TRAUMAUPDATE News from the Trauma Center at Bryan Medical Center

WINTER 2015

According to the National Trauma Institute, trauma is the leading cause of death for ages 1-46. Nebraska’s State-wide Trauma System is a net-

work of definitive care facilities that provide a spectrum of care for all injured patients. It is essential to the development of a trauma care system to have designated trauma care facilities (DHHS Nebraska, 2014).

The goal is to create an integrated system of health care providers and facil-ities throughout Nebraska to match each patient’s needs to the resources of the facilities, from activation of the Emergency Medical Services system until their return home.

Bryan Health commends these Nebras-ka Trauma Designated Hospitals for their dedication to their communities and the Statewide Trauma System.

Annie Jeffrey Memorial County Health Center, Osceola; Avera Creighton Hospital, Creighton; Avera St. Anthony’s, O’Neill; Box Butte General Hospital, Alliance; Brown County Hospital, Ainsworth; Chadron Community Hospital, Chadron; Chase County Community Hospital, Imperial; Cherry County Hospital, Valentine; CHI Health Creighton University Medical Center, Omaha; Children’s Hospital and Medical Center, Omaha; Columbus Community Hospital, Columbus; Cozad Community Hospital, Cozad; Crete Area Medical Center, Crete; Dundy Coun-ty Hospital, Benkelman; Faith Regional Medical Center, Norfolk; Genoa Community Hospital, Genoa; Good Samaritan Hospital, Kearney; Gor-don Memorial Hospital, Gordon; Gothenberg Memorial Hospital, Gothenberg; Great Plains Regional Medical Center, North Platte; Howard County Community Hospital, St. Paul; Jennie M. Melham Memorial Medical Center, Broken Bow; Kearney County Health Services, Minden;

Kimball Health Services, Kimball; Litzenberg Memorial Hospital, Central City; Mary Lanning Memorial Hospital, Hastings; McCook Commu-nity Hospital, McCook; Memorial Community Hospital, Blair; Morrill County Community Hospital, Bridgeport; Nebraska Medical Center, Omaha; Nemaha County Hospital, Auburn; Oakland Mercy Hospital, Oakland; Ogallala Community Hospital, Ogallala; Pawnee County Memorial Hospital, Pawnee City; Perkins County Health Services, Grant; Phelps Memo-rial Health Center, Holdrege; Regional West Medical Center, Scottsbluff; Saunders Medical Center, Wahoo; St. Francis Medical Center, Grand Island; St. Francis Memorial Hospital, West Point; St. Mary’s Community Hospital, Nebraska City; Thayer County Health Services, Hebron; Tri-County Hospital, Lexington; Tri Valley Health Systems, Cambridge; Valley County Hospital, Ord; and West Holt Memorial Hospital, Atkinson.

