heroes and saints: issue 2 - september 2012
DESCRIPTION
News for EMS teams at Saint AlphonsusTRANSCRIPT
HEROES SAINTS
Idaho’s First Senior ER | ONTARIO GLOBAL VILLAGE DISASTER | Cardiac Care
News For eMs TeaMs aT saiNT alphoNsus
ISSuE 2 | SEpTEmBER 2012
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LETTER FROm THE EDITOR
Etymology of Heroes - Coined in English 1387, during the time of King Arthur’s round table, the word hero comes
from the Ancient Greek. “Hero, warrior”, literally “protector” or “defender”. It is also thought to be a cognate of the
Latin verb servo (original meaning: to preserve whole) and of the Avestan verb haurvaiti (to keep vigil over).
Welcome to the 2nd edition of the
“Heroes & Saints.” Since our last issue, I’ve
been traveling around the region and getting
acquainted with First Responders in Ontario,
Baker City and surrounding areas. It was
an honor to meet most all of the people
involved in helping the victims of the Global
Village crisis that happened June 2 at Lion’s
Park in Ontario, OR, and hear the details
of responders and the Incident Command
activation. Eleven agencies from Ontario,
Nyssa, Vale, OR and Payette, ID supported
the transport of thirteen patients in 37
minutes from the first dispatch. We’re proud
to share their story, insights and incredible
teamwork in caring for these patients and the
community on page 8. They are all Heroes!
In addition, I’ve enjoyed giving more
details about our new Senior ER and the
tailored delivery of care it represents for older
patients. We are also very proud to unveil
the Northwest’s only 640 Slice Toshiba CT
Scanner. This state-of-the-art CT improves
diagnosis and saves lives through amazing
speed and functionality – especially for stroke
and cardiac patients.
I’m truly honored to be able to serve
the EMS community on behalf of the Saint
Alphonsus Health System. Every day I am
inspired by your dedication and commitment
to saving lives and enhancing the health and
quality of life for people in our communities.
Welcome to the 2nd edition of the
HEROES AND SAINTS
AImEE STEIN
SIStER bEtH muLVANEy
Emergency & trauma Services Relationship manager & Editor
“I’m truly honored
to be a part of
your communIty.”
“Heroes.” “Saints.” they have a lot in common.
When the Catholic Church names someone a saint, it is official recognition that during the person’s lifetime, he or she was outstanding in the way they responded to God’s love and demonstrated it to others. Saints respond to needs. Saints overcome all kinds of obstacles to make good things happen. Saints often put other people’s hopes ahead of their own.
Yes, our present day emergency medical responder “Heroes” and the “Saints” as described above, have a lot in common.
reflections from
September 2012 3
sarmc.org
Global Village Disaster First Responders:
Al Higinbotham, John Dillon, Anthony
Hackman, Yorick de Tassigny, Doug Williams,
Alyssa Harrington, Jordan Barnett, Mark Saito,
Mike McLean, Justin Allison, Jared Gammage,
Kevin Hill, Chris Lowry, Luke Smith, Josh
Alvarado, Liz Amason, Wade Douglas, Dale
Jeffries, Allen Montgomery, Julia Rodrigruez,
and Mark Alexander. See page 9 for more on
the Global Village Disaster.
