Doc Works on the Edge

October 20, 2001

Heather Heilman
Phone: 865-5714

Norman McSwain spends about a hundred hours a week on the job, but he claims never to have worked a day in his life. "Every day when I come down here, I'm having fun," he said. "It's not work." Maybe so, but just reading his curriculum vitae is exhausting.

McSwain is a professor of surgery at Tulane, associate director of trauma at Charity Hospital, surgeon for the New Orleans Police Department, and medical director of the New Orleans Jazz and Heritage Festival. He has written 25 books, and developed the course that has been used to train 300,000 emergency medical technicians in 25 countries.

He's a legend in his field and an expert on the treatment of gunshot wounds. He's done important research on resuscitation techniques, the efficient use of blood, and the impact of motorcycle helmet usage. He's served in both the Air Force and the Naval Reserves, and has volunteered his services to the Navy as military action is taken in response to terrorism. Next year will mark his 25th anniversary at Tulane.

During medical school, he found he enjoyed working on the edge in the way that trauma called for. After a few years in private practice at the beginning of his career, he woke up one morning and realized he was truly bored to death. His interest was piqued by the chance to develop a medical system for an automobile racetrack near Atlanta.

"That turned out to be a career changer," he said. Accidents and injuries at the track were few, but he got a great deal of satisfaction out of developing a system for handling emergencies. "System development has always been an interest to me, whether it's system development of event medicine, or system development of pre-hospital care, or system development of a trauma system," he said.

In 1973, he took an academic job at the University of Kansas. At the time, the state had no coordinated system for training emergency medical technicians, but the school had just been charged with developing one. So he created Kansas' first EMT training course, which later evolved into the national standard curriculum.

Along the way, he began to ride with ambulance crews on the weekend in order to experience their work first-hand. Eventually he became a certified paramedic. He arrived in New Orleans in 1977 to develop an EMT system for the city and to help the trauma department at Charity Hospital evolve. At the time, several different agencies in the city ran an ambulance service, but there was no coordination between them. There were many nights when there was only one ambulance on the street, McSwain said.

Today, New Orleans Health Department ambulances handle all 911 calls, and all trauma cases in Orleans Parish are taken to Charity Hospital. Charity handles about 5,000 trauma patients a year, making it the second-busiest trauma hospital in the United States.

And that's a good thing, according to McSwain. "It means all the education and training is concentrated in one place, so you've got people who are really skilled at handling trauma patients," he said. "Often people don't understand the difference between a trauma center and the emergency room of a regular hospital. A trauma patient is someone who has suffered a gunshot or knife wound or who has been in a serious accident. A cardiac patient is not a trauma patient. They truly believe that any hospital can take care of trauma, and that's just not true," he said.

"At Charity, a full trauma team is in-house 24 hours a day. In other hospitals, a surgeon might need to be called in. It might take him 45 minutes to get to the hospital. In 45 minutes we already have the operation done and the patient in the recovery room," McSwain said. "And doctors who only see a few trauma patients a year are not going to be as efficient at taking care of them."

In every trauma case there's a golden hour--a period of time that may vary in which it's crucial to correctly treat the patient before energy production drops. Even in the best of circumstances, half of that time may elapse before the patient gets to the hospital. When EMTs work in a coordinated manner with the trauma team at the hospital, the patient is better off.

That's why McSwain has spent so much time developing their training. He also wants the public to have a better understanding of what trauma centers are about, which is why he's appeared in three television documentaries that have aired on the Learning Channel and the Discovery Channel.

An episode of Life in the ER focused on Charity, Code Blue-New Orleans is currently being rerun, and The Golden Hour will appear in December. "It's important to support them," he said of the television crews. "If they don't get the story right, people on the street get the wrong impression of what emergency medicine and trauma centers are all about. The more folks understand it, the better off you are when you're dealing with patients."

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Tulane University, New Orleans, LA 70118 504-865-5000