Every minute counts: How the Emergency Children’s Surgery and Traumatology Institute works

Every minute counts: How the Emergency Children’s Surgery and Traumatology Institute works
In 2003, the Emergency Children’s Surgery and Traumatology Research Institute opened in Moscow. Mos.ru visited the clinic to learn more about it.

There is a special building located in the heart of Moscow, on Bolshaya Polyanka Street: seven floors above the ground, four underground floors and a helicopter pad on the roof. There is a small arch with a well-known emblem, a dove with a red cross, at the entrance. This is the Research Institute of Emergency Children’s Surgery and Traumatology. This October it marks its 15th anniversary.

Despite this seemingly young age, the institute’s history, or pre-history, goes well into the past, to the 19th century.

“We celebrate 15 of the 122 years of our institute’s history. It goes back into the past. Initially, it was the Iviron Sisters of Charity hospital, and later, in the 1930s, a children’s hospital opened here, whose doctors were famous all across the country,” said the institute’s President Leonid Roshal, PhD in Medicine.

Leonid Roshal, PhD in Medicine, President of the Emergency Children’s Surgery and Traumatology Research Institute.

The institute constantly carries out research: the staff writes theses and develops new methods to treat serious traumas and their consequences for the youngest patients.

“Our status as a research institute implies that we carry out research and serve as a scientific base. We are currently conducting about 50 research projects. Over 15 years, we have defended almost twenty theses, with six of them being doctoral theses,” added Deputy Director for Science Olga Karasyova.

Theory and life

Still, the doctors say that at the institute, the science is intertwined with practice. Each year they see over 90,000 children and 15,000 more are sent for hospitalisation here.

“We have managed to create remarkable conditions for the children and their parents. There is no institute like ours in Russia or anywhere in the world, nor in the Soviet Union. Today every third child in Moscow with a head injury is sent to us for hospitalisation. We have made a contribution to the development of children’s surgery in the capital; we have changed the approach to treating children’s traumas. Our equipment can be compared with any clinic in the world, and we will match it,” Leonid Roshal said.

The staff uses the most advanced equipment and methods. For example, most operations are carried out using keyhole surgery. This method allows operating on a patient without large incisions, which makes the recovery process much easier.

“Children’s surgery is moving to keyhole surgery, and today, for example, we do almost 100 percent of acute abdomen related surgery with this method. There may be one or two cases per year when open surgery is used. We use the same method in traumatology: over 300 keyhole surgeries on joints a year,” noted the institute’s Director Valery Mitish.

Doctors also use the most advanced materials. For example, the trauma surgeons do not use metallic screws that must be removed after recovery; they use biodegradable fasteners to mend broken bones. They completely dissolve as soon as the bones are fixed. This means at least one less surgery.

One-minute transfer

Patients arrive at the institute by land and also by air. Patients who are not in serious conditions (when a child is stable) are sent to the admissions. After that they are examined, X-rayed and sent to a specialised department. This is routine.

But there also are more serious cases, especially for numerous injuries, for example, after a car crash or fall from high up. These are called polytraumas.

In these cases, every second counts. Doctors carry out the initial examination at the entrance or the helicopter pad and then transfer the child to a special room, a shock ward, where they normalise blood pressure if necessary and connect them to a medical ventilator: they do everything possible to stabilise the situation.

“In some emergency cases we can even operate there: the room has all the necessary equipment, including shadowless lamps,” says Head of ER Andrei Nikonov. And adds: “It is good that we haven’t had to use it.”

After stabilisation, it is time for a deep X-ray scan, followed by the operation table, resuscitation unit and recovering in the ward. The distance from the ER to the first point of this medical conveyor line only takes one minute. One minute is needed to carry a stretcher from one door to the other.

During rehabilitation

While doctors work with a child patient, another team is working with the parents. They are not allowed into the room while the first aid is being provided to the little patient for safety reasons.

A nurse accompanies the parents of a patient in serious condition to the admissions counter and helps fill in all the necessary papers. Then psychologists from the rehabilitation centre step in.

“We begin to work with the family right after accepting the child into intensive care. The parents may be in shock; they are disoriented. And we prepare them for the fact that there will be no quick recovery after intensive care. Recovery is always a long-distance run,” noted First Deputy Director, Head of the Rehabilitation Department Svetlana Valiullina.

This department was established in 2011. Several years before that, when the institute’s team was complete, there was the matter of treating children after a serious trauma. Back then, Russian medicine mostly used medical fitness and physical procedures, which was not as effective.

According to the doctors, the new Rehabilitation Department was a real breakthrough. They begin to restore a patient’s lost functions right in the first 24 hours after intensive care, and continue to do this at each stage of rehabilitation.

They use X-ray diagnostics and then create an individual programme. Rehabilitation specialists, psychologists, physiologists and speech therapists also join the process.

Over 3,600 children pass through the rehabilitation process each year.

It is also very important for the entire family to take part in the treatment. Training sessions for this are held with parents.

Limitless

In addition to Moscow’s children, patients from other cities and even countries also come here. Moreover, if there is a disaster somewhere, doctors are sent to help. For example, children’s surgeons and trauma specialists worked in Indonesia, Nepal and Haiti during earthquakes and aided victims of the fire at the home for the deaf-mute children in Makhachkala.

The team has responded to almost 30 missions to hotspots and disaster areas in total.

Today the Emergency Children’s Surgery and Traumatology Research Institute is a centre where children are provided with diagnostic, medical and rehabilitation help. The neurosurgical department alone conducts some 900 brain surgeries per year; neurosurgeons treat over 4,000 children per year in total.

This year, the institute plans to begin to transplant liver and kidneys.

“We need to keep developing all the time. Children’s surgery, children’s trauma and all children’s surgical areas need to be especially precise, because children must live long and healthy lives. The quality of their lives depends on our treatment,” Valery Mitish said.

Apparently, no one at the institute is prepared to argue.