HIGHLIGHTS
2 LEttER FRom tHE EdItoR
3 HIGHLIGHtS 4 mEdICAL
dIRECtoR GREEtInG
5 CARdIAC CARE
6 tRAumA tALK
8 LooKInG At uS
11 nEuRo/StRoKE
14 EAGLE ER
15 AWARdS & RECoGnItIon
STROkE CASE REVIEw Coughlin Conference Room 2 3rd Wed. of the month • 7-9am
TRAumA ROuNDS Coughlin Conference Room 2 • 7-8am 2012: 9/26, 10/10, 24 & 31,
11/14 & 28, 12/12
EmS ROOFTOp BBQ September 27 • 3-7pm
ED GRAND ROuNDS (CmE CREDIT)Saint Alphonsus boise mcCleary Auditorium • 11am-1pm2012: 10/25 2013: 2/28, 4/25, 6/27, 8/22, & 10/24
SkI & mOuNTAIN TRAumA CONFERENCEnovember 1-3
upCOmING EVENTS
EDITORIAL BOARD
ABOuT THE COVER
AImEE STEIN emergency & trauma Services relationship manager & editor
kRISTEN mICHELETTI communications director & editor
DR. BILLy mORGAN trauma medical director
NANCy TAyLOR aprn-np/cnS hospitalist & cardiac care
SISTER BETH muLVANEy mission education
DR. BEN CORNETT Iep/ada county medical director
DR. kARI pETERSON Iep/canyon county medical director
DR. EDwARD mCEACHERN Iep executive director/ceo
DR. ERIC ELLIOTT Iep/eagle er medical director
NICHOLE wHITENER mSn, cnrn, ne-bc neuro/Stroke director
JANE SpENCER cnS neuro Institute
JANA pERRy rn, mSn trauma /General Surgery director
RICH TRump pa-c trauma
ALISHA HAVENS Saint alphonsus nampa
LAuRA HuGGINS Saint alphonsus baker city
LEANNA BENTz Saint alphonsus ontario
pAT BERGEy rn, bSn
SOCIAL mEDIA Buzz Do you respond to medical emergencies on
the ski hill or back bowls? Then you need
to attend our conference! This conference
is for paramedics, ski patrol, fire, search and
rescue and any other first responder who
provides field care to patients in remote
mountainous terrain.
http://www.facebook.com/pages Saint-Alphonsus-Ski-mountain-Trauma-Conference/1638058003442
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mEDICAL DIRECTOR GREETING
It is truly a privilege to communicate to each
of you that EMSAC, the Idaho Medical
Association and, many of the hospitals in
Idaho are agreeably pressing forward to make
the state Trauma System a reality. The Health
Quality Planning Commission has given us their
blessing to proceed with town hall meetings
that will hopefully allay suspicions that “the
big hospitals” are trying to bypass the little
hospitals. Bypass of any hospital is not the
structure for the proposed trauma system that
we are embracing and forwarding. The critical
access hospitals and the other smaller facilities
in the State of Idaho are equally important
to the Trauma System’s functionality as are
the larger facilities. It is our intent that every
hospital in the state will have the opportunity
to participate at whatever level they choose
based on their resources and the desire of their
medical staffs.
On a related note, the Health Quality
Planning Commission also felt that the Trauma
System was a perfect vehicle to bring the
resources of any participating Trauma System
hospital, regardless of size or location, to the
local pre-hospital providers in the form of
mandatory educational opportunities. These
opportunities would be an expected part of
being a” Designated Trauma Center” under
the Idaho System and would be provided at
no cost to the hospital’s referring pre-hospital
personnel. This would assist greatly with the
needs for education now being required for
both volunteer and employed EMS providers
throughout the state. Wayne Denny and I will
be visiting Idaho’s many EMS regions over the
next several months to deliver this message to
the EMS providers in person.
In short, we thank you for your service
and want to once again communicate to
you that no system can function without
all its pieces. As the EMS provider, you
are as important as any other piece of
this puzzle and will be given a seat at the
table as we progress with the creation and
implementation of the system.
In the words of Mr. Spock, “Live long
and prosper”.
SuppORTING A SySTEm OF COOpERATION
bILL mORGAN, md
trauma medical director
“lIve lonG
and proSper.”
row 1: md trauma and General Surgery: dale Strawn, md, Steven casos, md, harry Stinger, md,
row 2: George munayirji, md rhoda linch, pa-c, richard trump, pa-c,
row 3: mike hardesty, pa-c Stefanie magee, pa-c, Jana perry, rn, mSn trauma /General Surgery director
row 4: Susan minow, case manager
meet the region’s only Level 2 trauma Center team
September 2012 5
sarmc.org
In the last few years one of the major
initiatives in pre-hospital care of patients with
chest pain is that of obtaining a 12-lead ECG
at the scene. Does this practice really benefit
those patients having a myocardial infarction
or does it result in a delay in transit time?
