least seven
of us have known each other for about 10 years
or more. We know each other very well, trust
each other to take care of patients and evaluate
patients. And if they send somebody up to me
in the OR saying they've got these injuries of
X, Y, and Z and need surgery, then I can do the
surgery. And that model has shown to be beneficial
in multiple mass casualty situations and military
training. And that's something that we've adopted
now for our mass casualty training as well. And
then lastly, as far as lessons learned with our
pre -hospital care. We already do drills with
them on a monthly basis. We rotate through different
services, whether we go to Lakeland, Apopka,
obviously Orange County, and we do drills with
them. And I think communication, as you probably
have seen and heard and experienced, that is
99 % of the battle. And that evening, I remember
some paramedics coming in and asking me, hey,
I can't get back to the scene. What can I do?
And I said, well, you're better at IVs than me.
Put IVs in these folks. And just having that
open dialogue and that ability to communicate
with each other, what are the needs and where
can I help? And so as a result, we just, with
our EMS, we've had that for a while now, but
with our OPD, the Orlando Police and Orange County
Sheriff, incorporating them into the drilling
even more and having their evaluations because
the police department actually brought in 11
patients that evening. So I think they were the
second biggest transporter that night. So in
a mass casualty situation, that's what you're
going to see. You're going to see your police
departments really stepping up and contributing
to patient delivery. And I think that's important
to recognize and important to involve them in
the training and the drills that you do. Yeah.
One of my previous guests, John Spira, he was
one of the first guys on the Aurora shooting
in Colorado. And he said the same thing. initially
trying to do the structured triage but then it
kind of went to the point where patients were
getting thrown in whatever they could and transported
in police cruises and I think even private vehicles
so I want to touch on that a little bit because
he mentioned in his how we have the start triage
and obviously we need a framework he mentioned
that there were some weaknesses in some areas
that in real life didn't pan out the way that
they would in training the the patients in in
the pulse were they triaged using start triage
or was it more uh just brought in you know uh
as a constant flow yeah very much like you're
saying initially i think they tried to triage
but then as the number increased i mean we had
a window there where we had i want to say 38
patients in 42 minutes wow so yeah to do the
typical triage with the tags and things like
that it's kind of unrealistic at that point so
um yeah it kind of just becomes get them here
and just evaluate them you know once they get
here and we did have a system where our critical
care medicine and er personnel were evaluating
patients when they first were brought to the
emergency department in the kind of the bay there
with ultrasound and vitals and if they were humanimically
stable and had no free fluid in their abdomen
they could do a little more structured evaluation
versus if they had either unstable vital signs
or had fluid in the abdomen, they were brought
directly to the trauma bay for us to evaluate.
Right. Okay, so I want to talk more about pre
-hospital. So I know one area that is kind of
introduced, but I know I've only been a fireman
for 13 years, but when I first became a fireman,
tourniquets were almost like... These terrifying
pieces of equipment that if you put it on for
more than 60 seconds, the person's leg was going
to drop off. So obviously that mentality has
changed now. So obviously from Pulse, but even
from the other pre -hospital traumas that you
have, are you seeing now in the civilian arena
a good result when these crews are using tourniquets?
Yes. I mean, I still don't see it. As much as
we would anticipate, we have started with the
Stop the Bleed campaign that you're probably
familiar with to educate not just obviously pre
-hospital personnel, but the true what can be
considered maybe even more of a first responder
or a pre -first responder, and that's civilians
that are at the scenes on how to put on tourniquets,
how to hold pressure, and things like that, and
educate people that... The research does show
that nobody's lost a limb from a tourniquet if
it's only left on for two hours or less. And
it's funny, in doing some of these classes that
we've started, talking with civilians, I remember
this one gentleman telling me, oh, I thought
anybody that had a tourniquet on lost that limb.
That's not exactly true. And in fact, most of
them don't. The majority don't. And even further,
the fact, at least if they do lose the limb,
but it saves their life, we still have a live
person. And, you know, people just are so fearful
of, oh, gosh, are they going to lose their limb?
