A trauma center is more than a trauma bay — it's a coordinated system that begins at the scene of an injury and extends through emergency care, surgery, rehabilitation, and recovery. But that system is under new pressure: serious injuries among older adults are rising, and e-bikes and electric scooters are reshaping what shows up in the trauma bay. Peter D'Souza, MD, joins host Matthew Strehlow, MD, to explore how trauma care is adapting. Why geriatric trauma and e-bike and scooter injuries demand new approaches How prehospital care for bleeding and traumatic brain injuries has evolved Why blood products and AI support haven't caught up to the ambulance yet What it takes to earn and maintain trauma center verification How strong partnerships connect each stage of a patient's care
A trauma center is more than a trauma bay — it's a coordinated system that begins at the scene of an injury and extends through emergency care, surgery, rehabilitation, and recovery. But that system is under new pressure: serious injuries among older adults are rising, and e-bikes and electric scooters are reshaping what shows up in the trauma bay. Peter D'Souza, MD, joins host Matthew Strehlow, MD, to explore how trauma care is adapting.
Dr. Peter D'Souza is an associate professor of emergency medicine at Stanford and is board certified in emergency medicine and emergency medical services. He serves as Stanford Emergency Medicine's liaison and lead for the trauma care program and as medical director for several local fire departments. He is a former medical director of Stanford Life Flight and course director for the Stanford EMT training program, with a career focused on strengthening trauma systems, EMS, and prehospital care.
Dr. Matthew Strehlow is a Professor of Emergency Medicine at Stanford and serves as Vice Chair for Innovation and Clinical Improvement. His work focuses on improving patient care through system redesign, global health initiatives, and advancing emergency medicine education.
Dr. Matthew Strehlow: Trauma care doesn't begin when a patient arrives at the emergency department. It begins the moment an injury occurs. Building a high-performing trauma system requires seamless coordination among EMS, hospitals, rehabilitation services, and the community. It's that commitment that defines a trauma center. Today, we're exploring what it takes to build and sustain our national trauma care system. Joining us is Dr. Peter D'Souza, an associate professor of Emergency Medicine at Stanford, who is boarded in both EM and EMS, and whose leadership and educational roles span the prehospital environment, where he serves as medical director for several surrounding fire departments, through our hospital system, where he serves as the department liaison and lead for Stanford's trauma care program. A former medical director of Stanford Life Flight and course director for the Stanford EMT training program, Dr. D'Souza has dedicated much of his career to strengthening trauma systems, EMS, and prehospital care. Peter, welcome.
Dr. Peter D'Souza: Thank you, Matt. It's good to be here.
Dr. Matthew Strehlow: Peter, Stanford recently celebrated the 40th anniversary of achieving trauma center verification. For clinicians who know it's important but aren't familiar with the process, what does it actually take to earn that status?
Dr. Peter D'Souza: When I first arrived at Stanford, I thought it was a given. I still remember showing up to our emergency department, and there was a certificate on the wall that said, "We are an American College of Surgeons Verified Trauma Center," and I thought that was standard. But as I've come to learn, through the process and having gone through six verification visits as the liaison, it takes a lot to get that status. In emergency medicine, we look a lot at what we do for trauma care in the emergency department, our level of activation; the logistics of having blood and equipment ready; who is showing up; and whether the CT scanner is on hold. And that's very important, especially when we think about the golden hour of trauma. But really, to have a trauma center, you have to have a whole system of care, and it involves some of the work that we do in EMS and engagement with our prehospital providers on identification of the right patients, with our local EMS agency to figure out which patients are going to be sent to trauma centers, and then everything that happens after what we see in the trauma bay, which includes the OR, the ICU, the floors, the rehab centers, and the clinics, and connections with the specialists. And so it really takes a whole system of care and input from different people and buy-in, and all coordinated by a trauma program that can see that big picture and know what the trauma patients need.
Dr. Matthew Strehlow: I think this idea of integrating or stitching together the different systems has been one of the big themes and improvements I've seen in care, both nationally and internationally, over the last one to two decades, this idea that we're not going to live in silos. What have you seen regarding our trauma care system that's evolved in a positive direction over the last 10 to 20 years?
