Saturday Night Bara Trauma Unit Johannesburg
As the sunsets over Sowetto township I head to the hospital for the famous Saturday night shift- swerving the minibus taxis on the way as they aim for head on collisions and own the road!
The shift starts at 7pm- arriving in trauma resus 10 patients are already there, seemingly a busy day MVAs and shattered pelvis, GSW to heart, stab requiring surgical thorocotomy - all to theatre and multiple stabs or assaults tubed in resus and waiting CT scans - scanner down again! And the ‘minors areas’ although not minors very busy, patients waiting everywhere.
What an experience- if I am honest through the night I lost count the amount of stabbings, GSW and MVAs - ejections, PVAs we resus’ed… lost count how many ICDs and CVPs where inserted!
Man comes in carried in a blanket by friends- stabbing pericardium … another open sucking chest wound/ pneumo..
Helicopter brings in a 22yr old female shotgun shooting…. Went out to the heli pad and retrieved the patients resus’ed.. lodox showed 17 BULLETS dotted over her abdomen- to theatre.
Tracheal- broncho injury….
Then 17yr old stabbed in the abdomen….. bowel evisceration… her whole bowel/intestines hanging out her abdomen….- to theatre
5 patients went to theatre that night.. 3 still waiting.
I spent the night doing or assisting with invasive procedures and investigations… all full resus’s. At the beginning of a shift the nurses draw up all the drugs- morphine, sedation and anaesthetic drugs so they are ready to use. The nurses know there roles but communication can be the challenge! I worked with a experienced trauma unit manager from the private sector who was volunteering for the night…she knew her stuff and very proactive.
One of the surgical professors was on shift all night, in between theatre he was in resus advising, teaching the registrars and interims. The teaching and support is readily there and such a high standard by experienced skilled clinicians.
I did lose count the amount of resus patients but the resus admin book stated 20 in the morning. In the middle of the night more patients attending with stabbings and GSW who lay in the ‘minors’ area, at 5.30 we had run out of space in resus the bays were doubled up to 16 but we had 18 patients so they couldn’t be monitored. There are no curtains in resus so every patient can see each other, the procedures and exposure.
At 6.45 the outside area had a sea of patients on a trolley if there was one or on the floor- with GSW and stabbings, MVAs.
Some of the patients particularly resus patients are not cooperative, they are violent and therefore difficult to treat. I do understand how this volume and presentation wears the healthcare professionals down, most patients have added infectious diseases/HIV- no wonder there is burn out, the risk is heightened in these situations.
One of the other professors arrived with the day team for the 7am shift, the unit was heaving. Jburg Gen had apparently closed – we had to close for the morning at least until the plethora of patients been cleared and managed, although a call came through with GSW… which of course was accepted.
So the trauma ward round commenced, every patient was discussed- then onto the trauma wards and then ICU. Each patient is discussed and managed, the professors set high standards this is heavily implemented or one will be told to ensure good care. The treatment is excellent, this cannot be faulted- centre of excellence. All the teams work hard, the professors, regs and interims work long hours 24hrs plus and more if work is incomplete.
Such a remarkable experience, very hard to even describe what happens weekly for them, this the norm here- violence and active physical consequences- another Saturday night shift here at Bara JHB the staff deal with….
I enjoyed every second of it- after all this is what I love doing. I finally finished at 9.30 after all the rounds… I felt satisfied, elated I can be part of this and help- and welcomed by the Bara staff. By far the best shift and clinical time I have had so far ever!! J
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