TRAUMAUPDATE News from the Trauma Center at Bryan Medical Center

SUMMER 2014

Joshua and Paula Hopping of Hartington were enjoying a nice afternoon by a Lincoln-area pool with their five children when the unimaginable happened. In just a few minutes they found their

3 year-old son, Ty, floating face downin the swimming pool, blue and unre-sponsive.

Upon the arrival of Lincoln Fire and Rescue Engine 4 and the EMS supervi-sor, CPR was in progress. Shortly after CPR was initiated, Ty began to have signs of life. Engine 4 was assisted by members of Engine 8. Ty was transport-ed to the Bryan West Campus Trauma Center via Lincoln Fire and Rescue Medic 6.

Ty was considered a Level I trauma. When he arrived at the trauma center, the entire trauma team was waiting for him and at his disposal. Dr. Reginald Burton stated, when Ty arrived, the child’s pupils were fixed and dilated, which indicated severe neurological injury. The trauma team immediately began the protocol for therapeutic hy-pothermia and began to pack Ty’s body in ice.

After 24 hours of hypothermia therapy, Ty slowly began to regain consciousness. He remained hospital-ized for the next couple of days and was soon playing catch in the hallway with Dr. Burton.

According to the Centers for Disease and Control Prevention about 10 people die every day from unintentional drown-ing. Of these, two are children under the age of 14. Drowning ranks fifth among the leading causes of unintentional inju-ry death in the United States.

Seconds count — learn CPR. CPR

performed by bystanders has been shown to save lives and improve out-comes in drowning victims. The more quickly CPR is started, the better chance of survival.

For tips on water safety, please visit the Centers for Disease Control and Pre-vention website at www.cdc.gov. n

Happy ending for 3-year-old after near drowning

Ty Hopping was all smiles while chatting with his parents, Joshua and Paula Hopping of Hartington, during a news conference on the day he left Bryan Medical Center.

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For more than 30 years, the trauma program at Bryan Medical Center has focused on performance improve-ment and quality outcomes.

In 2013, the Bryan Trauma Center began participating in the American College of Surgeons Trauma Quality Improvement Program (TQIP). This voluntary program is used by more than 200 trauma centers across the country. TQIP provides risk adjusted benchmarking of designated/verified trauma centers to track outcomes and help improve patient care.

The system uses infrastructure of the National Trauma Data Bank to collect valid and reliable data, pro-vide feedback to participating trau-ma centers and identify institutional characteristics that are associated with improved outcomes.

Bryan Trauma Center is one of only two trauma centers in Nebraska that are participating in TQIP. Did you know:n The Bryan Trauma Center is one of the highest volume trauma centers in Nebraska.n Bryan Trauma Center’s mortality rate is well below the national average.n The Bryan Trauma Center’s Average Patient Injury Severity Score is consistent with the national average.

Bryan Trauma Center puts quality first

AgriSafe Program:

FARM INJURY PREVENTION

Summer in Nebraska equates to long hours of entire fami-lies working on farms. Farm machinery is a major source of injury, and farm machin-

ery injuries affect people in nearly all decades of life ( Jawa RS, et al).

At Bryan Medical Center, we see nearly 100 farm-related traumas each year. Antelope Memorial Hospital, a member of the Bryan Health Critical Access Hospital Network, is leading the way in injury prevention. This hospital in Neligh has implemented a new AgriSafe Program as a pilot location through a UNMC College of Public Health grant.

Merry Sprout, RN, director of nursing at Antelope Memorial Hospital, says, “I have been an RN for many years in a rural hospital, and I’ve seen a variety of farm-related injuries in the ER. They ranged from minor cuts, a limb amputation when caught in an auger, to the death of a teenager crushed by steel cattle gates. In a small community, these patients are your friends, neighbors and even family.

“As an ER nurse who is also a farm wife, more than once I’ve had a moment of panic wondering if the boots rolling out of the ambulance belong to my house!”

One of her co-workers lived through that scenario last fall.

“As charge nurse, she received a call that a man was critically injured in a 4-wheeler accident on a rural road when going to move cattle,” Sprout says. “EMS diverted him to another hospital that was equal distance because they knew it was her husband. He unfortunately died later, and this hit our entire staff hard, as many have family in some type of agricultural career.