Dr. Peter D'Souza: Yeah. I think one of the things is just having some standard criteria for what needs to go to a trauma center. As I grew up in the system here, I learned the criteria that led our EMS providers to bring patients here as opposed to any acute care hospital. And really seeing what it takes at the national level, with the Centers for Disease Control and Prevention releasing criteria for what should go to trauma centers, and these getting constantly revised. And seeing that what is released as national standards gets tweaked, based on your individual system and recognizing local differences. One example I'll give is one criterion was for someone to be designated as a major trauma patient to have a fall over 15 feet. Well, locally, we're fortunate to have three trauma centers right here in Santa Clara County, and we saw that there were some significant injuries from falls of 10 feet. So even though there was sort of this national standard, we made it a little different here and included some more patients who had fallen maybe 12 feet or 14 feet, knowing that they're still staying within the county but going to a different trauma center. So seeing those standards develop, I think, has really helped. I think the other thing is also just what happens at trauma centers and the different services that are available, and how different centers are evolving just to look at the different populations. Geriatric trauma is becoming a bigger piece of the trauma puzzle, and we don't necessarily think of it in the same way we think of penetrating trauma, high-speed vehicle crashes, or falls from a great height. We're seeing a lot of significant traumatic injuries in folks with ground-level falls.
Dr. Matthew Strehlow: I agree. We've seen some great improvements in our geriatric response times and care, and that's been great to watch. I want to pull on that thread, though, because I think a lot of us don't understand trauma guidelines or, you know, how those get put together, whether they're national or local, as well as you do. So where did these guidelines come from? Are they government guidelines? Are they through the Centers for Medicare and Medicaid Services, CMS, or is it something else?
Dr. Peter D'Souza: Yeah. Certainly, the American College of Surgeons has its Committee on Trauma, which I think has really helped set standards throughout. One of the things that I don't think every emergency physician knows is there are both verification and designation processes. So the American College of Surgeons Committee on Trauma lays out its criteria for verification as a level one trauma center, level two, level three, and level four. The local EMS agency also plays a role. At least here in California, these are called LEMSAs. They determine which hospitals are designated to get trauma patients from the field, recognizing not all trauma comes by EMS. But those oftentimes mirror each other, especially in an area like ours. We actually have our EMS agency come when the American College of Surgeons conducts its review, so we complete the verification and designation processes together. I think the American College of Surgeons works with some of these other agencies to revise these guidelines. In 2021, the American College of Surgeons published updated guidelines in the Journal of Trauma and Acute Care Surgery. They were developed by a multidisciplinary group. So the group received funding from the National Highway Traffic Safety Administration, or NHTSA, as well as HRSA. And so it was developed in partnership with the agencies that helped fund it. But the guidelines were spearheaded by Dr. Craig Newgard, an emergency physician, and I think it was a group of emergency physicians, trauma surgeons, and EMS providers, and they designated red for the highest risk of injury and yellow for moderate risk. And they put these guidelines out, and I think for many systems they were in line with what they were already doing. But I think, you know, by releasing these guidelines, it gives every system a chance to pause, look at their criteria, see what's different, see what's changed, and see what they may want to do to change their individual agency, their individual region as far as their approach to trauma and who gets sent to trauma centers.
Dr. Matthew Strehlow: I have heard that recently released guidelines address who can work at these trauma centers and maintain that designation, or at least meet the recommendation. I don't know if it's the verification or the designation. Can you tell us a little bit more about that and what those recommendations say?
Dr. Peter D'Souza: Yeah. I think what you're referring to is, the American College of Surgeons guidelines for level four trauma centers, and so they will verify level one, two, and three trauma centers. And so in that case, trauma centers put together their plan. They reach out to the American College of Surgeons, and then they actually have a site visit, and they get verified. There's not currently a process in which they verify level four trauma centers, but they do release guidelines on what they believe is required to be a level four trauma center, and these guidelines are then often used by local agencies to determine if they want to designate trauma patients to go there. One of the big changes, and this just got released in July of 2026, was these standalone guidelines for level four trauma centers include language stating that there should be an emergency physician staffing these departments. This is a change from before, when it wasn't as specific whether it should be a physician or an APP. But these guidelines were developed by ACS with input from ACEP to really emphasize the importance of emergency physicians and their training and what they see in their training period that allows them to then provide the optimal care for trauma patients. Even if they're not working at a level one trauma center anymore, they've at least gone through that training and have that skill set. One of the things I think one of the things that comes up at a level four trauma center is who are you going to transfer and when are you going to transfer them?