And when you truly have somebody that's exsanguinating,
I mean, that's a life -saving situation. And
I think, you know, I have not seen a significant
increase in our pre -hospital personnel usage
of that. We did see a few that night, as I mentioned.
I had some people helping me take those down.
A lot of people feel uncomfortable because it
does hurt, as you probably know. When people
have tourniquets put on properly, if they're
conscious, it's not comfortable at all. But it's
not intended to be because it's intended to stop
the bleeding. So, you know, it's difficult to
crank that down on somebody with them wide awake.
You know, and you just have to instruct them
that this is stopping you from bleeding to death.
And hopefully they'll understand later. Yeah,
I think that that message needs to be taken out
there as you're talking about. It needs to be
told to people and make sure they understand
that those can be a life -saving, not just in
a mass casualty situation or a shooting. We talk
about people falling off ladders, tree cutters.
You've got sharp instruments in one hand, they
fall off the ladder. Next thing you know, you've
got a significant limb injury. Motorcycle crashes
we see all the time with significant limb injuries.
Having, you know, whether it be EMS, pre -hospital
personnel or even a civilian put on a tourniquet,
I think that's crucial. And as we've alluded
to, I think it's lifesaving. Right. OK. And then
touching on another kind of not gray area, but
maybe misunderstanding the airway. So obviously.
You start medic school, it's all about intubating.
And then we have the king tubes. And then people
say, you know, normal breather. I mean, excuse
me, normal breather. Back valve mask is good
as well. But the goal for me is to be the best
medic I can be and prepare the patient in the
best way for you guys. So think about, you know,
the large bore IVs or, you know, whatever it
is that's going to set you guys up for success
when we walk through your door. So in an ideal
world, not catering to the lowest common denominator,
which a lot of the medical direction I know is
kind of aimed at. Is a good intubation, is that
still the ultimate thing that you're looking
for a medic to bring through the doors? I mean,
obviously it makes our life easier. I think in
the properly trained individual, it is a life
-saving event. Have I seen adverse events from
attempted intubation or intubation that they
thought was proper or that got dislodged somehow
and now is an esophagus? Yes, and I told you
I've been, I don't know, blessed or cursed, however
you want to look at it, with a few experiences
of being in the field, being the first person
on a scene, and even helping EMS try to intubate,
things like that. And again, my hat's off. I'm
blessed with lighting and instruments and all
those things. I don't know how you guys get proper
intubation ever. It's just amazing to me. A good
intubation is very beneficial. Do I think you
can oxygenate somebody sufficiently with a bag
valve mask? I think so. I just have seen enough
where I think it depends on your comfort level
and your level of training. We see some horrific
injuries here. I saw horrific injuries in Tennessee
where the airway is very difficult. So making
an attempt is probably better just to get a mask
on them, start bagging them, and get them to
the closest facility to get them intubated properly.
I know that's a difficult situation, and that's
something that's easy for me to sit here and
say in the trauma bay, seeing things that roll
in, as opposed to being the guy in the field
having to make that call. But I do think that
that's something that we're going to have to
continue to look at. The good news is they keep
coming up with more and more instruments that
make it easier. Things like the king tube that
we seem to use a lot and see here. Different
scopes now where you actually have a camera view
on your laryngoscope. Right. I think those type
instruments are going to make it more and more
facile and better for our EMS providers to be
able to do that in the field. But with the traditional
laryngoscope and doing it in the field, I think
if you are not very well trained, which goes
to our responsibilities too as trauma centers,
what are we doing to help you guys do some airway
courses? We all have these simulators now where
we can make difficult airways. We can do different
things. How do we incorporate you guys into that
education? We do it for our ER residents. We
do it for our surgical critical care people.