Designated trauma care facilitiescrucial to successful statewide system

Kearney308-832-3400

Atkinson(402) 925-2811

Omaha Children's Hospital402-955-5400

CherryHolt

Custer

Sioux

Lincoln

Sheridan

Garden

Morrill

Knox

Keith

Dawes

RockBrown

Gage

Chase

Hall

Dundy

Grant

Buffalo

Clay

OtoeDawson

Cedar

Kimball

Frontier

York

Platte

Hayes

Cheyenne

Perkins

Blaine

Arthur

BurtLoup

Cass

Box Butte

Banner

Boone

Boyd

Polk

Hooker

Furnas

Butler

Saline

Antelope

Valley

Pierce

Logan

Thomas

Harlan

Lancaster

Dixon

Adams

Thayer

Dodge

Phelps

Saunders

Deuel

McPherson

Seward

Howard

Greeley

Cuming

Keya Paha

Garfield

Fillmore

Nance

Hitchcock

Wheeler

FranklinWebster

Madison

Merrick

Nuckolls

Colfax

Gosper

Wayne

Sherman

Red Willow

Kearney

Scotts Bluff

Jefferson

Hamilton

Pawnee

Nemaha

RichardsonJohnson

Thurston

Douglas

Sarpy

Stanton

Dakota

Washington

Ord(308) 728-3211

Wahoo(402) 443-4191

Grant(308) 352-7201 Cozad

(308) 784-2261

Auburn(402) 274-4366McCook

(308) 345-2650

Gordon(308) 282-0401

Kimball(308) 235-1951

Chadron(308) 432-3094

Osceola(402) 747-2031

Holdrege(308) 995-2211

Ogallala(308) 284-4011

St. Paul(308) 754-4421

Syracuse(402) 269-2011Imperial

(308) 882-7111

Alliance(308) 762-6660

Lexington(308) 324-5651

Benkelman(308) 423-2204

Valentine(402) 376-2525

West Point(402) 372-2404

Bridgeport(308) 262-1616

Broken Bow(308) 872-4100

Falls City(402) 245-2428

Pawnee City(402) 852-2231

Central City(308) 946-3015

Gothenburg(308) 537-3661

Cambridge(308) 697-3329

Norfolk(402) 371-4880

Hastings(402) 463-4521

Columbus(402) 564-7118

Grand Island(308) 384-4600

North Platte(308) 696-8000

Kearney(308) 865-7100

Lincoln(402) 475-1011

Scottsbluff(308) 635-3711 ext.234

Omaha(402) 559-9156

Omaha(402) 449-4686

Memorial Community Hospital(402) 426-2182

Crete402-826-2102

Oakland(402) 685-5601

Ainsworth(402) 387-2800

Nebraska Hospital Trauma Centers

LegendLevel IV

Level III

Level II

Level I

Pediatric Level IISource: Nebraska Department of Health and Human Services

I 80

US HWY 6

Q STUS HWY 275

I 680

HARRISON ST

STATE HWY 64

GILES RD

PACIFIC ST

FORT ST

STATE HWY 38F STS

72N

D S

T

BLONDO ST

S 168TH

ST

I 480

N 24TH

ST

AMES AVE

US H

WY 75

I ST

S 1

44TH

ST

S 36TH

ST

S 48TH

ST

STATE

HW

Y 133

N 72N

D S

T S 10TH

ST

N 50TH

ST

IDA ST REDICK AVE

I 80

I 80Lincoln(402) 475-1011

A ST

I 80

US HWY 6

STATE HWY 2

US HWY 34

US H

WY 77

VINE ST

I 180

S 27TH

ST

S 4

0TH

ST

S 56TH

ST

W A ST

S 84TH

ST

S 98TH

ST

S 48TH

ST

YANKEE HILL RD

ADAMS ST

S 1

7TH

ST

S 9

TH S

T

W VAN DORN ST

S FO

LSO

M S

T

VAN DORN ST

I 80

Om

aha

Vici

nity

Linc

oln

Vici

nity

Genoa(402) 993-2279

Nebraska City402-873-3321

Creighton402-358-5700

Kearney308-832-3400

Atkinson(402) 925-2811

Omaha Children's Hospital402-955-5400

CherryHolt

Custer

Sioux

Lincoln

Sheridan

Garden

Morrill

Knox

Keith

Dawes

RockBrown

Gage

Chase

Hall

Dundy

Grant

Buffalo

Clay

OtoeDawson

Cedar

Kimball

Frontier

York

Platte

Hayes

Cheyenne

Perkins

Blaine

Arthur

BurtLoup

Cass

Box Butte

Banner

Boone

Boyd

Polk

Hooker

Furnas

Butler

Saline

Antelope

Valley