Dr. Matthew Strehlow: Right. I mean, the care of those trauma patients at level four trauma centers, I would say, is probably more difficult oftentimes than it is to be working at a level one trauma center where you've got a lot of resources, partners working with you to take care of those patients. Talk to me a little bit about the system level. So that's what's in the emergency department, but we know that being a level one trauma center requires more than just having a great emergency department and having trauma surgeons available. It requires engagement with the community, it requires engagement with EMS, and it requires stitching this all together. Tell us a little bit more about the other activities required of a level one trauma center.
Dr. Peter D'Souza: Yeah, that's a great question, because as I said, we focus a lot on the emergency department, and until I started doing this work with our trauma service, I was just focused on what are we doing in that first 15 minutes, first hour in the emergency department. One of the strengths of our program is just our engagement with our local EMS providers. I think it helps that we have a section of EMS and prehospital care within our Department of Emergency Medicine and EMS-boarded physicians who are engaged. But I think one of the things that we do is help reach out and provide education on recognition of trauma and treatment of traumatic injuries. And our trauma program and our trauma surgeons are also very engaged and have been working with our local EMS agency. So for example, last year, when there were some updates to trauma triage, the local EMS agency actually engaged the trauma surgeons to do some videos that were provided in the annual EMS training update. And this year, our group's going to be involved in those as well. And so I think it helps for the field providers to learn from the folks who are taking care of these patients why it's important to recognize and some of the key steps that they can be doing in the field.
Dr. Matthew Strehlow: Now, you've been engaging from the prehospital community to the emergency department through the rest of the healthcare system here, and you've watched this evolution, and I was wondering if you can talk about the specific patients who now receive different or better care in the last ten to twenty years beyond the geriatric group? You know, what are we doing differently? And then what do you think's going to happen differently in the next ten years? Is it going to be we're all going to have AI robot EMTs, or is it going to be, you know, prehospital blood? Like, where do you think things are heading? So where have things changed, and where are they heading?
Dr. Peter D'Souza: Yeah, for sure. I would say in the prehospital setting, one of the changes that I've seen since I first started doing this is really changing our approach in terms of volume resuscitation. When I completed ATLS 23 years ago, you know, it was start two large-bore IVs and give two liters of crystalloid, and that was to everybody. And that's what we taught our EMS personnel too, right? And then over time we realized, oh, it's not great to give everybody two liters of saline. In fact, for most patients, it is detrimental, and it can contribute to further blood loss and acidosis. And we've brought that now to the prehospital field, so we're teaching about smaller boluses, monitoring blood pressure. I think another thing that I've seen that's been emphasized in-hospital and now also prehospital is care for traumatic brain injury patients. And so I feel like, you know, when I started, the attitude was simply, "That is a bad brain injury, and nature will do its thing", and you'll know in 6 to 12 months whether there's anything further that can be done. And I think, you know, looking at the prehospital, there's been a lot of work, and Dr. Dan Spaite out of Arizona gives these great talks about avoiding the H-bombs in TBI, so avoiding hypoxia, avoiding hypotension, and avoiding hyperventilation, and realizing that focusing on these things, which you can do prehospital. So you don't have to have an ICP bolt in order to evaluate these things. So, you know, that group really looked at what can the prehospital providers do to improve the ultimate outcome and the recognition that there is the primary brain injury, but in that golden hour, you know, we're thinking a lot about preventing ongoing blood loss and tourniquets and other things. There are things you can be doing in that initial phase, even before they get to the hospital, that can help prevent secondary brain injury, tissue hypoxia, sort of that ischemic penumbra around injury, and things like that. So I think that's really changed. It mirrors, you know, some of what we do in-hospital now. We'll see folks getting EVDs and intracranial bolts in the emergency department to really help do that. They're doing brain oxygen sensors as well. And so I think that along the spectrum, looking at TBI and what can be done to minimize the secondary effects of that have been really helpful, and I think it helps engage the prehospital providers who recognize they're in a unique environment where there's limited things that they can do, and giving them things to focus on has been really helpful.
Dr. Matthew Strehlow: On my last pediatric emergency department shift, I think I saw, like, four kids that struck their head on electric scooters or electric bikes and didn't have helmets on. Avoiding those H-bombs is probably going to only become more important, and I'm glad we're able to extend things that, you know, have been a nice advancement, in our emergency department care into that prehospital arena.