Should we not be partnering with you guys in
doing that? I think the answer is yes. Yeah,
absolutely. Getting you guys more engaged with
that, and that way you have that same comfort
level as us. But because, again, you guys are
having to make the same calls we are, but you
make it in the dark on a roadside. Whereas I
get to make it with a patient in a bed and five
to six people around me helping. So I think that's
where we need to look at is how do we get you
guys more training and more comfortable with
that when it does happen in the middle of the
night with a guy hitting a motor, running his
motorcycle into a wall or a sign. He's got a
bloody airway and he just has to be too. how
do we create that level of comfort so there's
no anxiety and you just do it just like you've
done a hundred other times on a mannequin you
know yeah yeah i think i'm not not defending
not making excuses but a challenge that a lot
of first responders have especially if they are
a firefighter and medic um is that we're just
jack of all trades master of none so it takes
so much training to make sure that you're competent
because you might be intubating you know a three
-year -old and then your next call be having
to rig a rope system to rescue a guy off a you
know a window cleaner so so our scope of practice
is so huge um it takes a lot of training which
this is what this is this whole thing is about
is not making excuses but reminding ourselves
and myself included that if we get complacent
and we stop training It's not being dramatic.
Lives truly do handle, you know, hang in the
balance, because if we miss these tubes consistently,
I mean, that might be the difference between
someone living and dying. Yes. So, OK, staying
on that kind of intervention, another area that
I hear people talk about is needle decompression.
When you have we have certain parameters that
we're supposed to have before we decompress.
Is that another area that. uh, you see could
be done more aggressively as well in the field.
Yeah, that's funny because, you know, I was a
few months ago, I was down in the trauma bay
and they brought somebody in and I remember they're
giving me the story and I'm looking at him like
this. I said, so this guy didn't meet. And he's
like, well, I really wanted to put a needle,
wanted a needle decompressive, but he didn't
quite meet our criteria. I was like, we need
to help you guys out on that. You need to be.
And then I go and look at the criteria and then.
I reviewed a couple more cases where, you know,
maybe it was different units or things like that,
but they had needle decompression and maybe wasn't
quite indicated. So, again, as you're pointing
to your last point about all the things that
you guys have to do, you know, it's just, again,
it's amazing and can be overwhelming, I'm sure,
to do all that training. But, you know, I do
think we need to give you guys, and there have
been multiple papers talking about. EMS and paramedic
discretion to determine trauma alerts and things
like that, even if they don't meet criteria and
how that sometimes is better than using the criteria
that we use. Yeah. So I think giving you guys
a little more freedom and a little more autonomy
in addition to, again, giving you the training,
giving you that practice is so key because I
mean, I've seen guys, I mean, seeing it used
just beautifully and it was a life saving situation.
and I've seen it sometimes, and the catheter
didn't quite get into the thorax. You know, I
do my CT scan, and it's sitting in the pec muscle.
Right. Or, you know, it was put in, and there's
no pneumo, but there's a pneumo on the other
side. And so, again, I have the benefit of getting
to play Monday morning quarterback by looking
at it through the CT scanner, not being in there.
In the field, trying to listen to the breath
sounds in the back of an ambulance or a helicopter
or things like that. So, again, I think it's
just more experience, more training. But I do
think based on and that's again, this is backed
up by more and more research that the more training
we give pre -hospital personnel, the better decisions
they're able to make. And quite frankly, they
do a better job at assessing what the patient
needs than even our criteria can determine. Yeah.
So I think that. In the long run, that is something
that probably would be beneficial. Okay. And
another area, I'm trying to delve in too deep
because I'm not breaking any HIPAA laws, but
actually my last day at Orange County, let's
just say that the gods weren't happy. The third
of my patients that I brought, my partner and
I brought in, was a gentleman that had basically
come out of a house on fire. And by this point,
third -degree burns from head to toe. Everything
wasn't burned but the soles of his feet. So our
only option really, apart from airway and IO,
was a burn sheet. So is there anything on the
horizon as far as pre -hospital care for care
for burns? Or is that always still going to be
the kind of only thing that we're able to do
apart from controlling the airway and fluids
and pain medication, of course? Honestly, I don't
know anything new on the horizon for them pre
-hospital. There's lots of stuff. you know in
the hospital for for their wounds and for things
like that um but pre -hospital there's not much
that i'm aware unfortunately um because there's
just so much that you need to assess you know
to do too much in the field and too much there
you know like we just had one the other day i
had to do an escharotomy on once he got here
for his circumferential burn of his leg so he
didn't lose pulses in the leg um you know they're
just little things not little things that's a
big thing but things like that that in the pre
-hospital setting it's going to be very difficult
to to determine and even obviously to be able
to do something like that in the field would
be very difficult at the most so i i think for
burn stuff we're still kind of behind unfortunately
on on the pre -hospital side and that there's
just not a lot that we're able to offer them
until we really get things evaluated and to be
honest there are things that we see you know
we'll think they're a certain percentage and
then we Get them to breed it and cleaned up and
everything and turns out they're much higher
percentage than what's what we once thought right
and they need you know that that increases or
maybe pushes them over to requiring a resuscitation
that involves a particle Parkland formula whereas
prior to their debridement we thought oh they
don't need Parkland formula these need fluids
at 125 and then we do the Parkland formula or
we do the debridement it's like oh my goodness
I underestimated by 10 15 20 percent what their
needs were, what their burns were, and now they
need a significant more amount of fluid. And
so I think that all those things are so limiting
in the field because you can't really clean them
off. You're trying to rush things to get them
here. Your main things are still your airway
and pain control and giving at least some fluids
before they get here. Yeah. Okay. All right.
