Now, after years of collecting such data, Augenstein is working with the auto industry to create a new generation of cars equipped with “black boxes,” much like those in airplanes, that will automatically convey information about the location and severity of a crash to an emergency dispatcher. His vision may sound far-fetched but it’s already been partially realized in some recent car models that offer Advanced Automatic Crash Notification (AACN): When an air bag goes off, the car transmits key information, including the GPS coordinates of the crash, to a telematic provider, who calls 911. Examples of these systems include BMW’s Assist, which Augenstein himself helped develop, and GM’s OnStar.
For a preview of what the most advanced AACN systems on the market can do now, the recent experience of Mike Monticello, a 38-year-old writer for Road & Track magazine, is telling. Last May, he was a passenger during a test-drive of a new BMW luxury sedan when the driver misjudged a curve on a country road just outside Modesto, California. The car flew into a drainage ditch and flipped over several times before finally coming to rest upside down. Miraculously, Monticello had only bruises and minor abrasions, but the driver was unconscious and bleeding badly from the head. As Monticello struggled to help him, the voice of a woman came through the passenger door: “I understand you’ve been in an accident. Are you OK?” Far from being shocked by the disembodied voice, Monticello felt—in his own words—“immensely comforted.” The telematic provider went on to assure him that an ambulance, a fire truck, and the highway patrol were already on the way. The upshot: The driver, who had a concussion and three vertebral fractures, got swift treatment and has made a good recovery. “We could have been in big trouble,” Monticello says. “We were in a rural area where neither of our cell phones worked.”
Given the concentration of talent under Ryder’s roof, the institution is understandably trying to extend the reach of its experts around the globe. Toward that goal, the center is positioning itself at the vanguard of telemedicine—a field that merges telecommunications and robotic technology. According to Antonio Marttos, a young Brazilian surgeon who heads the initiative, the centerpiece in this plan is a $200,000 robot on wheels. It resembles a high-tech upright Hoover mounted with a monitor, video camera, and microphone for two-way communication. From anywhere in the world, the robot can be remotely operated by a doctor seated next to a laptop with a joystick plugged into one of its USB ports. The image on the laptop’s screen portrays what the robot “sees” and the joystick controls the motion of its wheels and the angle of its camera. Funded by the military, Ryder is one of four trauma centers in the country involved in the project.
In the next few months, the Army intends to install these robots in a hospital in Landstuhl, Germany, where severely injured troops are transported for care before being ferried back to the United States. “A specialist could be seated in an office here, and using a laptop and joystick, do ICU rounds in Landstuhl,” Marttos says. The Ryder-based doctor could even roll the robot down the hall to Landstuhl’s operating room, he says, and give advice in real time about how to do a complicated surgery. Or here in the United States, telemedicine could offer rural hospitals far from any trauma center the same expertise. “Essentially,” Marttos says, “it allows us to bring the eyes and ears of our specialists to any place that has the robot.”
As telemedicine illustrates, the most essential ingredient of care is the people who provide it. Ryder is brimming with talented and devoted doctors, but one individual stands out. David Shatz belongs to a rare breed of trauma surgeon whose focus is EMS, or prehospital care. Shatz is a tall, easygoing man with an athletic build and the long, slender fingers of a piano player. He’s also a thrill seeker who loves flying planes and helicopters. And he may be the only trauma surgeon in the country who has done amputations outside the sterile, optimal conditions of a hospital. Just weeks before my visit to Ryder, Shatz was called upon to do a roadside amputation right in Miami itself.
A cement truck had flipped over on one of the city’s busiest highways, pinning the right arm of 17-year-old Leonard Sanchez underneath it. “I know my arm is gone,” Sanchez told the fire and rescue squads that arrived on the scene. “Just cut it off and get me out of here.” After exhausting every option for extricating him, the squads came around to Sanchez’s view, and 20 minutes later, Shatz was flown to the scene. Because it was impossible to get a clear view of the injury in the tight space of the wreckage, the surgeon faced the ultimate handicap: He’d have to do the amputation guided only by touch. “I’m reaching back there,” he says, “and I’m thinking this feels like muscle, this feels like skin, this is a cord that might be a nerve or a blood vessel.”
Just lopping off the arm at the shoulder would have been the easiest thing to do save the trapped teenager. But Shatz knew that every precious inch of the limb he could save would have a huge impact on the young man’s ability to benefit later from a prosthesis. So as he crouched down on the ground to do the operation, he took care to cut as far down the arm as possible. Once the teenager was safely ferried back to Ryder, Shatz kept constant vigil over him, operating on Sanchez six days in a row to keep the stump as clean as possible. “An infection at that stage could have been deadly,” Shatz explains.
The unstinting attention paid off. Not only did Sanchez live, but as this article goes to press, he is meeting with a prosthetic team to be fitted with a state-of-the-art artificial arm that responds to the nerves that activate muscles. “I’ve got high hopes for him,” Shatz says. “Our prosthetic team just showed me a video of a high-arm amputee outfitted with a similar prosthesis and he was tying his shoes the next day.”