Dr. Peter D'Souza: Definitely. And that actually leads me back to one of the things you were talking about earlier and what trauma centers see and how they can engage communities. I think one of the things that we've seen in our emergency department, and what our trauma surgeons are seeing, are injuries from these e-bikes, these e-scooters. And it's tough, I think, because my boys are a little younger, so we haven't had that discussion, but I was talking to one of our colleagues whose son's in high school and really wanted an e-bike, and he had to talk to him about helmet use. And you know what we're seeing here, and we were just on vacation in San Diego, I saw it there too, is just people tearing down the street. The rules are really loose. So I'll see what appear to be teenagers on these bikes that are intermittently acting like pedestrians on sidewalks, acting like bicycles in the bike lane, acting like motorcycles just tearing through traffic, popping wheelies. It gives me angst. But we're seeing some of the downstream effects, some of which are just the motors on these bikes are heavy. So Dr. Forrester, our trauma medical director, was just talking about the increase in lower-extremity trauma because they fall over, and people are getting bad tibial fractures, a lot more traumatic brain injury, and people aren't wearing helmets like they should.
Dr. Matthew Strehlow: No, they're not. I've seen that too. You know, I live at the top of a mile-and-a-half-long hill, and my kids go to high school at the bottom of the hill, my two younger ones, and they told me recently that these e-bikes have limitations on how fast they can go. Apparently, on YouTube it's very easy for them to actually disconnect that, and that's how these kids are zipping down that hill at 40 miles an hour without helmets all the time.
Dr. Peter D'Souza: Oh, yes. Well, I live halfway between you and that high school, and I see it, and there are times when my heart rate goes up and my blood pressure goes up just seeing them zipping and cutting off, you know, cars. And you'll see kids just on the back standing and getting a ride with their friends, and I'm thinking, you know, that's sort of that youthful ignorance of like, "Oh yeah, everything's fine." But you and I live in the world where we see the people for whom it's not fine.
Dr. Matthew Strehlow: So back to the second part of my question then. These EMS personnel that are out there, what's going to change in their practice in the next 10 years? Where are the big changes?
Dr. Peter D'Souza: I think it ties to some of the things that have been going on in terms of dealing with hemorrhage and hemorrhage control in the field. And, you know, we live in an area where we see more blunt trauma than penetrating trauma. But I remember when I first learned trauma, it was like tourniquets were a last resort, try and avoid them. And now in EMS we've really moved towards a tourniquet first if it looks like really bad extremity bleeding. Another area, although it is a little controversial, the use of pelvic circumferential compression devices or pelvic binders. We have deployed them in our county and did a recent push on education, and I do think that's where it's helpful to have some engaged EMS physicians out there educating the providers on which patients should and should not receive them. So I think that's helped. But I really think kind of the next step in what's being deployed sort of throughout the country and being studied is the use of prehospital blood. I think there's still a lot of questions about the right blood product if you're going to have it, and this is one of those things where we sometimes think, "Well, this works in our ORs, let's put it in our ED. It works in our ED, let's put it out in the field." In general, earlier is better. I mean, we have blood. There's a reason we have what we call the blood bucket at Stanford, but there's a reason we have somebody show up with blood products any time we get an alert of our highest level trauma. And I think, you know, in the field, it's still being studied. I think there are definitely logistics, and the big thing is you don't want blood products to go to waste. And so it's very different than just, "Oh, you know, we had this amiodarone, we didn't use it. We're just going to chuck it and get a new thing of amiodarone." We really don't want to be doing that with our blood products. So the logistics are much more complex. There are startup costs with equipment in terms of keeping it at the right temperature, tracking it, figuring out the deployment models. Is this really something you need on every first-in fire engine? Is this something on every ambulance? Is it something just with the supervisors? So I think every system has different logistical issues about it, but I do think there's real potential. And I think, you know, to highlight it, I went to a talk at the NAMSP conference with some folks from New Orleans EMS. And I forget the exact title, but it was basically, like, decreasing the homicide rate, and they were just saying that patients with penetrating trauma. They see a lot more penetrating trauma than we do, and the fact that they were able to give them blood earlier meant there was a higher number of folks surviving. And I think that's really powerful. You and I both worked at busy urban trauma centers with much more penetrating trauma when we were residents, and it's really hard when you see the downstream effects of that and you're starting behind the eight ball. There's nothing further you can do to resuscitate and get a good outcome. And that's really hard. It's really hard to see that and live with like, "Well, what could I do? What could we do differently?" So I think for an area like New Orleans to see the potential for that and say it's leading to better outcomes, I think that is a powerful thing for EMS providers who otherwise may feel they are arriving too late. And there's definitely the world of primary prevention and other things, but when those injuries happen, it is a powerful tool to give EMS clinicians.