So another area I kind of want to kind of...
steer us into now I'm going to read a few names
first before we delve into this because obviously
Pulse is just you know one one day at ORMC and
I've brought so many shooting victims and stabbing
victims I know a lot of my my peers have especially
from the you know OBT Pine Hills area where where
there's a lot of violent crime but you guys also
and I believe these people were all brought to
you. Lieutenant Deborah Clayton, Deputy Norm
Lewis, Deputy Brandon Coates, Deputy Jonathan
Pine. So we had several of our law enforcement
officers slain the last few years. And so have
you, I mean, you yourself, did you notice any
effects? mentally after um you know the pulse
specifically but also just the collective nature
of being a trauma surgeon and then also did you
see the effects on on your peers in the er as
well well i think you know the pulse in general
obviously brought our whole community together
in a much stronger way and uh i think you know
the events you're you're discussing obviously
i can't say say too much about each one but as
far as the the impact everything's had On all
of us in general, there's no doubt that there's
a lot more solidarity between us and our friends
and colleagues, brothers and sisters in the police,
in the Orange County Sheriff's Departments, and
in obviously the EMS departments around the Central
Florida area. So there is no doubt that when
one is injured or harmed, that it has a significant
impact on all of us. And that has been very well
demonstrated. On that day and on several other
days, unfortunately. But, you know, there's no
doubt that we're all much closer in our training,
but also in our losses when things like that
happen. So, again, I think Pulse is partly responsible
for that, probably a major responsibility of
that or a result of that. But I think those events,
you know, now have much more meaning than what
they did probably prior to Pulse. Again, it goes
to the point that we do a lot of training we
do together, a lot of different drills we do
together. So we know each other on a regular
basis. And as you pointed out, ORMC is a busy
place. You know, Friday, Saturday night, you
know, I actually I was at Chipotle the other
day and I see two officers come in. I went over
and just introduced myself and thank them for
what they do. And they're like, oh, I thought
I recognized you from the trauma bay. And so,
you know, we all kind of know each other now
and recognize each other. try to say hi to each
other, not just at these events and these drills
and these things like that, but when we're out
and about in our community. And I think that
speaks to the collegiality and speaks to the
unified manner in which we seek to serve our
community. Yeah, I agree. You hear these separations
of jurisdictions or police versus fire or medics
and nurses not getting on. take a step back we're
all part of that same chain of survival whether
it's you know on the police side or or the ems
side and and for there to be any separation doesn't
make any sense whatsoever no i agree totally
i agree and and like i said i mean i think unfortunately
you know we had that tragic event but the main
one of the big things was the unified manner
the whole whole city really came together and
that are um ems and police and our obviously
our trauma center really kind of combined and
then you add on top of that we're doing things
like stop the bleed you know how what do we do
positive going forward from that you know we
do we enhance our drilling we do things like
that but then we also go out to the community
and how do we educate them on stopping the bleed
and being aware and all these different things
to do to make our area safer yeah absolutely
it was uh interesting i had uh sebastian junger
who wrote tribe and and uh restepo and uh some
of the other uh work that he's done and tribe
was basically about how fundamentally humans
are tribal and how in times of tragedy whether
it was 9 -11 or the bombings in world war ii
in london how they saw mental health was so much
better there's a huge improvement as people banded
together and felt part of something again i think
that's has lost in in society and In a lot of
ways, especially in this electronic generation
that we're that we have. And sadly, it takes
tragedies like these sometimes to bring people
back together. Absolutely. You know, and that
