University Hospital Becomes a Level I Pediatric Trauma Center: A major milestone for South Texas and the care of seriously injured children

Tuesday, October 4, 2016

Bethany Coomes was about to step through the back door of her Universal City home just as the flash enveloped her 7-year-old daughter Stella in the backyard. Her 13-year-old son, who was fond of creating experiments — “the day before it was cornstarch and water,” Bethany says — was constructing a flaming moat in the backyard, pouring rubbing alcohol into a bowl and lighting it with a grill lighter.

Dr. Lillian Liao performs surgery on a young patient.

The flame instead shot up the stream of alcohol and ignited the bottle, badly burning Stella’s face, chest, arms, torso and thighs.

“I couldn’t stop it, it was so instantaneous,” Bethany says. “The only thing I could think of was ‘Stop, Drop and Roll,’” — the recommended method for extinguishing a person on fire. “But it didn’t work. The alcohol kept burning.” They finally put out the flames with a garden hose.

Stella was rushed to University Hospital, where she underwent a series of surgeries and skin grafts for second- and third-degree burns. After two-and-a-half weeks, she was discharged to continue the long process of recovery, therapy and rehabilitation. Today, she’s resumed most normal activities — including swimming at a special summer camp for burn patients.

On June 30, the Coomes family returned to University Hospital to help celebrate a major milestone, both for the hospital and the entire region. The American College of Surgeons Committee on Trauma verified the hospital as only the fifth Level I pediatric trauma center in Texas, and the only one outside Dallas, Houston or Austin. The pediatric trauma center also includes the only pediatric burn program in South Texas.

University Hospital has long been a major Level I trauma center, providing care for seriously injured patients of all ages throughout a vast, 22-county region of South Texas with its physician partners at The University of Texas Health Science Center at San Antonio. But with a growing emphasis on pediatrics, the hospital in 2012 sought and earned the designation of a Level II pediatric trauma center — the first in South Texas — and has been working toward Level I pediatric status ever since.

All that work has come at a time when the demand for pediatric trauma care has grown rapidly. The number of seriously injured children treated at University Hospital has risen steadily by 78 percent since 2010 — a product of being located in one of the fastest-growing regions of the country.

Lillian Liao, MD, Pediatric Trauma and Burn Program Director at University Hospital, often reminds people that injuries are the biggest killer of children and the main reason they are rushed to a hospital emergency room.

That’s why a first-class pediatric trauma center is vital for a community if it is to offer great medical care for kids, says Dr. Liao, Assistant Professor of Surgery at the UT Health Science Center.

Stella Coomes (left) and her younger sister Darla with Dr. Lillian Liao.

“Kids are different from adults,” Dr. Liao says. “Children have a different physiology and anatomical differences that make their injuries different than older patients. But also, a huge part of pediatric trauma care is their psychosocial care. And we’re one of the few places in the country that incorporates post-traumatic stress evaluation as part of trauma care.”

A child psychiatrist, Donna Roybal, MD, Assistant Professor of Psychiatry at the UT Health Science Center, works with seriously injured children suffering from post-traumatic stress disorder, or PTSD. The hospital’s Child Life staff also works with young patients to calm fears and reduce stress.

Organized Around the Optimal Care for Injured Kids

A pediatric trauma center is organized around the optimal care for injured children. CT scans, for example, are pre-calibrated to minimize radiation to children based on their size. The same is true for pain management. And with the high volume of injured kids, “we recognize serious injuries sooner that might appear subtle, because we see rare cases more often as a specialized hospital,” Dr. Liao says.

From left: Jenny Oliver, RN, Pediatric Trauma; Amanda Loquas, RN, FNP-BC, Pediatric Trauma; Anh Dinh, MD, Pediatric Critical Care; Izabela Tarasiewicz, MD, Pediatric Neurosurgeon; Lillian Liao, MD, MPH, Pediatric Trauma and Burn Program Director.

The trauma team is family focused. Car crashes are a leading cause of serious injury and often involve entire families. Having a Level I adult trauma center and Level I pediatric trauma center in the same facility means that families won’t be separated during hospitalization.

As a Level I pediatric trauma center, University Hospital joins an elite group of centers across the country that improves quality by developing pediatric trauma treatment protocols for all hospitals, Dr. Liao says. The hospital is already a national leader in adult trauma care. In fact, San Antonio has long been a hub of trauma research, trauma system development and training, working closely with the San Antonio Military Medical Center’s Level I trauma center (which only treats adults).