Dr. Matthew Strehlow: I appreciate both your skepticism and your optimism. You are saying, "Maybe we should be giving blood. It makes sense, and there is some data for it, but let's think carefully about it," because there are potential downside risks. The Red Cross recently said we have a blood shortage. I think that's a great way to introduce new care practices, new technologies. One of the technologies that I'm involved with globally is the introduction of an AI-based clinical decision support tool for prehospital care providers. However, their training and adherence to protocols is probably not that strong compared to the training our prehospital care providers have in the U.S. What are your thoughts on the introduction of AI-based support tools for our providers here?
Dr. Peter D'Souza: Certainly, our EMS clinicians are protocol-driven, so they have to have a working impression and then go off that in terms of what they're going to do. Some of it is just having a handy reference. Back in the day, they used to have a protocol book. Now there's apps and things like that, but sometimes it's just a PDF, and the app is just helping you reference the PDF. Some people really like the algorithmic approach and having a tool that lets you follow an algorithm, and prompts you to indicate whether the blood pressure is normal. If it's not normal, it's going to eliminate all that other stuff. If you're looking at a PDF and you do the wrong branch point or you look away to go pull up a medication and you come back amid a chaotic scene and return to a different section that's very similar-looking, you may get off-track. So I think there is an opportunity there to do that in real time. I think the other issue, when I mentioned going to get a medication, one of the things I really try and tell our ED residents and ED nurses is that, for much ALS care, there is a single paramedic who's responsible for figuring out what medication to give, drawing it up, at times having to do bedside compounding and administering it. Add pediatric care, in which they now have to do weight-based dosing. There is a lot of potential for error. Some tools are emerging to address that and could help minimize how much you have to step away from, "Hey, I am providing care. Do I really need to focus this much on preparing the medication?" Then return to the patient. I think that can really help decrease the cognitive load, especially in those high-intensity situations if there were some tools that allowed you to make sure that you were giving the right medication for this indication at the right time in the protocol.
Dr. Matthew Strehlow: That's a great area. I'm always so impressed by our prehospital care providers. I think we critique their work and just as people downstream of us critique our work. I was unfortunately resuscitating a patient on the beach a couple weeks ago, and the prehospital care providers arrived and were incredible, and at some point, you know, they're like, "Hey, doc, you're coming with us to the hospital." And, you know, my kid was still out in the ocean and I said, "Well, actually, I don't think I'm doing that much. You've got this. You're following best practices on every step of the way." And, you know, me sitting there was not going to change their care from loading to the arrival at the facility. So that's looking at the future of potentially the care of individual patients. Is there anything around regionalization or other workforce models that you think might change at the system level in our trauma care systems in the future?
Dr. Peter D'Souza: Yeah. I mean, I think one of the things is really just the viability of trauma centers. I mentioned we have three in our county. We actually had one close, and then it got bought by a different organization and kind of reintroduced as a trauma center. But I think that's tough, especially for some of the smaller hospitals that are a level three or level four. A whole community that loses access to a trauma center if one of those closes. So I think that's difficult. As the evolution of trauma care progresses, I do think that there are going to be the quaternary care centers that receive certain trauma patients. We're a level one. We still get transfers in from other level one trauma centers for certain things like complex orthopedic injuries and aortic injuries. We don't see them through the emergency department because they're generally ICU to ICU transfers. But through my work with the trauma QI committee, I'm able to learn about these cases and realize that even within trauma care and specialty trauma care and subspecialty trauma care, there are certain injuries that are best treated at particular centers. One example I'll give, and this is really a great story from the trauma survivors reunion. So in conjunction with the celebration of our 40 years as a trauma center, there was a trauma survivors reunion, which our trauma program puts together every few years. There was a man who got up to speak and share his story, and he started with, "Here's a picture of me going for a bike ride on Page Mill Road." And even though I wasn't there the day he came in, I instantly knew who it was. His story involved a really bad lung injury and ended up having to be placed on ECMO. And I felt very fortunate that he had ended up here because there are not a lot of level one trauma centers that also have a CV ICU with teams that can cannulate patients for ECMO right away. And when his lung injury progressed to the point where they couldn't oxygenate him, they were able to do that. And I think that is something that some trauma centers will develop, while others will establish agreements governing when they need to transfer to another trauma center for things like that.