goes to, you know, you talk about I think that's
another reason I like trauma is because it's
definitely more of a team or try. I like the
tribal link there mentality. And, you know, growing
up, I played a lot of sports and things like
that. So very much team sports minded. And trauma
kind of leans itself in that direction. And obviously
with working with EMS, working with police and
you see that across the country. You know, I
talk to other trauma directors and they're involved
with their SWAT team and they're involved with
different areas and different teams and different
parts of their community. And, you know, obviously
there's a big part of us that wants to serve,
but there's a big part of that also that is serving
us and serving something that we need inside
of us. And I think you hit it on the head with
the tribal. aspect of it that need for support
and being able to support others at the same
time you know and the one thing i talked to i
talked to a group called volunteer florida just
a great group of individuals who were here in
florida just to uh it was from all across the
south actually they're all in volunteer communities
they're all none of them are very few or medically
trained but they want to help see how they can
help their communities better just an amazing
group of people and so i got to talk with them
and you know we talked about it's just When you
break it down, it's just humans being human,
right? I mean, doing the right thing. It shouldn't
be that difficult. No. And sometimes it is, as
you pointed out. But if you just break it down,
it's really not that hard, I don't think. Maybe
I'm simplifying it too much, but it just doesn't
seem hard in my simple mind. Yeah. No, I agree.
And to kind of, I guess, pull it back into pulse
for a second. We're seeing the opposite, too.
We're getting these people that are inhuman claiming
whatever ideology they believe in, doing these
horrible things. And I think to underline it,
this Facebook killer that's just been on the
news the last couple of days that killed that
poor gentleman, Robert Goodwin, for no apparent
reason. He didn't claim any affiliation, so it's
just a murder. But you claim an affiliation,
it becomes something else. And again, I think
that... It's a crazy concept. It's a murderer
who went in and killed a bunch of other fellow
human beings. That's where it ends. And you can
either be a human and help your community or
you can be someone like that and hurt your community.
Absolutely. You alluded earlier to the mental
aspect for us. For trauma, especially when you
look at patients and victims of violent crimes
and the violent crime people that commit those
things, Obviously, there's a big psychological
component that we don't quite understand and
they are in desperate need of understanding and
help with. And unfortunately, that's a big kind
of a big void in our in our country right now,
I think. Yeah. Yeah, I agree. All right. Well,
I have taken an hour of your time and I really,
really appreciate it. We had some technical difficulties
earlier, so it's probably been closer to almost
an hour and a half. So I thank you so much for
that. I've got a couple of short questions and
then we'll let you get on your way. So firstly,
I always ask my guests this. Do you have any
books and or movies or documentaries that you
recommend to people that you you rave about?
About specifically about what? Anything at all.
I don't know. These are more of the personal.
But, you know, there's a writer. He's kind of
Christian based. His name is John Eldridge talks.
He's very much speaks about it's more to men,
but it's, you know, what what men are looking
for and what they need in life and what they're
supposed to do with their lives. And that that
one has really he's been a great person to read
different things about in my personal life and
how I want to live my life. OK, so he's he's
a great one. You know, as far as. I think there's
some other, you know, I've read a lot about the
Boston bombings. I can't give you exact names
right now, but different. There's a military
surgeon who wrote a lot about those, their events
and their situation up there. There are a lot
of things that happen just by happenstance, right?
And I can give you examples from our situation
too, but for the Boston bombing, they... They
had additional EMS personnel at the finish line.
