10 Years On, Surgeons Recount Trauma Response to I-35W Bridge Collapse

During evening rush hour on Aug. 1, 2007, the I-35W Bridge buckled under the weight of slow-moving commuter traffic. More than 100 vehicles dropped at once. Some were left in a heap of concrete and twisted rebar, others sunk into the murky Mississippi. Injured victims were everywhere.

Area hospitals were placed on orange alert, meaning no physicians could leave their posts, ensuring best-possible care for the potential influx of trauma patients.

It wasn’t until Jeffrey Chipman, M.D., acute care surgeon and at the time co-medical director of the University of Minnesota Medical Center operating room, got home in the early evening that he learned of the collapse.

“I arrived and my wife said, ‘good, you’re home! A bridge in Minneapolis fell.’ We turned on the news to get details,” Chipman said. “That’s when I called the hospital. The resident I talked to said I should get there quickly.”

Less than a mile away from the bridge, care teams at the University of Minnesota Medical Center Emergency Department received patients by ambulance, in the back of pick-up trucks and on foot.

The collapsed I-35W bridge in 2007Source: https://flic.kr/p/5EnEii

“Those patients are called the ‘walking wounded’ and they present some additional challenges compared to patients who arrive by ambulance. We need to register them and assess their injuries efficiently,” said Kaysie Banton, MD, assistant professor within the University of Minnesota Medical School’s department of surgery and medical director for the current trauma program at the medical center. “On that day, our care teams had to handle many of these cases.”

Just weeks earlier the medical center formed its trauma program and had begun pursuing trauma verification from the Minnesota Department of Health and the American College of Surgeons (ACS), a time intensive process the led to official level II trauma designation in 2010. Because they had spent so much effort developing the newly minted program, teams were well prepared to treat victims.

While all hospitals have emergency departments, not all hospitals have certified trauma programs. To be recognized by ACS, hospitals must meet stringent criteria. For example, there must be at least one CT scanner and one operating room available at all times. Care teams are also required to have additional training so they can respond quickly to dire injuries.

Still, on the day of the bridge collapse, care teams at the University of Minnesota Medical Center had to think on their feet.

“We were getting piecemeal information about patients and how care teams were responding,” Chipman said. “When we grasped the situation, I stood on a chair in the Emergency Department, then introduced myself as the trauma surgeon and attending physician for the surgical intensive care unit. From there we found our rhythm.”

Patients Saved, Lessons Learned

In a 2008 retrospective study to analyze how area emergency departments handled the mass casualty response, University of Minnesota’s trauma experts found that although hospitals’ capacity were not overwhelmed, there were opportunities to improve communication and patient tracking.

These lessons have informed how trauma experts at University of Minnesota operate their program today.

In the moment, instead of having a single triage physician managing all incoming patients – a practice that is common among trauma protocols – the University of Minnesota team decided to take a team-based approach. Chipman assigned care teams to particular responsibilities, which offered improved efficiency and more comprehensive care.

“I identified two or three trauma teams made of an attending physician or fellow and senior surgical resident, as well as an orthopedic team,” Chipman recounted. “I told them to develop care plans for their patients, then I reviewed and approved every plan with them. No patient was to go to the OR without my approval.”

One trauma team stayed in the emergency department and the other went to manage CT scan images and make disposition plans. After patients went to the scanner they were placed in the radiology recovery area instead of back to the emergency department.

“The main thing I learned was the need for a method to offer immediate and fast registration of those mass casualty patients,” he added.

The trauma program has retained elements of this in-the-moment protocol 10 years on.

Trauma Program ‘Halo Effect’

In laying the ground work for an ACS-certified trauma program – which enhanced the treatment of I-35W Bridge collapse patients – the University of Minnesota Medical Center bolstered all specialties across the hospital, said Greg Beilman, MD, professor within the department of surgery.

“It’s well documented, not just at our hospital, but if there’s a certified trauma program, it creates a ‘halo effect.’ All other areas of care improve because teams automatically work more cohesively and develop efficiencies that benefit patients,” Beilman said.

The team was unstoppable, driven to care for every person who was involved in the collapse if that’s what was needed.
—Jeffrey Chipman, M.D.

For example, since its certification, the trauma team implemented a “massive transfusion protocol” that, when initiated, sets off a chain reaction to help stop a patient from bleeding to death. A recent review showed the protocol benefitted about 60 patients in 2015. Despite having originated during trauma certification, not a single one of the patients it benefitted was considered a trauma patient, which shows the added value of trauma certification.

In the decade since the I-35W Bridge collapse, the University of Minnesota Medical Center has not experienced a similar mass tragedy. The closest situation was a 2014 apartment explosion in the Cedar Riverside neighborhood, when doctors were debating on whether to set in motion their mass trauma processes.

“Although we’ve had some tragic situations in our community that required trauma care, we haven’t seen anything like the bridge collapse,” said Banton. “But we continue to hone our emergency response protocols for a mass casualty event. That preparation is also helping us improve our day-to-day skills. It’s a win-win that helps patients.”

By 9 p.m. that night, emergency management services reported they had transitioned from search and rescue efforts to victim recovery. Save for the walking wounded, trauma teams could focus solely on the patients who were already admitted. All told, nearly 100 patients were taken to area hospitals. University of Minnesota Medical Center, along with Hennepin County Medical Center, treated more than half of those victims.

“I was amazed at the spontaneous response of the medical center staff, many of whom returned to the hospital on their own to help,” Chipman said. “The team was unstoppable, driven to care for every person who was involved in the collapse if that’s what was needed.”