Dr. Matthew Strehlow: Yeah, we are really blessed to work in a place where those sorts of care practices are available, the expertise to carry them out, and the resources to carry them out are available. I was reading earlier this week about cuts to Medicaid funding, and the dramatic cuts to Medicaid funding that are happening, and how those are going to increase over the next decade. How do our trauma care systems get funded? I know that we hear a lot about closures of level three and level four trauma centers and emergency departments in rural and more remote areas. How does the funding work for hospitals and trauma centers in rural and remote areas?
Dr. Peter D'Souza: That is definitely a challenge. You know, one of the reasons these hospitals are closing is for financial reasons. It depends a little bit on the state. So in California, there's a Maddy Fund, which was started in the '80s, and the California legislature has to renew it and extend it, although it sometimes gets reduced. It is a fund driven by fines and penalties. If you get a speeding ticket, a portion of what you pay beyond the base fine will go towards the Maddy Fund to reimburse hospitals and trauma centers for care. There's also kind of a carve-out for pediatrics. Those are always, you know, threatened. We've been fortunate to get them renewed, but there's also just been cuts in federal funding. The people who do trauma care really care about the patients and the care and trying to make it equitable. You know, when you arrive as a trauma patient, you should get the best care. Yeah. And I think that is harder to do as funds get cut. What it ends up impacting are some of the other services you can provide, including prevention and how much you can dedicate to that. It just gets harder to do when you're really just trying to keep the lights on and make sure you have the money for equipment and personnel.
Dr. Matthew Strehlow: We're a level one pediatric trauma center too, and I know how scarce those are. And so you really think about the equitable care of children across the country. How can that be done in a setting where we don't have the resources even in areas that are highly resourced to have equitable pediatric trauma care?
Dr. Peter D'Souza: Pediatrics is definitely a big one. I mean, we are the only hospital that is a level one adult and level one pediatric trauma center in this region. It is hard to have that full level of specialists. If you look, there are different criteria, as you might imagine, for the level one adult and level one pediatric trauma centers, and just having that whole spectrum of pediatric specialists, both surgical and non-surgical, it's hard to maintain.
Dr. Matthew Strehlow: And I remember when we became a level one pediatric trauma center, and we were going through that process, how much coordination it required across our pediatric surgeons and the trauma surgeons and the critical care physicians. What are things that emergency medicine doctors can do to engage with the broader trauma system and other providers?
Dr. Peter D'Souza: Yeah. During my first two verification visits, I would say it was more reactive in the sense that the trauma program would reach out and say, "Here's what we need from the emergency medicine liaison," and it would be a checklist, and I would just kind of work on the checklist and deliver it. We would meet the standard. And I think over time, it became more active. For example, we look at the emergency department phase of care in our trauma quality program, and I oftentimes didn't know until the meeting what was being discussed. I took that frustration of like, "Hey, I'm showing up to this meeting and might get surprised about why did the emergency department do this?" I made my role more active. So it kind of grew over time to like, "Send me the cases. What are the specific things we're looking at?" I'm really lucky to have our quality expert, Dr. Gharahbaghian, working with me on that. We're able to actually enter the meetings having already looked at the EM phase of care through the lens of an EM doc. We're really lucky that our trauma program manager, Chris Gallegos, I'm always afraid to say her name because I don't want anyone to poach her, but she is fantastic. Her background as a medic and then a nurse and her knowledge of kind of, you know, the whole trauma program has been great. She knows exactly what criteria are needed. Being proactive also really helps with, you know, "What do you need? What can I help you with?" That helps strengthen our relationship. We have a really strong relationship between emergency medicine and trauma here, and I think knowing people, knowing what they need, knowing how they work all matter. It is kind of like what we do on shift sometimes, which is like, "Hey, I'm going to call this specialist. I know they're going to need this," or, "I'm going to prep the patient by using these same terms that I think they're going to use," really helps make it a smoother experience. You know, when we're in the clinical world, it makes it a smoother experience for our patients, and I think when we're looking at the system, it just makes it a smoother experience for the trauma program manager who really has to get everything lined up if we're already aligned, as opposed to me presenting something that would create extra work for her to view it through a different lens.