Pierce

Logan

Thomas

Harlan

Lancaster

Dixon

Adams

Thayer

Dodge

Phelps

Saunders

Deuel

McPherson

Seward

Howard

Greeley

Cuming

Keya Paha

Garfield

Fillmore

Nance

Hitchcock

Wheeler

FranklinWebster

Madison

Merrick

Nuckolls

Colfax

Gosper

Wayne

Sherman

Red Willow

Kearney

Scotts Bluff

Jefferson

Hamilton

Pawnee

Nemaha

RichardsonJohnson

Thurston

Douglas

Sarpy

Stanton

Dakota

Washington

Ord(308) 728-3211

Wahoo(402) 443-4191

Grant(308) 352-7201 Cozad

(308) 784-2261

Auburn(402) 274-4366McCook

(308) 345-2650

Gordon(308) 282-0401

Kimball(308) 235-1951

Chadron(308) 432-3094

Osceola(402) 747-2031

Holdrege(308) 995-2211

Ogallala(308) 284-4011

St. Paul(308) 754-4421

Syracuse(402) 269-2011Imperial

(308) 882-7111

Alliance(308) 762-6660

Lexington(308) 324-5651

Benkelman(308) 423-2204

Valentine(402) 376-2525

West Point(402) 372-2404

Bridgeport(308) 262-1616

Broken Bow(308) 872-4100

Falls City(402) 245-2428

Pawnee City(402) 852-2231

Central City(308) 946-3015

Gothenburg(308) 537-3661

Cambridge(308) 697-3329

Norfolk(402) 371-4880

Hastings(402) 463-4521

Columbus(402) 564-7118

Grand Island(308) 384-4600

North Platte(308) 696-8000

Kearney(308) 865-7100

Lincoln(402) 475-1011

Scottsbluff(308) 635-3711 ext.234

Omaha(402) 559-9156

Omaha(402) 449-4686

Memorial Community Hospital(402) 426-2182

Crete402-826-2102

Oakland(402) 685-5601

Ainsworth(402) 387-2800

Nebraska Hospital Trauma Centers

LegendLevel IV

Level III

Level II

Level I

Pediatric Level IISource: Nebraska Department of Health and Human Services

I 80

US HWY 6

Q STUS HWY 275

I 680

HARRISON ST

STATE HWY 64

GILES RD

PACIFIC ST

FORT ST

STATE HWY 38F STS

72N

D S

T

BLONDO ST

S 168TH

ST

I 480

N 24TH

ST

AMES AVE

US H

WY 75

I ST

S 1

44TH

ST

S 36TH

ST

S 48TH

ST

STATE

HW

Y 133

N 72N

D S

T S 10TH

ST

N 50TH

ST

IDA ST REDICK AVE

I 80

I 80Lincoln(402) 475-1011

A ST

I 80

US HWY 6

STATE HWY 2

US HWY 34

US H

WY 77

VINE ST

I 180

S 27TH

ST

S 4

0TH

ST

S 56TH

ST

W A ST

S 84TH

ST

S 98TH

ST

S 48TH

ST

YANKEE HILL RD

ADAMS ST

S 1

7TH

ST

S 9

TH S

T

W VAN DORN ST

S FO

LSO

M S

T

VAN DORN ST

I 80

Om

aha

Vici

nity

Linc

oln

Vici

nity

Genoa(402) 993-2279

Nebraska City402-873-3321

Creighton402-358-5700

2

The role of Emergency Medical Service providers in

SUICIDE PREVENTIONBy David Miers, PhD, LIPC

It is estimated that each year suicide takes the lives of about 38,000 Americans, and approx-imately 465,000 individuals are seen in hospital emergency departments for self injury (CDC,

2010). It also is estimated that each year

more than 8 million adults think serious-ly about taking their life, and over 1 mil-lion make an attempt (NSDUH, 2011).

Emergency Medical Service (EMS) providers are called on to respond to patients who may be at risk for suicide or who may have attempted suicide. Therefore, it is important that EMS pro-viders understand their role in helping to prevent suicide.

The Suicide Prevention and Resource Center (SPRC) has developed a hand-out, called “The Role of Emergency Medical Service Providers in Preventing Suicide,” that can be found at http://www.sprc.org/sites/sprc.org/files/ems.