For patients who undergo percutaneous
coronary intervention for ST segment
elevation myocardial infarction (STEMI),
studies have clearly shown that each 30
minutes of delay means a 7.5% increase in the
relative risk of mortality in 1 year (Circulation,
2004). Longer door-to-balloon (D2B) times
are associated with higher adjusted risk of
mortality as well (30 min = 3%, 60 min =
3.5%, 90 = 4.3%, 120 min = 5.6%, 150 min =
7%, 180 min = 8.4%). (BMJ, 2009)
So does obtaining an ECG at the scene
result in an increase or decrease in the time
to intervention? In a retrospective study
published in the July 25, 2012 issue of the
Journal of American College of Cardiology
by Patel, et. al, the impact of performing a
pre-hospital ECG on scene-to-hospital time
was measured in patients with chest pain of
cardiac origin and ST elevation myocardial
infarction. They reviewed the run sheets for
patients with chest pain served by the City
of San Diego (nation’s eighth largest city)
Emergency Medical System from January 2003
to April 2008. Scene time was defined as the
time from the arrival of the first paramedic-
staffed unit to departure of the ambulance.
Transport time was defined as the time from
the ambulance departure from the scene to the
time of arrival at the emergency department.
21,742 patients were evaluated for chest
pain. The average age of the patient was 62,
and 53% were men. They looked at 12,111
cases before they started performing ECGs
at the scene, and 9,631 cases after initiation
of pre-hospital ECG protocols. 3.1% of
the patients who had a pre-hospital ECG
performed were diagnosed as STEMIs.
When the use of pre-hospital ECG was
instituted, a minimal increase in median scene
time of 15-20 seconds was noted. Previous
studies reported increased times anywhere
from 1.5 minutes to 5 minutes. However,
when a STEMI was identified combined scene
and transport time decreased by more than
2 minutes. This decrease in time is extremely
significant in a process where “time is muscle”.
This study clearly supports what all EMS
providers already know. Early identification of
STEMI in the patient with chest pain allows
expedited treatment by early notification of
the hospital and cath lab. While it may take
a minute or two to complete a 12-lead at the
scene, the time saved in early notification
decreases mortality.
ECGS, ISCHEmIA, AND TRANSIT TImES
“doeS thIS
practIce really
benefIt thoSe
patIentS havInG
a myocardIal
InfarctIon or
doeS It reSult
In a delay In
tranSIt tIme?”
CARDIAC CARE
nAnCY TAyLORaprn-np/cnS
hospitalist & cardiac care
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TRAumA TALk
the Growing Problem of AtV Accidents THE “T” STANDS FOR TRAumA
The trauma season is well upon us here at Saint
Alphonsus Regional Medical Center and there
is a variety of activities that are available to the
citizens who recreate in our state that can lead
to traumatic injury. One of the more common
forms of recreation that leads to serious
injury is the all terrain vehicle (ATV). We see a
tremendous influx of injuries related to their
use during the summer months and into the
fall as hunters take to the forests.
The Idaho data is broken out in 2 sections.
The number of deaths reported above is from
2006-2010 and from 1982-2006 there were
105. The data related to the 16 and younger
demographic is from 1982-2006 (1).
Local data at our facility for the past 12
months: 76 admissions for ATV accident
with the following dispositions: 2 deaths,
53 discharged to home, 1 to the long term
acute care hospital, 2 to nursing home, 15 to
inpatient rehabilitation, 1 not recorded for
disposition and 2 transfers to tertiary facilities.
As you can tell with simple arithmetic
ATV accidents are a growing problem
over time and do deserve our attention and
consideration. The injuries related to their use
we see on a regular basic includes closed head
injury, multiple rib fractures, pneumothorax
with and without hemothorax, internal
abdominal solid and hollow viscous injury,
open and closed extremity fractures, significant
pelvic fractures and spinal cord injuries.
