When shots rang out at a Tucson grocery store on Jan. 8, 2011, the sound of sirens were not far behind. Eleven victims were rushed that day to southern Arizona's only Level I trauma center, The University of Arizona Medical Center.
All but one of those 11 survived. Nine-year-old Christina-Taylor Green died on the way to the hospital. She was the youngest of six people killed that day.
The mass shooting, which injured former U.S. Rep. Gabrielle Giffords and 12 others, thrust UAMC into the international spotlight, as media from around the globe gathered outside the hospital awaiting news on the congresswoman's condition.
While the hospital and its talented team of surgeons were recognized on a global stage for saving Giffords' life, they have since humbly stressed that they were merely doing their jobs that day.
In an interview with Arizona Public Media producer Tom Kleespie following the shooting, Dr. Peter Rhee, one of the surgeons who treated Giffords, emphasized that the actions taken by UAMC staff on Jan. 8, 2011, were no different than they are on any other day. For this team of highly trained professionals, trauma is routine business.
Rhee – UAMC's chief of trauma, critical care, burns and emergency surgery – made the comments during an interview for the AZPM documentary "Together We Heal," about the tragic Tucson shooting.
But Rhee's sentiments stuck with Kleespie long after that documentary aired in 2012. And they gave him an idea for another project.
That now-finished project – a one-hour documentary called "Level One Trauma" – will air for the first time on Wednesday on PBS 6.
Trauma on film
"Level One Trauma" takes an in-depth look inside UAMC's trauma center – at its staff and daily operations. It features sometimes-graphic footage of caregivers in action and includes interviews with surgeons, doctors, nurses, patients, families and others.
It also includes footage from 911 call centers and ride-alongs with first responders – capturing the life cycle of a trauma from the moment it's called in.
"What made the deepest impression on me throughout the whole 'Level One Trauma' filming was how much every single person involved in the process genuinely cares for each and every patient," said Kleespie, who produced, directed and wrote the documentary.
"The 911 operator answering the initial call, the first responders, the doctors, nurses and specialists all care about each individual person they treat and everyone does everything possible to save each patient," he said.
Rhee, professor and vice chair for clinical affairs in the UA Department of Surgery, has called trauma a "team sport" because of the number of people who work together on every case.
Kleespie and Rhee talked about the trauma center and the new documentary during a "sneak peak" event at UAMC last week, where the audience viewed clips from the new film.
Southern Arizona's only Level I trauma center
UAMC is southern Arizona's only Level I trauma center, and it's the busiest in the state, seeing nearly 5,000 patients a year.
By comparison, Phoenix has six nationally recognized Level I trauma centers. Yet, being the only one for the southern part of the state has its advantages, says Michelle Ziemba, the hospital's associate vice president for perioperative, trauma and emergency services.
"We want a trauma center that stays busy," she said. "When the volume of trauma patients is high, the more you do, and the better you get at what you do."
As the only center of its kind in the region, UAMC plays a vital role. Without it, critically injured patients would have to be transported to Phoenix or to other Tucson hospitals, where expertise in trauma care might vary, Ziemba said.
A trauma center is separate and different from its close partner, the emergency department. While all hospitals are required to have an emergency department, they are not all trauma centers.
Trauma centers see patients with serious injuries, such as multiple skeletal fractures, internal bleeding and brain injuries. The centers can range from Level I – those with the highest level of preparedness to treat traumatic injuries – to Level IV.
Studies show that critically injured patients have a 30 percent higher chance of survival when treated at a Level I trauma center.
To be considered Level I by the American College of Surgeons' Committee on Trauma, a hospital must meet a number of criteria, including having surgeons who are board certified in critical care and having on-call surgical specialists immediately available.
A hospital must be reverified every three years. UAMC is up for reverification this year. A complete list of trauma centers nationwide is available here.
The most common trauma case seen at UAMC is injury from falls, Ziemba said. Following that are car wrecks, pedestrian accidents, and ATV or motorcycle accidents, all of which are considered "blunt" traumas. Meanwhile, injuries from stabbings or shootings fall into the "penetrative" trauma category.
Trauma a relatively new field
Trauma is the leading cause of death among people under age 48, Rhee said, yet the field of trauma surgery is still relatively new.
"In many countries, trauma surgery doesn't exist, so we are the world leaders in this area," said Rhee, who holds the Martin Gluck Endowed Chair in the UA Department of Surgery.
When Rhee arrived at the UA in 2008 he was one of only two trauma surgeons in Tucson, and the city didn't have a nationally verified Level I trauma center.
Rhee, a retired U.S. Navy captain, was charged with building the UAMC program from the ground up, so he got on the phone with colleagues in New York, Los Angeles, Phoenix and elsewhere to ask for help.
The hospital received its Level I certification later that year, and today it has nine trauma surgeons.
Projects like the "Level One" documentary remind the public of the important, lifesaving work that goes on inside these centers every single day.
"Both Dr. Rhee and I feel that it's our obligation as a Level I trauma center to educate the community and partner with the media on projects like this. We're somewhat of a transparent place," Ziemba said.
Added Rhee: "Our field is not well understood, so this is an opportunity to raise community awareness of what we do."
"Level One Trauma" will air on PBS 6 on Wednesday at 8 p.m. and on the UA Channel on Thursday at 7 p.m. It will air again on PBS 6 on Friday at 8 p.m. and on the UA Channel on Saturday at 6 p.m. Plans are in the works to air the documentary in Phoenix and nationally later this year.