The document discusses identifying people who may be at risk, responding to patients who may be at risk for sui-cide or have attempted suicide, helping suicide survivors at the scene, becoming involved in suicide prevention in your organization and community, and it pro-vides resources. It is important to review all of these topics.

This article highlights the section identifying people who may be at risk.

Identifying people who may be at risk for suicide

It is important to look for signs of im-mediate risk for suicide. There are three behaviors that may mean a person is an immediate risk for suicide and should prompt you to take action right away:

• Talking about wanting to die or to kill oneself.• Looking for a way to kill oneself, such as searching online or obtaining a gun.• Talking about feeling hopeless or having no reason to live.

If individuals exhibit any of these three behaviors, it is important to connect them with resources immedi-ately so that they can be evaluated by a trained professional. Bryan West Cam-pus has a 24/7 Mental Health Emergen-cy Department available for individuals in crisis to determine if they meet the criteria for hospitalization.

Other behaviors may also indicate a serious risk, especially if the behavior is new, has increased and/or seems related to a painful event, loss or change.

Ask if the patient has been exhibiting these behaviors:

• Talking about feeling trapped or in unbearable pain.• Talking about being a burden.• Increasing use of alcohol or drugs.

• Acting anxious or agitated; behaving recklessly.• Sleeping too little or too much.• Withdrawing or feeling isolated.• Showing rage or talking about seeking revenge.• Displaying extreme mood swings

Other problems that increase risk

Certain problems may increase a person’s risk for suicide. Asking if the patients have any of the risk factors can help you assess the current situa-tion more accurately and enable you to provide more complete information to medical staff.

Some more significant risk factors to ask about are:

• Prior suicide attempt.• Alcohol or drug abuse.• Mood or anxiety disorders, e.g., depression, post-traumatic stress disorder (PTSD).• Access to means to kill oneself, i.e., lethal means.

3

Suicide risk usually is greater among people who have more than one risk factor. For individuals who already are at risk, a “triggering” event causing shame or despair may make them more likely to attempt suicide. These events may in-clude relationship problems or breakups, problems at work, financial hardships, legal difficulties and worsening health.

Even though most people with risk factors will not attempt suicide, they should be evaluated by a professional. It is important to know the resources available in your area. It also is import-ant to prepare ahead of time and review protocols and procedures required by your organization and in your local area for responding to potential suicides and patients at risk for suicide.

Help is available

Bryan Medical Center Mental Health Services has resources available to help individuals with mental health needs.

• Emergent care — The Mental Health Emergency Department (located in the main Emergency Department at Bryan West Campus) provides as-sessments to determine if individuals in crisis need hospitalization. Staff are available 24 hours a day, seven days a week. If outside of the Lincoln area, call 9-1-1 or go to the nearest emergency room.

• Non-emergent care — The Bryan Counseling Center is for non-emer-gency clients who would benefit from outpatient services. To schedule an appointment at the Counseling Center, call the Counseling Center at 402-481-5991.

• Online confidential depression, anxiety and alcohol screenings: go online to www.bryanhealth.org/ onlinescreenings.• The Suicide Prevention Lifeline for people in suicidal crisis or emotional distress is 1-800-273-8255.

Information for this article was adapted from http://www.sprc.org/sites/sprc.org/files/ems.

Camino ICP monitors debut in NeuroTrauma Critical Care Unit

The NeuroTrauma Critical Care Unit and Operating Rooms at Bryan Medical Center West Campus implemented a new intracranial pressure (ICP) mon-itoring system this fall.

The Camino sys-tem’s monitors allow for measurement of pressure inside the cranial vault with concurrent drainage of excess cerebral spinal fluid (CSF). Previously these two functions could not occur simultane-ously. Two additional benefits of the

new monitors are touch screen tech-nology and a display of pressure wave-forms, making it easier to interpret and report results. The monitors are simpler

for the neurosurgical team to calibrate and for the intensive care staff to synchronize with the bedside monitors.

