Trauma programs make sure survivors don't feel alone

When Alex Jackson wheels himself into a room, it’s clear he’s far from being handicapped.

Just ask anyone who knows him and has witnessed his effervescent spirit.

Jackson, who’s excited about how the Medical University of South Carolina is expanding its services to help trauma survivors, said it’s important to celebrate Trauma Survivors Day, held nationally May 18. It keeps the millions of people whose lives are touched by trauma from feeling alone, he said.

“Trauma Survivors Day is important because former patients get the chance to see doctors and nurses who helped take care of them. Plus, it's a great opportunity for the survivors to meet others who have been through similar situations. This day helps build relationships that can last a lifetime.”

Jackson is involved with MUSC Health’s Trauma Survivors Network (TSN), which started here last year. In collaboration with the American Trauma Society, MUSC has joined a national network that offers programs and resources to help trauma patients and their families better manage their recovery.

Part of that program allows former patients, such as Jackson, to serve as peer mentors to previous and current patients. Jackson, who had a C5-C6 incomplete spinal cord injury when he was a baby, volunteers as a peer mentor for newly-injured spinal cord patients.

“It's really rewarding to help others return to a sense of normalcy after injury. Since others have helped me along the way, I want to help pay it forward to other patients.”

Following a life-changing trauma, it’s hard for some people to see what their new life can be like. Jackson, who writes the blog, “Tuesday Talk With Alex,” knows the difference a little encouragement can make.

“Even though I was injured at a young age, it hasn't stopped me from living my life to the best of my abilities. I'm grateful I've had the chance to graduate with my B.A. and M.A. in communication from the College of Charleston. I'm employed in my career field, and I appreciate the opportunity to drive my adapted van with a joystick hand control system.”

Researchers are finding out that encouragement is critical.

Ken Ruggiero, Ph.D., is director of MUSC Health’s Trauma Telehealth Resilience and Recovery Program, which started last fall. It’s a clinical service to support the mental health recovery of adults and children following a traumatic injury.

Ruggiero said most acute trauma centers in the nation do not have a clear way to support emotional recovery after serious injury, despite the fact that these patients are known to have a very high risk of developing post traumatic stress disorder and depression.

In six months, TRRP’s staff has met with more than 250 patients who received treatment in MUSC Health’s Level 1 Trauma Center. Nearly all of them agreed to enroll in a 30-day mental health phone screening. When patients tested positive for PTSD or depression during that phone conversation, clinicians offered them counseling options.

“Already, we have enrolled 27 patients in treatment, 21 of whom have preferred home-based telehealth, with 6 preferring to come to the clinic for treatment. Many patients live more than 25 miles away from MUSC or have limited mobility due to their physical injuries, so offering a telehealth option is important.”

Ruggiero said the program is a chance to make a big difference locally, regionally and nationally in the lives of patients affected by traumatic injury. “Programs like this are critical to meeting the mental health needs of these patients, and our team is working hard to create a model of care that is scalable and sustainable.”

To make a program like this work takes a multidisciplinary group that is deeply committed, he said. That team includes Samir Fakhry, M.D., chief of general surgery and a trauma specialist; Keith Borg, M.D., Ph.D., director of the Division of Pediatric Emergency Medicine; and Jimmy McElligott, M.D., medical director of the MUSC Health Center for Telehealth.

Fakhry is one of the driving forces behind enhancing trauma recovery services at MUSC Health through TSN and TRRP. Though he’s a surgeon at heart, he’s pushing to shift the attitudes of health care providers past the acute nature of traumatic injuries. It goes well beyond the physical recovery, he said.

“Level 1 trauma centers increase the chance of survival from major injury by 25 percent,” he said, explaining why achieving that level has been an important goal for MUSC Health. “So strong efforts have been put in in the past 25 years for trauma centers to save patients’ lives. But it’s also become apparent that that’s only the first part of the process, where we have to save a patient’s life and then we have to deal with the consequences that are non-physical.”

That means helping trauma patients cope with life after the hospital as they return to their families and communities, a task MUSC researchers are finding is harder than they thought.

“Because it turns out that the emotional toll of injury is much larger than we thought – than we knew – actually, “ Fakhry said. “So this day is important because it’s there to tell the survivors and their families that there are things we can do to help you recover. We do recognize your emotional, non-physical injury exists. There are things we can do to help you, and you’re not alone.”

MUSC has done two studies in this area. In the more recent one, Whole Assessment of Trauma Recovery, or WATR, clinicians interviewed 100 trauma patients two months after hospital discharge. Forty-nine percent of them had emotional and psychological issues, depression, anxiety and PTSD problems, he said. Fakhry said researchers didn’t know how many patients would want to receive counseling.

“I was overcome by the success of this program. We thought that maybe a few patients would take us up on it. In fact, through the end of March 2016, we’ve approached over 250 patients and the vast majority have agreed to undergo screening 30 days after discharge.  

Even for him, the research has been an eye-opener, he said.

“I didn’t know that so many of them would be willing to talk to us 30 days out. Because it’s hard. It’s a difficult subject,” he said. The studies help clinicians improve on services that should be offered to trauma survivors. “There are hundreds of trauma centers and thousands of hospitals, so we think the next step for us, once we consolidate this program, is that we have the opportunity to be the best practice, to be a national model. We’re definitely ahead of the curve on this subject.”

Fakhry said it also requires a change in the way health care providers see trauma.

“Most acute care practitioners, trauma surgeons included, discharge a patient and feel like that’s it, they’ve done their job or their part. And although there is truth to that, what we’re trying to demonstrate is that you’ve only dealt with part of the problem as a trauma center and a trauma system. As an individual physician you’ve done your job, but if you’re truly a Level 1 trauma center, and you’re a leader of the trauma system, you can’t stop there.”

The goal is prevent people from suffering psychologically after they leave the hospital. In a worst case scenario, depression can lead to suicide.

“One day we’re going to figure out how many suicides in our state are because of PTSD resulting from trauma. The suicide rate in this country is the highest it’s ever been. There are more suicides than deaths from car wrecks, deaths from homicide, deaths from anything in injury. And this may be a way to deal with some of that.”

Having the Trauma Survivors Network program at MUSC Health not only helps patients, but also the providers. Fakhry said the network of peer mentors and support group of families touched by trauma gives doctors insight into how to give better treatment. A lesson he’s learned: Trauma recovery is for life.

“So this is a public awareness campaign. It’s awareness to the providers of the importance of non-physical injury. It’s awareness to patients and their families, that we recognize the issue, and we’re trying to do something to help you, and you’re not alone. And it’s a public awareness campaign for the public at large. And that includes our legislators and the people who decide where our money goes and public policies.”

TSN mentors help patients, but they also help themselves in the process, Fakhry said. “That they’re giving back, they’re helping, I think it reinforces their recovery. I think what TSN will do is allow people to talk to other people who have been through what they’re going through now and hopefully inspire them and put hope back into their lives. They help them find some of the answers they’re looking for."

“And once people do that, it’s the first step toward realigning fear and anxiety to hope, resiliency and optimism.”

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For more information about the Trauma Survivors Network at MUSC, call Regina Creech at 843-792-1068 or email creec@musc.edu.