In the critical hour after a life-threatening injury, trauma centers can make a life and death difference in helping patients survive.

From the early days when emergency departments began to focus equipment and expertise to treat the most severe injuries, trauma centers were designed to bring together all the resources necessary to deliver the most effective treatment at a time when every moment counts.

However, there was still one design problem that could cost precious time--if the patient was a child. Most trauma centers were geared for adults.

Children, however, come in many different sizes from newborns to teenagers. Much of the equipment needed to care for them comes in a range of sizes. Dosages of medications are different and vary by weight. Even vital signs and responses can be different.

Recognizing those differences led to the development of pediatric trauma centers.

"During the mid-1980s, there were only a few pediatric trauma centers in the largest cities. Our new surgeon-in-chief, Dr. Keith Georgeson, made building a trauma center for Children's Hospital of Alabama one of his top priorities," Trauma Coordinator Geni Smith, RN, said.

In the 30 years since Smith moved from head nurse of the emergency department to trauma coordinator, almost 11,000 children have been treated in the Children's Hospital trauma center.

"We had been treating traumatic injuries in the emergency department, but after the first trauma room opened in the summer of 1986, it helped us shorten the time in the ED so we could get patients to surgery or to other care they needed faster," Smith said.

Georgeson spearheaded the effort to build the trauma team and develop protocols for rapid resuscitation and care. The room was equipped with a specially designed stretcher that allowed x-rays to be taken without moving the child to a radiologic table. All equipment and supplies needed to stabilize the patient were placed in a systematic order around the stretcher, and the trauma room was directly connected by phone to all key departments so care could be coordinated from a central location.

Smith has seen the center grow from one trauma room that alerted team members by beeper when incoming cases were on their way to four trauma rooms capable of caring for multiple patients if the need arises as it did during two severe tornado outbreaks.

"After the April 2011 tornadoes, 61 trauma patients came in, and 60 of them survived," Smith said. "That night and the following day proved how much our trauma and care teams and support staff could achieve by working together."

From across the state, eastern Mississippi and western Georgia, patients arrive by helicopter and ambulance at the first and only pediatric trauma center and the only freestanding state-designated Level 1 Trauma Center in Alabama.

"We're part of the Alabama Trauma System, which allows first responders to activate the appropriate resources and transport mechanisms needed to expedite transfer of the patient to Children's," Smith said.

"When a patient arrives, the principles of dealing with a pediatric trauma--maintaining the airway, fluids, and other essential--are the same, but almost everything else is different. So much depends on body size, weight and height. We have multiple sizes of some equipment, and a range of different dosages of medications are immediately accessible. And it's a big help to have pediatric specialists in so many disciplines right at hand and ready to step in when needed."

There is also a slight difference in the type of injuries likely to come through the doors of a pediatric trauma center.

"Adult trauma centers tend to see more penetrating injuries," Smith said. "Blunt force injuries are probably the most common trauma we see. Child safety seats, booster seats and bike helmets have helped, but we still see too many children severely injured in vehicle accidents. Injuries from ATV accidents have increased, and this year, we're also seeing more gunshot wounds. There was a spike in the 90s and then the numbers came down, but gun injuries are up again."

For children who are discovering their world, there are always risks of falls, burns and a range of hazards. It is reassuring for parents to know the trauma center at Children's is here.

"Over the past 30 years, I've seen the trauma center grow," Smith said. "There is a new helicopter pad, advances in technology, improvements in diagnostic equipment and imaging--but the one constant is teamwork. Our people pull together, combining their expertise to save children's lives."