Ronald Stewart, MD, a trauma surgeon and Chair of the Department of Surgery at the UT Health Science Center, is Chair of the American College of Surgeons’ Committee on Trauma, which sets standards for trauma care nationally. Dr. Stewart also founded the National Trauma Institute, an independent nonprofit based in San Antonio that supports and advocates for trauma research and prevention.

Ronald Stewart, MD, a trauma surgeon and Chair of the Department of Surgery at University Health System and the UT Health Science Center, speaks at the news conference announcing University Hospital’s becoming a Level I Pediatric Trauma Center.

Injured patients from throughout South Texas are brought to University Hospital through MEDCOM, a San Antonio-based communications center that facilitates more than 500 critical trauma transfer requests each month. MEDCOM is staffed around the clock to connect physicians at regional hospitals with trauma surgeons in San Antonio.

Once they arrive, patients are met by a wide range of subspecialists that Level I trauma centers are required to have available in-house, around the clock. That includes orthopedic surgery, neurosurgery, anesthesiology, pediatric critical care, emergency medicine, radiology, internal medicine, plastic surgery, and oral and maxillofacial surgery.

While a Level I or II pediatric trauma center must be capable of providing high-level care to badly injured children at any hour, a Level I center requires much more — including faster response times, a greater emphasis on research and a leadership role in trauma care nationally.

University Health System has long had an active injury prevention program that goes into schools to educate kids about risky behaviors such as impaired driving and texting and driving. In the community, the trauma team has worked to raise awareness about the dangers of leaving children in hot cars, swim safety, concussion education and more. For the past two years, University Health System has sponsored free summer swimming lessons to kids throughout the city. It has provided hundreds of free infant and booster seats to families and taught them how to install them properly.

High school students sign a pledge not to text and drive as part of University Health System’s Drive Now, Text L8R program.

“Not only do we lead in care of the injured, but we are leader in the region for outreach and education of the public on how to prevent injuries in the first place,” says Dr. Liao, who also holds a master’s degree in public health.

A Level I pediatric trauma center is also required to be a referral source for nearby regions, provide continuing education of trauma team members, incorporate a comprehensive quality assessment program, operate an organized teaching and research effort to help direct new innovations in trauma care, maintain a program for substance abuse screening and patient intervention, and meet minimum requirements for an annual volume of severely injured patients.

All of those resources pay off in improved outcomes. A number of research studies have found that younger and more seriously injured children have better outcomes at a pediatric trauma center, which is staffed by specially trained physicians and nurses and provides appropriate resuscitation equipment and medications, special protocols for imaging and other diagnostic procedures, and special pain management guidelines.

Advanced Technology for the Care of Trauma Patients

The trauma program is located in the million-square-foot Sky Tower at University Hospital, which opened in 2014. The new, technologically advanced tower includes an expanded, dedicated Trauma Resuscitation Unit with separate bays for adults and children that can manage up to 30 patients at a time. The trauma program has its own ambulance entrance within the hospital’s larger, new Emergency Department.

University Hospital’s Sky Tower

With more surgical capacity, the tower has a dedicated operating room for trauma and emergency patients at any hour. Like all of the new surgical suites, it includes multiple, high-resolution video displays and touch-screen controls so that the surgical team can view X-rays, live images of the surgical field, lab results and patient records all at once. Another state-of-the-art hybrid operating room can be used to perform multimodal surgical care of the injured patient.

A new 30-bed trauma ICU is equipped with the latest technology. And the inpatient trauma unit consists of all private rooms.

Two board-certified UT Medicine trauma-critical care surgeons and their team members are on-site at all times, working alongside dedicated trauma nursing staff and other members of the trauma team. University Hospital has added a number of ancillary staff to the trauma team to handle the added requirements of a Level I pediatric trauma center. A child needing emergency surgery can be in the operating room within minutes of arrival at the hospital.

“You cannot predict when trauma will affect your life,” Dr. Liao says. “What you can count on is our University Health System trauma team to be here ready to treat the injured people of San Antonio and South Texas 24 hours a day, seven days a week.”

For more information about the Level I pediatric trauma center at University Hospital, please visit