You may or may not know that. And the reason
is the previous year they had an increase in
their heat stroke rates. And so they had extra
personnel at the finish line. Patriots Day is
probably the worst day those gentlemen, those
guys could have picked because the traffic is
less because the whole city pretty much shuts
down. That's why they had the good outcomes that
they did for the injured ones that made it to
the hospital because they had ease of access,
they had more EMS personnel, and they could get
them to the hospitals quicker. In our situation,
we had three or four ER residents that were working
that night. Well, they were two weeks from graduating,
so they were basically attending physicians.
So that increased our complement of physicians
significantly. Right. You know, it happened in
June and not July. And if you work in academic
centers, you recognize that July is when the
transition occurs and you get the new interns.
Whereas we had interns that had at least 11 months
of experience underneath them. So they weren't,
you know, shocked by what they were seeing. I
mean, they were obviously to some extent with
that, but they still knew how to facilitate and
triage and help out significantly. So the little
things like that that just happened, that if
you look at all these different mass casualties
were present in these other situations too. So
I think it goes to show that while it would be
nice if these tragedies never happened, there's
at least some hand above that's kind of watching
over those. That being said, I can't give you
a specific name on that. Any of those articles
you read, I wish I could remember his name, but
he's a military surgeon that worked in the Boston
bombings. He has very good evaluations of that.
But those are kind of the big ones I've read
about. Did you see the Patriots Day movie they
made? I have. I thought it was well done. I mean,
it's a movie made for entertainment. It's got
Mark Wahlberg. So it's simply entertaining. Is
it something... you know i don't know i tried
to see was there anything i could learn and draw
from it other than you know obviously the experience
that they had and how you know i didn't recognize
as an outsider how they shut that city down completely
to find to find those those individuals that
was pretty amazing yeah extremes took into decisions
they had to make so i really was impressed with
that aspect of it Yeah, I know there was definitely
some medical glitches, though. There's a lady
there with a tube down her throat, and the guy
said, yeah, she just told me whatever it was.
And I'm like, how did she tell you that? She's
got a tube in her throat. Oh, yeah, you can't
know that. Something like that happens in a movie
or video, or you're just like, well, I can't
believe anything that happened. It's just part
of working in medicine, and we want everything
realistic. So what about any documentaries? Yes.
Little Town. I don't know if you've seen that
yet. It's a documentary on the Sandy Hook shooting.
Oh, I haven't. No. It was on PBS. Actually, I
got to see one of the first screenings of it
at the Eastern Association meeting for surgery
of trauma. And very well done. In fact, the director
visited here. And I think she has something in
the works to do something about Orlando's experience.
But that's a very good documentary going into
the lives of the victims' families, even. I mean,
you'll need Kleenex. I mean, it's a very emotional
documentary. But that was something that was
very moving. And obviously, having seen it after
our experience, it had even more meaning, I think.
But that's something to look for. It's something
I think people would appreciate, especially after
our experience. It's called Littletown. You won't
see it in theaters or anything like that, but
it was on. They were showing it on PBS. I'm sure
if you Google it, it may even be on YouTube at
some point in the future. Okay, I'll have to
look at that. My little boy was exactly the kindergarten
age when that happened, so that was just absolutely
gut -wrenching. Sure. Well, yeah, this will be
a very difficult one for you to see. Having kids,
it makes it even more difficult. Yeah. All right.
Well, bringing it back up again, when you do
need to decompress, you're done with your day,
you've been saving lives, what do you do as an
outlet? Well, I get to spend time with my boys.
They're fantastic. They're 12. I have twin boys.
They're a great outlet. enjoying life. It's fun
to see them grow up. That's amazing to me that
they're 12 already. Beyond that, reading and
running. To be honest with you, swimming too.
Swimming's been a good one. Spending time with
my friends and family. I've done a lot of traveling
just to do talks and meeting other people. While
that may not seem... somewhat of an outlet because
I'm still talking about the same things. It is,
it's, I always take something away. You know,
I go and teach the lesson of preparedness and
stop the bleed and all those things. I've kind
of, our whole facility and organization has taken
that on as kind of our responsibility now is
not just to tell the story, but to tell people
how to be prepared and how to, how to do these
things. But I always take something away. I always
learn something and it's fun to meet people.
Give us more credit than I think we deserve.