“I think we all realized how easily this could of been one of us, and the loss affected so many in the community.

One of the EMTs responding had been a best friend since childhood. Small com-munities have very few to respond to 911 calls, and it can be a struggle to put emotion aside when caring for a friend or family member.”

Neligh’s safety officer, Carol Andersen, APRN, completed the AgriSafe Program and is now an AgriS-afe provider. She says a bin engulfment demo during training brought back a lot of hurt and emotion.

“My brother-in-law was only 30 when he died in a bin engulfment acci-dent,” Andersen says. “Merry mentioned how the loss of our nurse’s husband affected the entire staff. Accidents such as these can take down a whole farming operation, so it is important we get the message out about safety.

“Our hospital has made a commit-ment to provide these AgriSafe services to our community agricultural produc-ers — farmers, their families and those associated with agriculture.”

Andersen notes, “We have had five health fairs since January to include implement dealers Greenline, Reinke’s Farm Service and Kayton International of Neligh, an FFA program with Elgin Public Schools and the Elgin Q125 celebration.

“We are very excited about this program and will move into other areas, such as farm safety visits, or we may focus on pesticide exposure, injury pre-vention or other health promotion proj-ects. We are excited to be able to work with other community entities, such as CON Northern Division, CVA, Schools and local implement dealers.”

Farm injury management education is available to rural hospitals and EMS through the Trauma Services Education Program from Bryan. Please contact heather.talbott@bryanhealth.org about available programs. n

Megan Reid, APRNOriginally from Topeka, Kan.,

Megan is a graduate of Washburn University in Topeka. Before starting at Bryan, Megan worked as a critical care staff nurse in Topeka, Kan., and a cardiovascular critical care travel nurse in Las Vegas. Megan lives in Lincoln and is looking forward to get-ting a puppy someday soon. Outside of work, Megan enjoys triathlons, running, biking and staying active.

Jennifer Middlekauff, BSN, RN,trauma performance improvement registered nurse

Originally from Lincoln, Jennifer is a graduate of the University of Nebraska Medical Center. Before joining the Bryan Trauma Program, she was a staff nurse in a neuro/trau-ma intensive care unit at UCLA in Los Angeles. Jennifer lives in Lincoln with her husband, Nick, and their son, Wyatt.

Contact Jennifer at 402-481-4145, or email jennifer.middlekauff@bryanhealth.org.

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Heather Talbott, MSN, RN,trauma outreach and injury prevention coordinator

Originally from Summerfield, Kan., Heather is a graduate from the Bryan College of Health Sciences who recently graduated from Nebraska Wesleyan University with her MSN. Heather worked in the neuro/trauma ICU at Bryan and recently served as clinical manager of the neuroscience unit at Bryan West Campus. Heather

lives in Firth, Neb., with her husband, Ben, and their children, Carlie and Cael. For Outreach and Injury Prevention informa-tion, Heather can be contacted at 402-481-4087 or at heather.talbott@Bryanhealth.org.

Julie Walcutt, MD, trauma surgeon

Dr. Julie Walcutt of Gretna, Neb., is associated with Nebraska Trauma and Acute Care Surgery.

She earned a B.A. in Biology in 2004 from Washington University in Saint Louis, where she received her medical degree in 2008.

Dr. Walcutt completed a general surgery residency at the University of Texas Southwestern Medical Center in Dallas and a surgical critical carefellowship at the University of Missouri-Columbia before joining the medical staff at Bryan.

Welcome new faces Bryan Trauma Team adds four

These courses are in the Conference Center at Bryan West Campus, unless noted otherwise.

ATLS — March 12 and 13.ATLS — July 30 and 31.ATLS — Oct. 1 and 2, Location TBD.ATLS Refresher only — Nov. 13.

Advanced Trauma Course for Nurses — The March 12 and 13 session is full, but you may register for Advanced Trauma Course for Nurses — July 30 and 31 course.

TNCC — April 13 and 14.TNCC — Nov. 2 and 3.

ENPC — March 24 and 25.ENPC — Oct. 21 and 22.

Trauma Grand Rounds — Fourth Friday of every month except July, September, November and December.

2015 Trauma Symposium — Sept. 25.

Information about these courses can be found at bryanhealth.csod.com/LMS/catalog/Welcome.aspx.