Dr. Matthew Strehlow: Well, it's great to see that partnership, the genuine partnership you have helped build. I know that we've both worked at trauma centers where it was an us versus them sort of adversarial mentality. That obviously was a while ago, and we'd do the trauma M&Ms that were really finger-pointing sessions. And you've helped be a part of that growth and evolution to this equal partnership, patient-focused system that we live in now within Stanford. And so looking back on your career, was there a moment that made you feel like you were truly part of something bigger than yourself?
Dr. Peter D'Souza: A recent case comes to mind. A young woman with a traumatic injury was resuscitated by an excellent medic, and I heard about it through a few different avenues. One was the medic, who asked, "Can you tell me how this person is doing?" I also heard about it from a colleague during one of our mentoring meetings. He was the physician who had received the patient. I was sharing how pleased I was with some training I had done on pelvic binding, and he said, "I was on shift, and they did such a great job." Then I saw the case from the trauma side through our quality-improvement review. I heard how she did, learned that she had several complicated surgeries but made it to rehabilitation, and was able to take that information back to the medic who first treated her. It was a meaningful way to see the different hats I wear, which can often feel very siloed. Here I am as an EMS clinician teaching paramedics. Here I am as an ED physician receiving patients in the emergency department. And here I am listening to everything that happens after that first hour, through hospital day 60. It was gratifying to know that I played some role in all those phases of care for a patient whom I never met.
Dr. Matthew Strehlow: It sounds like one of those movies, where they take all the different angles of a single event. And then you watch the movie, and then it all merges together at the end. You're like, "Oh, that's how it's all tied together." Your life is a movie. We like to end on a lighter note, Peter, and I know that you have done a lot of, you know, on-the-field work. And by field, I mean, you've been at Super Bowls working, you've been at a lot of NFL games. You were recently working the World Cup on the grass there, real grass, I think, at least, at Levi's Stadium. Tell us, is there anything from those experiences that really stands out?
Dr. Peter D'Souza: Yeah, I mean, I think probably some recency bias, but the World Cup was just a really different event, and it was exciting to be kind of engaged. There was a lot of training that happened ahead of time in preparation, and I learned a little bit about how FIFA approaches things, realizing it's actually people from all across the world, and they want the same hand signals, level of preparation, same operational procedures for folks from different countries, for matches that happen across different countries. So it was really impressive to see that level of organization. And then just being there felt different. I was fortunate to spend many years with the 49ers, and even got to travel with them one year and go to different stadiums and see the excitement. But the World Cup just felt different. Seeing a mass of people walking down the street to walk into the stadium together, and it just felt different. And I was fortunate to be on the pitch for a match. There are not nearly as many people at field level for a FIFA match as there are for an NFL game. It was special to be among those select few and see the game happening right in front of me. And then I think the final thing, I wasn't on the pitch for it, but I got to be at the knockout-round match that the U.S. played here, see them win a knockout round match and be, you know, out on the pitch after hearing them sing Take Me Home, Country Roads, and it was something I will remember forever, and it was a nice perk of the job.
Dr. Matthew Strehlow: Yeah, I heard great things about that from every fan that was there, and they just said it was incredible. I was thinking it probably would be difficult, though, to be on the sidelines of that because, how do you know when to run out onto the pitch? 'Cause those guys are rolling around like they got killed half the time.
Dr. Peter D'Souza: The referee knows, and the referee will give you the signal of, "Hey, get over here." That tells you whether someone actually has a broken leg or maybe just a small bruise.
Dr. Matthew Strehlow: Okay. Yeah. Good. Good. Well, that's a wrap for today's episode. I want to thank Dr. D'Souza for his time, insight, and expertise, and on a personal note, for all the energy and effort you've put into our trauma program. If you liked today's episode, don't forget to subscribe, leave a review, and share it with a colleague. And as always, we want to hear from you. Send us your questions, ideas, or feedback at the link in the description. Thanks for tuning in. We'll see you next time. Until then, keep taking care of anyone with anything at any time.