And for the first time ever, there is an ICP moni-toring catheter that is MRI compatible. This will facil-itate earlier MRI scans in our patients with severe

head injuries and assist us in caring for them. n

Bryan Trauma Team members attendAdvances in Trauma Conference

Bryan Health Trauma Center members attended the 37th annual Advances in Trauma Conference Dec. 5-6 in Kansas City, Mo. This is one of only three meetings in the United States held by the American

College of Sur-geons Commit-tee on Trauma.

2014 was Reginald Burton, MD’s last year as Region 7 Chair. Dr. Burton’s leadership was instrumental in expanding access to con-tinuing medical education for trauma

surgeons, general surgeons, ED physicians, trauma program managers, nurses,

physicians assistants, EMS providers and others in health care.

Region 7 includes Nebraska, Iowa, Missouri and Kansas. As chair, Dr. Burton assembled preeminent speakers from the United States and Eu-rope to lecture at the annual conference.

His mission was to strengthen and advance the trauma system, from EMS and rural trauma centers to state and ACS verified trauma centers. Promoting collab-oration within these systems and offering access to pertinent education helps lead to the best possible outcomes for patients.

Dr. Burton with Crete Area Medical Center emergency director Amy Vertin, MD, whose presentation on rural trauma care was well received at the conference.

Dr. Burton (right) helped bring prominent speakers to the conference, such as Demetrios Demetriades, MD, of Los Angeles County, Calif.

4

Amy Vertin, MD, (left), Bryan Cotton, MD, and Reginald Burton, MD, made keynote presentations at the symposium.

The Bryan Trauma Symposium again was a popular destination for those interested in improving emergency and trauma services in their communities. Full houses greeted speakers, such as Dr. Cotton, (above) in the conference center at Bryan West Campus.

2014 Bryan Trauma Symposium

Meeting your needs

On September 19, 2014, more than 170 participants attended the 11th annual Trauma Symposium at Bryan Medical Center West Campus.

Keynote Speaker was Bryan Cotton, MD, MPH, associate professor of

surgery at the University of Texas Health Science Center in Houston. Dr. Cotton discussed Viscoelastic testing in the emergency and trauma setting, as well as practice management guidelines for pre-hospital fluid resuscita-tion in penetrating trauma patients.

Amy Vertin, MD, emergency medical director at Crete Area Medical Center, educated the audience on rural trauma and its challenges. She helped identify key differences between managing trauma in a rural setting versus an urban hospital, including pre-hospital care, hospital resources and staffing. Dr. Vertin also explained the role of a hospital based rural ALS intercept program in a trauma patient. Currently Crete Area Medical Center has a rural ALS intercept program in place that has prov-en to be a great program not only for the patients and their communities but the medical professionals that are caring for the patients.

Ron Kirschner, MD, medical director of the Nebraska Regional Poison Center and assistant professor for the Department of Emergency Medicine at the University of Nebraska Medical Center, informed the audience on: What’s New on the Street and an update on drugs of abuse.

In addition to the speakers, participants attended four separate breakout sessions which included: pediatric simulation, geriatric simulation, rescue airways and trauma center follow up, as well as Public First Aid —Train the Trainer.

The day concluded with Reginald Burton, MD, speak-ing about What’s New in Trauma and Stanley Okosun, MD, presenting trauma case reviews. Before attendees left the symposium, Robbie Dumond, RN, EMT-I, gave An Overview of Modern Trauma Care.

Thank you to our sponsors and all who presented and attended. We are excited the symposium continues to grow, and we look forward to seeing you next year on Sept. 25, 2015.

5

Dr. Burton teaches about pediatric trauma.

Stanley Okosun, MD, (above) uses a simulation mannequin for a mock scenario involving a chain saw incident. Elizabeth Schoemaker, MD, (below) discusses “intubating like a pro.”