For additional questions, contact Trauma Outreach and Injury Prevention Coordinator Heather Talbott at 402-481-4087.

Sign up for these 2015 Trauma Courses

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Paramedics Jeff Hays (left), Phillip Oelschlager, Jay Beavers and (not pictured) Troy Peterson and James Yost work with Dr. Amy Vertin (right) in the ALS Intercept Program.

By adding a paramedic, care ad-vances to include sedating patients, securing airways, stopping seizures, starting IVs and administering medica-tions. A paramedic from the ALS Inter-cept Program is able to obtain EKGs (an electronic tracing of the heart), interpret them and send the readings ahead to the hospital, providing vital information before the patient arrives.

“Great patient care is always pro-vided, but the ALS intercept just takes it to the next level by being able to meet additional patient needs,” paramedic Jay Beavers says. “Working with the local squads is awesome. When I arrive at the scene or climb onto their ambulance, they have a full report ready, so I can do what is needed for the patient immedi-ately.”

Unique program The collaboration makes the pro-

gram unique — the first and only one of its kind in the state. It pairs at least one

of the medical center’s five paramed-ics with rescue squads in surrounding areas. While the squads continue to provide ambulance services, the para-medics travel in the emergency vehicle funded by Saline County. The arrange-ment makes CAMC the first Nebraska medical center to provide ALS intercept services as a non-transporting agency.

For medical calls in Crete, the para-medic usually meets the rescue squad at the scene with a bag of equipment and medications typically needed in the first 30 minutes of an emergency. For calls from some outlying communities, the paramedic may arrange to meet the squad and begin providing advanced care at that point.

Most small towns have volunteer rescue squads of emergency medical technicians. The minimum training to become an EMT in Nebraska is around 180 hours, while training for paramed-ics requires about 2,000 hours. With a 2,000-hour time commitment, para-

medic training often means moving to Lincoln, Omaha and other urban areas where more employment is available. The ALS Intercept Program provides new opportunities, right at home.

Saving precious minutes Meanwhile, the Saline County Board

of Commissioners says this is proving to be a worthwhile expenditure.

“This was a medical service we could provide for the entire county, a small investment for a huge service. And the response from the rescue de-partments has been very positive,” says Commissioner Willis Luedke.

In only a few short weeks, the pro-gram has shown its value. Now, para-medics are able to deliver the level of care needed within the critical “golden hour” — the period with the highest likelihood that prompt medical treat-ment will prevent death. Bringing ALS to the scene often saves precious time.

“For example, we can do an EKG in a patient’s living room now rather than having to wait to do that testing until we can get to a hospital — we bring the hospital to them in a sense and make them comfortable,” Phillip adds.

“Saving precious minutes is what the new ALS Inter-cept Program is all about.” n

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CAMC paramedics (light blue shirts) from the new ALS Intercept Program travel to emergency scenes to assist rescue squads from Crete, DeWitt, Dorchester, Friend and Wilber. The unique collaboration brings advanced life support to communities surrounding Crete.

At 3 a.m. on a mid-December night shift, a 911 call tones out over the radio at the Crete Area Medical Center (CAMC):

“Wilber resident unconscious in bed-room.”

Local volunteer rescue squad members rush from homes to the ambulance; at the same time, paramedic Phillip Oelschlager gathers his gear, rushes out of the medical center and drives a shiny white CAMC emergency vehicle to the scene. Upon arriving, he works with the rescue squad to stabilize the patient and begin an IV.

Minutes pass agonizingly slow when you are injured and in need of pain medications that local volunteer rescue squads are unable to give. Every second counts when dealing with a trauma or heart attack. That 3 a.m. call was the opening run of the Advanced Life Sup-port (ALS) Intercept Program, a quiet

kickoff to a new level of emergency care in Saline County spurred from the desire to respond more quickly and effectively.

“About three years ago, we started diving into the idea of really expanding our paramedic services and working with area rescue squads to improve outcomes. We found that ALS intercepts are a great tool in rural emergency care systems,” says Amy Vertin, MD, Emer-gency Department medical director and the ALS Intercept Program director.

“There are a lot of small communi-ties in our area without the capabilities to staff and support full paramedic am-bulances. Even if they had the money to pay for all of the equipment and training needed for paramedics, they may not have the call volume needed to keep the paramedics busy and their skills sharp.

