Saving lives — it’s what the University Medical Center (UMC) Trauma Center is all about. Day after day people suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds arrive by ambulance, often barely clinging to life.
Under the direction of Dr. John Fildes, who is now serving as dean of the UNLV School of Medicine, the center has had a remarkable record. National Trauma Data Bank statistics reveal that of those who arrive alive at Nevada’s only Level 1 trauma center — where many have less than a 1 percent chance to live — 96 percent survive and are discharged.
Dr. Douglas Fraser, who in 2015 completed the Acute Care Surgical Care Fellowship in Las Vegas prior to becoming a trauma surgeon at UMC, became the center's director in November, the first new leader the center has had in 23 years. “We are a leader in the nation in trauma care and we will continue to do so with our talented staff,” said Fraser.
The UNLV School of Medicine division chief for acute care surgery & burn surgery, as well as the medical school’s Acute Care Surgery Fellowship program director, Fraser also serves as a key figure in the Tactical Emergency Medical Support Unit for the Metropolitan Police Department’s SWAT teams. Whenever SWAT teams are deployed in Las Vegas, so is a tactical rescue vehicle containing a physician and medic.
Working Under Pressure
“I have found over the years that I work best under pressure,” said the surgeon, who as a child growing up in Southern California thought he’d pursue a career as a fireman. “I need the adrenalin rush to perform at my highest level.”
At a UMC luncheon for trauma survivors, Fraser was honored for his work with 14-year-old Janeen Hinden and her mother’s fiancé, Stephen Picardi. Both were critically wounded. The teen nearly bled to death from damage to her femoral artery, the main artery of the upper leg and abdomen. Wounds of this type are often fatal because an individual can entirely bleed out within five minutes. But Fraser managed to tie it off.
Early reports were that the gunshot trauma to Picardi’s legs was so severe he’d lose use of one of them. Hours of surgery by Fraser saved his leg.
Janeen Hinden, the teen’s mother and Picardi’s fiancée, told the Las Vegas Review-Journal why the pair survived. “I know Stephen and Janeen are alive today because of Dr. Fraser. He’s not only talented; he’s gifted.”
A Born Life-Saver
Even as a 9-year-old boy, Fraser wanted to save lives. “I used to hose down our house pretending it was on fire,” he told the Review-Journal. “My mother didn’t like that because I flooded her planters and killed her plants.”
At 6 foot 4 inches and 270 pounds, Fraser was a high school football standout and played at the University of Notre Dame, but found he didn’t have the instinct required to be a star at the highest levels of the game. He wanted to help people, not hurt them.
“I really only played football because of my size,” said the surgeon who quit Notre Dame’s team to concentrate on his grades for medical school and to become a commissioned member of the Notre Dame Fire Department while he was in school. “I’m still the only Notre Dame student to ever do that...I’d go out on all kinds of calls. I was also trained as a paramedic.”
It was while he was doing his residency in surgery at Rutgers University that Fraser realized what his life’s work would be. “I found there was no one better. I wanted to do surgery all day and all night. I still feel the same way. I have a passion for helping people when they need it most.”
Fraser, whose research has appeared in publications ranging from the Journal of the American Medical Association to the American Journal of Surgery, is also making a name for himself as a teacher.
Trauma surgeon Dr. Allison McNickle, who completed the Acute Care Surgery Fellowship in 2018 prior to beginning work as an UMC trauma surgeon and as an UNLV assistant professor of surgery, calls Fraser her mentor. “He sets very high standards for himself and for fellows. He pushes you to be your best. He challenges you. He’s not afraid to tell you that you could do better...if there’s a specific course somewhere that he thinks could help you, he’ll send you to it.”
Fraser said he noticed in the first few months of her training that McNickle could become an exceptional trauma surgeon. “I feel like I notice everything to a fault. She’s very purposeful, laser-focused. She thrives in the operating room. She’s very fast and smooth. She doesn’t have to do things over again. She’s the kind of surgeon we want to keep here.”
Organizing the Chaos
Quick to point out that success in trauma care can only come with medical professionals working as a team — there are frequently more than a dozen people working on one case — Fraser says trauma nurses, residents, medical students, fellows, anesthesiologists, respiratory therapists, X-ray technicians, and blood bank lab technicians all understand what they must do.
“When the trauma pagers go off, we are required to attend to a patient that can be very sick and have multiple things going wrong with them all at once. To an observer, a trauma resuscitation can seem like chaos. However, we all have assigned jobs and each person is designated to one specific thing for that patient. The job of the trauma surgeon is to organize what appears to be chaos and make sure that the patient is getting everything done in a rapid fashion for the best possible outcome. The trauma surgeon can make all the difference if the right things are done in the right order in the right amount of time.”
In the wake of the Oct. 1, 2017, mass shooting on the Strip that killed 58 people and wounded 413, Fraser said one of the lessons he’s learned over the years working in trauma is that you see the worst of the worst. “You can’t always save everybody. You have to shake it off, compartmentalize, and move on to the next patient. The next person depends on you. You can’t dwell on something that’s happened because that wouldn’t be fair to the next person.”
Talking to the loved ones of someone who didn’t make it is never easy. Dr. Fraser said that when relatives learn that their family member was so severely injured that they didn’t suffer at the hospital, many find that reassuring. “And I have to remind young surgeons who feel awful that a patient died that they weren’t the ones driving drunk or the guy who pulled the trigger.”
Fraser said he feels fortunate to have so many people committed to saving lives working at the trauma center. “It’s a real privilege to be leading individuals with one common goal. As far as I’m concerned, I’m working with the best nurses in the country when it comes to trauma care. Both Dr. Paul Chestovich, chief of trauma research, and Dr. Deborah Kuhls, director of the trauma intensive care unit as well as an incredible researcher, do tremendous things with their leadership. Dr. Syed Saquib is doing an amazing job as director of the burn center so I can concentrate on trauma. I could go on and on. Trauma care is really team care.”
To this day, Fraser’s antics as a boy still provoke laughter. It was in elementary school that he convinced his 5-year-old sister, Laura, to throw her beloved Care Bears to the ground from a second-floor balcony. Why? So he could practice bringing them to safety in case a stranger came along and threw them to the ground.
After the Care Bears hit the ground, Fraser rigged a rope from the balcony’s railing and then ran downstairs and put the bears in a laundry basket. Next, he attached the rope to the basket and pulled the bears to safety, to the squealing delight of his sister, who had quickly stopped crying.
“I practiced my technique on her Care Bears more than once,” Fraser said, laughing. “I guess I knew early on that much of success is in the planning.”