A high index of suspicion for severe
injury needs to be on the forefront of your
mind as you respond to these calls for what
may sound like an innocent accident of a single
vehicle on a farm, in the woods or where ever
they may lay. Most of the people using these
vehicles are not using protective gear as they do
not recognize the risk involved if they were to
fall from the ATV. All too often alcohol use is
coupled with the incident as once again people
underestimate the risk and do not consider an
ATV in the same was as they do an automobile
of motorcycle on the city street.
RICHARd TRumppa-c trauma
2010 NATIONAL & IDAHO DATA
Idaho national
deaths 52 317
Injuries not Reported 115,000
deaths <16 30 55
“one of the
more common
formS of
recreatIon
that leadS to
SerIouS InJury
IS the all
terraIn vehIcle ”
Continued on next page
September 2012 7
sarmc.org
Travis Gilbert and his father-in-law, Barry
Manning, were out exploring the austere and
visually striking Owyhee Desert in April. Barry
was driving the pickup around noon when he
noticed his father-in-law sitting next to him
starting to “pass out.” Travis immediately
stopped the vehicle and gave Barry a chest
thrust, which seemed to bring him temporarily
back to consciousness. No cell phone coverage
was available so Travis drove to the Mud Flat
BLM Guard Station, where a radio distress call
was made to 911 and Life Flight Network.
Life Flight Network’s critical care
team, Jay Putra, RN, and Scott Rairigh,
EMT-P, arrived at 1:39 p.m. and were the
first ALS responders to arrive on scene.
Upon arrival the patient was unresponsive in
asystole with no palpable pulse or reaction
to noxious stimuli. CPR was initiated in the
back of the Dodge pickup at a rate of 100
compressions per minute.
Travis had previous BLS training and
was called upon to help perform CPR on his
father-in-law as an oropharyngeal airway was
established and BVM ventilations with oxygen
was administered. Five minutes after the flight
crew started CPR, there was still no pulse. An
intraosseous infusion (IO) was inserted into
the bone marrow to provide a non-collapsible
entry point into the systemic venous system.
The flight crew continued resuscitation
steps and started administering medications
via protocol for a cardiac arrest. Along the
way these steps also included a successful
orotrachael intubation.
All in all, the Life Flight Network critical
care team spent 28 intense and focused
minutes in the back of a pickup truck in
the Owyhee desert, providing continuous
medical support of the highest order on Barry
Manning. Barry’s cardiac rhythm went in and
out of asystole and third degree heart block
requiring aggressive CPR and ACLS drugs.
An external pacemaker was started which
stabilized his rhythm with a heart rate of 70.
The patient was prepared for transport
to the helicopter and once he was safely
secured in the aircraft, they departed for Saint
Alphonsus Regional Medical Center in Boise.
Constant monitoring and IV medications
were maintained and hypothermia protocol
was initiated as the flight crew relayed patient
condition information to the emergency
medical team preparing to handle arrival of
the patient. Barry’s vital signs stabilized during
the flight with the assistance of a Dopamine
drip and external pacemaker. As they were
arriving at Saint Alphonsus Medical Center,
Barry started following commands to open his
eyes and squeeze his hand. The patient was
wheeled into the trauma room and
immediately connected to Saint Alphonsus’
monitors and ventilation. The flight crew
provided a bedside report to the medical team
on site and prepared for departure in order to
be ready for another emergency call.
By any measure, this was a harrowing
and death-defying experience in the desert
straddling the Idaho and Oregon border. The
patient survived due to tenacity, focus, and
a substantial range of critical care skills in
order to obtain a positive result. He ended up
spending less than a week receiving cardiac
medical care at Saint Alphonsus and returned
home with full cognition and function.
Today Barry is riding his bike five miles a day,
mowing his lawn with a push mower and
feeling great.
DEFyING DEATH IN THE DESERT
Case Report 06/21/2012; 16 year old male
on his ATV tried to jump a ditch and ends
up with the ATV rolling over the top of him.
His injuries included a severe traumatic brain
injury which rendered him with a GCS of 3
on scene. He was intubated by paramedics
and transported to as a level one trauma to
our facility. Other injuries include a massive
pulmonary laceration with what is known
as a traumatic pneumatocele (pictured left)
with active pulmonary hemorrhage requiring
massive blood transfusion and endobronchial
blocker placement to tamponade the bleeding,
bilateral rib fracture and hemopneumothoraces.