“That’s why consolidating the paramedics and sharing them among services in smaller surrounding areas makes sense. The community volunteers respond as an initial stabilization, and

a faster, more mobile unit with higher skills runs out to meet them. It’s a tiered response system.”

Paramedics provide ALSSpecifically, the program sends

CAMC paramedics on potentially time-sensitive rescue calls to provide Ad-vanced Life Support in conjunction with Basic Life Support provided by rescue squads from Crete, Wilber, Dorchester, DeWitt and Friend.

“We have very dedicated rescue squads who are doing everything they can for their communities, and they do a fantastic job,” says Phillip, one of the two full-time paramedics at CAMC who took the lead in getting the program off the ground.

The scope of medical procedures that local rescue squads can do before getting to the hospital is limited to procedures such as supplying oxygen, splinting fractures, administering CPR and controlling bleeding.

ALS Intercept Program

Primed to save lives in Crete area

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Paramedics Jeff Hays (left), Phillip Oelschlager, Jay Beavers and (not pictured) Troy Peterson and James Yost work with Dr. Amy Vertin (right) in the ALS Intercept Program.

By adding a paramedic, care ad-vances to include sedating patients, securing airways, stopping seizures, starting IVs and administering medica-tions. A paramedic from the ALS Inter-cept Program is able to obtain EKGs (an electronic tracing of the heart), interpret them and send the readings ahead to the hospital, providing vital information before the patient arrives.

“Great patient care is always provid-ed, but the ALS intercept just takes it to the next level by being able to meet additional patient needs,” paramedic Jay Beavers says. “Working with the local squads is awesome. When I arrive at the scene or climb onto their ambulance, they have a full report ready, so I can do what is needed for the patient immedi-ately.”

Unique program The collaboration makes the pro-

gram unique — the first and only one of its kind in the state. It pairs at least one

of the medical center’s five paramed-ics with rescue squads in surrounding areas. While the squads continue to provide ambulance services, the para-medics travel in the emergency vehicle funded by Saline County. The arrange-ment makes CAMC the first Nebraska medical center to provide ALS intercept services as a non-transporting agency.

For medical calls in Crete, the para-medic usually meets the rescue squad at the scene with a bag of equipment and medications typically needed in the first 30 minutes of an emergency. For calls from some outlying communities, the paramedic may arrange to meet the squad and begin providing advanced care at that point.

Most small towns have volunteer rescue squads of emergency medical technicians. The minimum training to become an EMT in Nebraska is around 180 hours, while training for paramed-ics requires about 2,000 hours. With a 2,000-hour time commitment, para-

medic training often means moving to Lincoln, Omaha and other urban areas where more employment is available. The ALS Intercept Program provides new opportunities, right at home.

Saving precious minutes Meanwhile, the Saline County Board

of Commissioners says this is proving to be a worthwhile expenditure.

“This was a medical service we could provide for the entire county, a small investment for a huge service. And the response from the rescue de-partments has been very positive,” says Commissioner Willis Luedke.

In only a few short weeks, the pro-gram has shown its value. Now, para-medics are able to deliver the level of care needed within the critical “golden hour” — the period with the highest likelihood that prompt medical treat-ment will prevent death. Bringing ALS to the scene often saves precious time.

“For example, we can do an EKG in a patient’s living room now rather than having to wait to do that testing until we can get to a hospital — we bring the hospital to them in a sense and make them comfortable,” Phillip adds.

“Saving precious minutes is what the new ALS Inter-cept Program is all about.” n

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The National Association of EMS Physicians and American College of Surgeons Committee on Trauma produced this Position Statement of use of the long backboard for trauma patients.

• Benefit of long backboards is largely unproven.

• The long backboard can induce pain, agitation, respiratory compromise and pressure ulcers.

• Utilization of backboards for spinal immobilization during transport should be judicious so the benefits outweigh the risks.

• Appropriate patients to immobilize with long board:

o Blunt trauma and altered level of consciousness,o Spinal pain or tenderness,o Neurological complaint (numbness or motor weakness),o Anatomic deformity of spine,o High energy mechanism and:

Drugs or alcohol intoxication. Inability to communicate.Distracting injuries.

• Patients for whom immobilization is not necessary:o GCS 15, normal level of consciousness,o No spine tenderness or anatomic abnormality,o No neurological findings or complaints,o No distracting injury,o No intoxication.