I mean, we're just doing our job just like you
do. It's like everybody, every other individual
does. It just happened that we had a lot of work
to do that day. But, you know, we didn't choose
any of this by any stretch. But it's always fun
to meet people and learn and take some of these
lessons and bring it back here and make our community
better. But really enjoying just that aspect
of it too, just as you mentioned, the tribal,
because trauma is a tribe in itself. Our trauma
community as a whole is very small. I mean, I've
met people even before this, but even more so
now, from all the way from Seattle down to here
to Boston to... southern california that you
know i can call at any moment just talk to them
and that's been it just brings our makes our
country seem so much smaller than it is but uh
that that's been really enjoyable getting to
be getting to meet individuals on the national
committee on trauma the chairman of the committee
on trauma getting to meet him and call him and
and talk to him about different aspects of things
has been just amazing and he's been a great help
for a lot of things but Doing all those things.
But when it comes down to it, as far as just
truly decompressing, I think running and swimming
and exercise are still my main outlets. Right.
Yeah, that's a common denominator. I've said
this multiple times on the show, but exercise
and family are huge ones. And then hobbies, which
obviously your passion for learning and growing
in the trauma field is, I guess, technically
a hobby as well as a job. um all right and then
so the last thing i say where can people find
you but i'll expand that to to where can people
contact you and find your work but also um if
you want to uh talk about where they can access
information for programs like stop the bleed
as well sure so let's do stop the bleed first
because that's way more important than me um
stop the bleed is uh it's easy it's stopthebleed
.org very easy okay website they have all Everything
on there, material -wise, things that you need,
great information. We at Orlando Health, if they're
in the Central Florida area, they can go to our
website and look for information as well. And
we'll actually soon have, if it's not up already,
have some sign -on capabilities for classes that
we'll be offering. And they're free. So that's
something to take advantage of. And then as far
as for me, You can obviously find me on the hospital
website. My email for the hospital is joseph
.ibrahim at orlandohealth .com. And I'm glad
to take any opportunities. I love to get involved
with our community. I speak at high schools,
talk to RMS agencies. I just love to be involved
with these guys and get them involved with us
more so because, again, Level One Center is part
of the community. That's the main thing we want
to get out there. Brilliant. Yeah, I'd love to
try and maybe in the future get you down to my
department, because even though it doesn't make
the news normally, because what happens at Disney
stays at Disney, but we do have an incredible
amount of... of incidences that, that happened
that, you know, may not be the same violent streets
of, uh, some of the other areas of Orlando, but
we have, we have areas that we'd certainly need
to, uh, you know, stay trained on too. So. No,
I would absolutely love that. No, I know you
guys do a great job and a lot of training and
things like that that occur behind the scenes.
So yeah, I'd absolutely love to be involved with
that anyway, help any way I can. I need, uh,
Sabrina actually corrected me here and she's
right. It's the, the documentary is new town,
not little town. New town. Okay. I will change
that. I'll put a link on that in the, uh, in
the website as well. Okay. Brilliant. All right.
So while we just pause for a second, then I'm
going to, uh, I'll do the fake sign off, say
goodbye to you, and then we can switch back to
video and I'll just talk to you about, um, getting
all this, the, the links to you so that you can,
uh, you know, listen to it and share it as well.
So. all right so well thank you so much for your
time joe i really really appreciate it this is
something that i personally wanted to do for
a long time but way before this podcast but actually
just sit down with with with a surgeon like yourself
and and find out how i can become a better medic
and and and raise the uh the possibility of saving
someone's life by doing the right things before
we walk through your door. So I really, really
appreciate you, um, talking about that and obviously,
you know, reliving that day, which I'm sure is,
is not exactly the most comfortable thing to
do. No, it's my pleasure. You know, it's again,
we were, we were given this opportunity and it's
our responsibility to share that with you guys.
And again, my hat's off to all the first responders.
Again, amazing job. I, we're blessed to have
the comforts of, uh, all the things we have in
the facility and you guys do it at extremes that
we can only imagine so thank you for the for
that and thank you for this opportunity okay
well thank you so much you have a good day