He required a ventriculostomy and remained in
our ICU until 7/09/2012 at which time he was
transferred to a long term acute care hospital
where he remains today with a tracheostomy,
feeding tube and is making a gradual recovery.
He is much more alert as time goes on but it
will be months before it can be determined
what his overall cognitive recovery will look
like. He remains with a tracheostomy due to his
massive lung injury and the care that is takes to
keep his lungs open for proper aeration.
TRAumA TALk
the Growing Problem of AtV Accidents THE “T” STANDS FOR TRAumA
Continued from page 6
ERIC BORLANDmarketing director life flight network
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LOOkING AT uS
On Saturday, June 2, hundreds of
surrounding Idaho and Oregon residents
went to Lion’s Park in Ontario to attend the
Global Village Celebration, a special event
dedicated to sharing the richness of global
cultures. The Boise Highlanders Bagpipers
were performing on the stage, with Master
of Ceremonies Dale Jeffries (radio station
KSRV) commenting on the festivities.
Suddenly, out of the blue, a car exploded
through the stairs of the crowded stands
and stopped after taking out a corner of the
stage. It was 2:33 pm. At Ontario’s police
department, Liz Amason witnessed the
phones and 911 panel light up.
Alan Montgomery, an off duty EMT/
Fire officer, was selling soda in the Pepsi
trailer when he heard the crash. He looked up
just as the car hit the stands. He scrambled
out of the trailer and raced toward the scene,
expecting to find an elderly person in the
midst of a medical emergency. Instead, he
was stunned to see two young men in the
car. It took a few seconds for him to process
the reality, and then his training kicked in.
He saw a woman under the car, a child on
the ground, a man with his nose severely
lacerated. About a half a dozen “off duty”
people rushed to Alan’s side, citing their
training – nurse, police officer, EMT, first-aid
trained Aquatic Center staff. He directed
each of them to stay with an injured victim,
and began to triage patients by severity. When
the first EMT personnel – Chris Lowry
and Luke Smith – arrived Alan turned over
medical triage to their care.
Five minutes after the call, police, fire,
and ambulance support began to arrive.
Dale Jeffries was already in action, using his
microphone to urge spectators to remain
Anatomy of a Community Crisis: THE GLOBAL VILLAGE DISASTER by Kristen micheletti
“Suddenly, out of
the blue, a car
exploded throuGh
the StaIrS of the
crowded StandS
and Stopped after
taKInG out a corner
of the StaGe.”
September 2012 9
sarmc.org
LOOkING AT uS
calm, to direct witnesses and victims to
separate areas and to help a women translate
his words into Spanish.
Jared Gammage, Ontario Fire
Department, launched the Incident Command
System and acted as Incident Commander
during the disaster response. He called Liz for
more resources as his first order of business.
He set up a triage and transport area, directing
incoming units in a clockwise, orderly fashion
to take out the most critical victims first.
Within minutes, paramedics and ambulances
arrived from Nyssa, Vale, and Payette County.
Oregon State Police and MCSO personnel
joined the scene.
Paramedics and bystanders helped
rescue a woman who had fallen under the
bleachers and knocked unconscious. In
the fall she had sustained critical injuries.
Ambulances were arriving and leaving like
clockwork. Thirty-seven minutes elapsed
from the first dispatch (1436 hrs) to the
last transport (1509). In all, 13 patients had
been transported to Saint Alphonsus –
Ontario via eight ambulances. Another 12
“walking wounded” crossed the street to
the Saint Alphonsus – Ontario Emergency
Room. Only one patient was transferred to
Saint Alphonsus Regional Medical Center
in Boise. Once there, they were met and
cared for by scores of nurses, volunteers,
chaplains, engineering, physicians, and many
other staff who rushed in to help as needed.
FIRST RESpONDER REFLECTIONS, Q&A
Q: What struck you the most when you
reflect on the Global Village Disaster,
and what advice would you give to first
responders across Oregon and Idaho?
