NORTH WILDWOOD — Christina Ulbrich knew she had to get her son to the hospital, and she knew time mattered.
A certified nurse, Ulbrich, 26, returned home at about 10:30 p.m. Feb. 25 to find her son, Elijah, unresponsive, his eyes rolled back in his head.
The night of Feb. 25 was the worst of nights for a child to have a major head injury at the shore. Another winter storm had hit North Wildwood and the helicopters that could get a victim quickly to Cooper University Hospital in Camden could not fly.
Ulbrich had no way of knowing it then, but it would take more than five hours before a neurosurgeon would operate, removing part of Elijah’s skull so his injured and swollen brain could expand.
By then, the damage would be done. Much of his brain would be dead. Only the brain stem would be alive, sending basic signals to keep the body breathing.
Elijah was in a coma from that night until Wednesday afternoon when he died. Prosecutors have since charged the man who was watching him, Charles Kane Jr. 35, of the Villas section of Lower Township, with aggravated manslaughter.
In an interview before Elijah died, Christina Ulbrich said she was angry at more than just the man accused of assaulting her child. She was angry that there are no Level I pediatric trauma units at the shore.
“It was a brain injury where every minute counts. Cape May County needs a head trauma unit for children,” said Ulbrich, of East Walnut Avenue in North Wildwood.
A region with summer recreation such as amusement parks, beaches and boating offers plenty of opportunities for pediatric head injuries. For the Ulbrich family, the dead of winter became a bigger problem.
Only Level I center
Cooper University Hospital is the only Level I Trauma Center for children in southern New Jersey and one of only three in the state.
Other hospitals at the shore can stabilize a child, but for major surgery they send patients to Cooper. The trip by ambulance from North Wildwood is more than an hour, but by helicopter it could be sliced to about 20 minutes.
The Regional Trauma Unit at AtlantiCare Regional Medical Center in Atlantic City is one of seven Level II Trauma Centers in New Jersey. It can treat children above the age of 13, but younger children will only get some initial treatment before being transferred to Cooper.
Official reports are unclear on when Elijah was injured, but it was before 10:30 p.m. and possibly nearly an hour earlier.
A number of circumstances complicated the events of that night.
According to Richard Ulbrich, Kane drove Christina and Elijah to the Shell station in North Wildwood, and they waited for a helicopter that never came. Police officers had called for medical help.
Christina said they waited for a helicopter for an hour before paramedics from AtlantiCare Regional Medical Center decided to take Elijah to the Cape Regional Medical Center in Cape May Court House for a CAT scan. Then Elijah was taken by ambulance to Cooper, arriving at 3 a.m. and getting into surgery at 4 a.m.
A helicopter from Cape Regional to Cooper takes about 20 to 25 minutes while an ambulance takes about an hour and 20 minutes to an hour and 25 minutes.
Ulbrich argues Elijah should have been taken directly by ambulance to Cooper, or at least had pressure removed from his swollen brain at Cape Regional or AtlantiCare before going to Cooper.
“It could have made such a difference. Now my 3-year-old baby, who is so beautiful, is lying in bed with only the basic function of a brain stem,” Christina said two weeks ago, when Elijah was in a coma.
“If they cut his skull when he got to Cape Regional he might be aware right now. He might be talking. We’ll never know.”
Ed Koehler, Elijah’s paternal grandfather, who followed the ambulance to Cooper that night with his wife, Donna, and son, Richard, who is Elijah’s father, said his grandson “stroked twice in the ambulance” and had to be revived en route to Cooper.
Timeline of events
A timeline supplied by Cape May County Prosecutor Robert Taylor is close to what Ulbrich remembers, though not an exact match.
Taylor said North Wildwood police were notified 10:59 p.m. and the North Wildwood Fire Department was on the scene at 11:02 p.m. Medics from AtlantiCare arrived at 11:10 p.m.
By 11:35 p.m., it was apparent a helicopter could not fly and a decision was made to go to Cape Regional. Taylor said medics were in contact with doctors. His timeline shows AtlantiCare was talking to Cooper at 11:30 p.m.
“The victim’s condition is deteriorating and due to the distance to a pediatric trauma center the doctor tells the Fire Department to transport the child to the nearest hospital,” Taylor said.
Arrival at Cape Regional was 11:50 p.m., according to Taylor’s timeline, and ground transport to Cooper began 1:15 a.m. with arrival at 2:50 a.m. Christina had said arrival at Cooper was 3 a.m. with surgery at 4 a.m.
In the worst-case scenario, the injury happened around 9:30 p.m. and surgery began more than six hours later.
“If you can’t fly, you go to the nearest emergency room,” said Monica Titus, AtlantiCare’s trauma program director.
Titus said the right decision was made to go to Cape Regional. She noted Cape Regional transferred 150 trauma patients to AtlantiCare in 2009, but would not send a 3-year-old.
“We treat above the age of 13 in our Critical Care Unit. If less than 13, we transfer to Cooper. Cape Regional did the right thing transferring that kid to Cooper,” Titus said.
Medical personnel on scene follow Pediatric Trauma Triage Guidelines to match the patient’s need with the right hospital. The most seriously injured patients are to go to trauma centers, but they can go to other hospitals to be tested or stabilized.
Titus said the system normally moves patients “pretty quickly,” but in this case weather was undoubtedly a factor.
She said another factor in such cases is the time it can take for a family to call 911. In this case, it’s not even clear when Elijah was injured. Was it right after Christina left to do her laundry, or right before she got home?
Upgrade in status?
Titus said AtlantiCare is continually evaluating whether to seek Level I status as the region grows. She said the hospital used to be busy seasonally but now is busy year-round.
Reaching Level I means more staff, such as pediatric cardiologists, neurosurgeons and orthopedic doctors. A Level I is usually a teaching hospital affiliated with a university, which also supplies other services such as rehabilitation and prevention.
The state certifies the different levels and requires a Level I to treat a minimum of 600 trauma patients per year. A Level II must treat 350 trauma cases a year.
Titus said AtlanticCare had 1,908 trauma patients in 2009, but 549 were transferred from other facilities. AtlantiCare, in turn, transferred 45 of the 1,908 patients to other facilities.
“We would need more staff. It’s not a small thing to accomplish. We talk about it and look at it, and know its something we should continue to look at,” Titus said.
Titus did not have figures on how many children are sent to Cooper. Teddy Thomas, executive director of the Ronald McDonald House, which gives out-of-area families a place to stay near the hospital, said his ogranization gets quite a few families from the shore.
Donna Leusner, a spokeswoman for the state Department of Health and Senior Services, said New Jersey’s system was set up 30 years ago. She said it meets standards of the American College of Surgeons, which recertifies the state’s system every three years. The last time was in 2008.
“We relied on the experts to set it up and they came here in 2008 and verified the adequacy of our system. They found New Jersey has an appropriate distribution of trauma centers to ensure high-quality care,” Leusner said.
One key, said Leusner, is having a lot of patients.
“If you come in for brain surgery you want somebody who’s done some volume. You want a doctor with experience in pediatric critical care.”
Leusner could not speak to the Ulbrich case, but she said a Level II center should stabilize major trauma patients and send them to a Level I hospital.
Leusner said the goal is to deliver appropriate and high-quality care “when they need it.”.
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