• Patients with penetrating injuries to the head, neck or torso with no evidence of spine injury should not be immobilized.

• Spine precautions can be maintained by application of a rigid cervical collar and securing the patient firmly to the EMS stretcher and may be most appropriate for the following patients:

o Found ambulatory on scene.o Transported for protracted time or inter-facility transfers.o Patients for whom backboard is not indicated.

• Whether or not a long board is used attention to spinal precautions in high risk patients is paramount. (Application of cervical collar, adequate security to stretcher, minimal movement w/ transfers, mainte-nance of inline stabilization.)

• Education for EMS should include evaluation of the risk of spinal injury.

• Protocols or plan to promote judicious use of long backboards during pre-hospital care should engage as many key stakeholders from the trauma and EMS system.

• Patients should be removed from backboards as soon as practical in an emergency department.

Resource: Position Statement: EMS Spinal Precautions and the Use of the Long Backboard, National Association of EMS Physcians (approved Dec. 17, 2012) and the American College of Surgeons Committee on Trauma (approved Oct. 30, 2012).

Here are new guidelinesfor using long backboards

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Celebration salutes survivors and heroes who saved them

Wall-to-wall courage and dedication were on display as caregivers were recognized at Bryan’s annual Tribute to Trauma Champions at the Rococo Theatre in Lincoln.

Reginald Burton, MD, (above left) presented the 2014 Trauma Directors Award to Ed Mlinek, MD, during the April 24 event.

Rodney Krogh (in center of Photo No. 1) and Cindy Renner (center, No. 2) pose with their families and their first responders — Lincoln Fire & Rescue representatives and a Lincoln Police officer with Rodney and Hickman Fire & Rescue and others with Cindy.

We recognized trauma survivors Rodney Krogh of Lincoln and Cindy Renner of Hickman and honored the dedicated professionals

from throughout the statewide trauma system involved in saving their lives. To hear their remarkable stories, go to bryanhealth.org/trauma-champions-2014.

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TRIBUTE TO TRAUMA CHAMPIONS

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the editor at 402-481-8674. Trauma Update also

is available at bryanhealth.com/traumacenter.

Kimberly Russel, President and CEO, Bryan

Health; John Woodrich, President and COO, Bryan

Medical Center; Edgar Bumanis, Director of Public

Relations; Paul Hadley, Editor

TRAUMAUPDATEBryan West Campus2300 S. 16th St., Lincoln, NE 68502-3704

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Save the date for the 2014 Bryan Trauma Sympo-sium! This year’s symposium is Friday, Sept. 19, in the conference center at the Bryan West Campus.

Packed with expert speakers, this year’s symposium will have something for every discipline, from the rural rescue squad to the primary care physician.

This event will feature nationally recognized speaker Dr. Bryan Cotton from the Center for Translational Inju-ry Research in Houston. He is an associate professor of surgery at the University of Texas Health Science Center, Houston. Dr. Cotton will present on the use of Thrombo- elastometry in Trauma and Prehospital Management of Penetrating Trauma.

Other highlights of this year’s event will be a two-hour didactic simulation and skills session which will feature simulation devices from The Center for Excellence in Clinical Simulation, which is a collaborative partnership among Southeast Community College, Bryan College of

Health Sciences and Bryan Medical Center.Dr. Amy Vertin will provide an update on Rural Trauma

Care. Dr. Ronald Kirschner will discuss Drugs of Abuse in the Trauma Population, and Dr. Reginald Burton, Bryan trauma medical director and Dr. Stanley Okosun, Bryan

trauma surgeon will present an exciting case review and update on current trends in trauma care.

Registration deadline for the symposium is Sept. 15, 2014. Reg-ister online at bryanhealth.org — select Professional Education. n

For more information, contact Bryan Trauma Program Manager Robbie Dumond, RN, by calling 402-481-5150, or email robbie.dumond@bryanhealth.org.

Dr. Bryan Cotton: Keynote speaker at Trauma Symposium Sept. 19

Bryan Cotton, MD

If you would like to be added to the Trauma Update mailing list, call Trauma Outreach and Injury Prevention Coordinator Heather Talbott at 402-481-4087, or email her at heather.talbott@bryanhealth.org.