Jared Gammage, IC, Ontario Fire:
With three law enforcement agencies, four
ambulances, Ontario Fire, and all sorts of
people trying to help, it could have been ugly
in terms of cooperation. There were no turf
wars or jurisdiction issues at the scene. It
just could not have gone better – it was “text
book” perfect. Really, it went smoother in
real life than it did in a drill.
Liz Amason, Dispatch, Ontario police Department:
We had just gone through a mass casualty
training session a few weeks earlier, so that
recent exercise helped us. As professionals,
we have a lot of training hours and
experience under our belt, and that kicks in
during a real crisis. Take drills very seriously,
because everything you practice and do falls
into place when it is real.”
Continued on page 10
Thank you to The Argus Observer & the following First Responder Agencies:
ontario Police department ontario Fire department malheur County Sheriffs department City of ontario treasure Valley Paramedics ontario Aquatic Center Lifeguards nyssa, oR Vale, oR Payette, Id oregon State Police oregon Red Cross
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Saint alphonSuS | emS newSletter
LOOkING AT uS
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Liz Amason, the dispatcher on duty
at the oregon Police department
received the first of hundreds of
911 calls.
R1/m1 En route
m1 Requests m2 be paged
R1/m1 on scene
R1 request general page
General page
m1 Requests m3 be paged
m3 paged
R1 advises command &
on west side of grand stand
101 En route
157 En route
m2 En route Saint Alphonsus
ontario
m2 At Saint Al’s
m6 on scene
m6 En route Saint Al’s
m6 at Saint Al’s
m6 CLEAR Saint Al’s/En route scene
m2 CLEAR Saint Al’s/En route scene
m7 on scene
m6 CLEAR Saint Al’s/En route scene
m2 En route Saint Al’s
m2 at Saint Al’s
m7 at Saint Al’s
m6 En route Saint Al’s
m2 CLEAR
m7 CLEAR
m6 at Saint Al’s
Payette Fire CLEAR
m6 CLEAR Saint Al’s
m6 Released from scene
157 RELEASEd from scene
m2 CLEAR
101 RELEASEd from scene
Command tERmInAtEd/
CLEAR scene
R1 CLEAR Saint Al’s
m1 CLEAR
Allen montgomery,
Ontario EmT/Fire (off-duty):
I can’t thank and overstate the importance of
the citizens at the event who stepped forward
to volunteer and help. Dale was just fabulous
as the crowd-calmer, using the PA System
to tell people what to do. You NEVER have
that at disaster! Off-duty nurses, and family
members, and strangers were fantastic. One
lady who suffered a compound fracture
happened to be on Coumadin. Someone had
put a tourniquet on her leg, and that action
likely saved her life. I was just so impressed
by how the community began helping each
other immediately, instead of panicking. It
really made my job easier to begin triage and
to be able to help best where it was needed.
Continued from page 9the Global Village disaster timeline
September 2012 11
sarmc.org
Keeping care close to home while providing
state-of-the-art advanced stroke care in a
rural state such as Idaho can be a challenge.
The region’s only Joint Commission Certified
Advanced Primary Stroke Center is dedicated
to treating stroke early and has answered the
rural challenges by developing the area’s first
and only telestroke program.
Telestroke uses a state-of-the-art
robotic system and a web connection to
link rural emergency departments to stroke
specialists whenever their expertise is needed.
Without being physically at the hospital,
the specialists can examine and speak with
stroke patients and consult with physicians
by using equipment that includes a webcam
and video screen. Neurologists backed by a
specially trained team of certified healthcare
professionals are available 24 hours a day, 365
days a year. This is essential because time is
crucial when someone is having a stroke.
Research has demonstrated that stroke
patients who are seen by stroke specialists
in addition to the Emergency Department
physicians have a greater chance of
improvement. This same research has proven
that stroke specialists are uniquely qualified to
diagnose and treat stroke patients and should
be consulted on all acute stroke patients. The
Saint Alphonsus Telestroke Network is the
only place where patients can receive a stroke
specialist consultation 24/7. All hospitals in
the Saint Alphonsus Health System (Boise,
Eagle, Nampa, Ontario, and Baker City),
West Valley Medical Center, Grande Ronde
Hospital, Cascade Medical Center, and Walter
Knox Medical Center are linked to our
telestroke network.