We hear youParticipant surveys say:“This was great!”“Another excellent sympo-

sium! Getting better every year!” “Best conference I’ve been to

in a while!” “This is one of my favorite

conferences, and I always learn so much. The staff was wonder-ful — very knowledgeable, practical and great senses of humor. The food was delicious. Thanks for all the great informa-tional handouts.”

Lincoln Fire and Rescue (right) provided hands-on Back to Basic training, such as this lesson in applying tourniquets.

6

As part of the Bryan Trauma Program’s commit-ment to providing excellent care to patients across the region, the Emergency Depart-ment staff and Trauma Team have worked on

putting together standardized carts for the placement of chest tubes in the Emergency Department.

The carts provide a mobile supply for chest tube in-sertion that could essentially be performed in any room of the Emergency Department. In addition, all staff have been trained in the use of the cart and each supply that

is found in the cart. This performance improvement led initiative is one

example of the Bryan Trauma Program’s commitment to excellence in trauma care.

If you have any questions or would like to learn more about equipment and supplies related to trauma care, please contact trauma performance improvement nurse Jennifer Middlekauff at 402-481-4167 or Trauma Pro-gram manager Robbie Dumond at 402-481-5150. n

Chest tube cartsStandardization is key in trauma care

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

ATLS — April 2 and 3.ATLS — July 30 and 31.ATLS — Oct. 1 and 2, at Seward.ATLS Refresher only — Nov. 13.

Advanced Trauma Course for Nurses — July 30 and 31.

TNCC — April 13 and 14.TNCC — Nov. 2 and 3.ENPC — March 24 and 25.ENPC — Oct. 21 and 22.

Bryan Trauma Symposium — Sept. 25.

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

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, MSN, RN, at 402-481-4087, or email heather.talbott@bryanhealth.org.

Free continuing education available to youContact Heather Talbott to inquire about free trauma

education provided at your facility or in your community. Some of the topics earning CME credits and CEUs are Current Trends in Trauma, the Trauma System and EMS Trauma Case Reviews.

Sign up for these 2015 Trauma Courses

Here’s an example of the standardized carts used at Bryan Medical Center.

7

Decontamination trainingpreps Bryan staff for potential incidents

Twenty-five staff members from throughout Bryan Medical Center participated in a full-scale decontami-nation exercise Sept. 9-10, 2014.

This training is essential to the adequate prepara-

tion for receiving contaminated victims at Bryan.The training was conducted with support from the Center

for Preparedness of Omaha. n

Trauma Update is published for friends of

Bryan Health. Your comments and suggestions

are welcome. Direct correspondence to the

Advancement Department at Bryan, or telephone

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

Address service requested

Non-profit Org.U.S. Postage

PAID Permit No. 267

Lincoln, NE

Robbie Dumond, RN, has been appointed to a three-year term to the Nebraska Department of Health and Human Services State Trauma Advisory Board.

Dumond has served as trauma and emergency preparedness manager at Bryan Medical Center since 2012. His day-to-day responsibilities include managing Bryan’s Level Two Trauma Center, as well as emergency preparedness endeavors at the medical center.

He is the board’s trauma nurse representative.

For more than 25 years, Bryan has been the designated Trauma Center for southeast Nebraska. n

Neurosurgeon Andrew Livingston, MD, has joined Neurological and Spinal Surgery. He specializes in surgery of the brain, spine and peripheral nerves.

Dr. Livingston graduated cum laude in 2003 with a Bachelor of Science from Chadron State College, where he also participated in the Rural Health Opportunities Program (RHOP). He went on to receive his medical degree in 2007 from the University of Nebraska Medical Center College of Medicine, Omaha.

Dr. Livingston completed a general surgery internship at Houston Methodist Hospital, Texas, where in 2014 he completed his neurosurgery residency. He has contributed to numerous publications in the areas of neuro and spinal surgery. n

Dumond appointedto Trauma Advisory Board

Meet Dr. Livingston,neurosurgeon

Robbie Dumond, RN Andrew Livingston, 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.