When a person who may be having a
stroke arrives at the emergency department,
doctors can activate the secure system to
connect with a neurologist. Using the robotic
system, the neurologist can see and hear the
patient and emergency department doctor
(and vice versa), perform a stroke exam,
review brain scans, take a patient history,
and work with the emergency physician.
The result is a swift determination as to
whether TPA or other treatments are needed.
This allows treatment to begin in the rural
emergency department, even before transfer
to Saint Alphonsus. Early treatment has been
shown to improve outcomes and decrease
the long-term effects from stroke.
Telestroke is a partnership that helps
us deliver stroke care as quickly as possible.
But prehospital providers are our partners,
too. The Saint Alphonsus telestroke network
provides 24/7 access to stroke consultations
in hospitals without these specialists.
TELESTROkE BRINGS STROkE SpECIALISTS TO yOu
nICHoLE wHITENER
mSn, cnrn, ne-bc neuro/Stroke director
State-of-the-Art 3d modeling from the new 640 Slice Ct
NEuRO/STROkE
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Saint alphonSuS | emS newSletter
When emergency medical services personnel
alert hospitals of incoming stroke patients,
evaluation and treatment are improved, but
prenotification occurs in only about two-thirds
of cases, according to findings from two new
American Heart Association/American Stroke
Association (AHA/ASA) studies.
Both of the Get With The Guidelines–
Stroke program studies involved the same
group of nearly 372,000 patients with acute
ischemic stroke, who were transported
by emergency medical services to one of
1,585 participating hospitals between April
2003 and April 2011. One of the studies
showed that compared with no notification,
prenotification of an incoming stroke patient
was associated with significantly more
rapid evaluation and treatment, and with a
significantly greater likelihood of treatment
with tissue plasminogen activator (TPA) within
3 hours, Cheryl B. Lin of the Duke–National
University of Singapore Graduate Medical
School, Singapore, and her colleagues reported
online in Circulation: Cardiovascular Quality
and Outcomes.
For example, among patients who arrived
at the hospital within 3 hours of symptom
onset, median door-to-imaging time was 26
minutes, compared with 31 minutes for those
without prenotification. Door-to-imaging time
was within 25 minutes for 48.8% and 40.5%
of those with and without prenotification,
respectively. Also, symptom onset–to-door
times were lower with prenotification (113
vs. 150 minutes) (Circ. Cardiovasc. Qual.
Outcomes 2012 July 10 [doi: 10.1161/
circoutcomes.112.965210]).
Prenotification also significantly
improved door-to-needle time and symptom
onset–to-needle time, and more eligible
patients who arrived at the hospital within 2
hours were treated with TPA within 3 hours
(71.8% vs. 62.2%).
The problem is that prenotification
occurred in only 67% of cases, the authors said.
“Our analysis supports the role [of EMS
prenotification] as a potentially important but
under used means to improving rapid triage,
evaluation, and treatment of patients with
acute ischemic stroke,” they wrote, noting
that although prenotification is recommended
in guidelines from both the AHA/ ASA
and the National Association of Emergency
Medical Services Physicians, it appears many
hospitals “still find difficulty in meeting these
performance goals.”
In the related study published online
in the Journal of the American Heart
Association, Ms. Lin and her colleagues found
that prenotification varied widely by hospital
and region, with rates of prenotification
ranging from 0% to 100%.
EmS Prenotification of Hospitals Lags for INCOmING STROkE pATIENTSSharon worceSter, ImnG medical news
“prenotIfIcatIon
of an IncomInG
StroKe patIent
waS aSSocIated
wIth SIGnIfIcantly
more rapId
evaluatIon and
treatment”
EdWARd mCEACHERN, mdIep executive director/ceo
NEuRO/STROkE
September 2012 13
sarmc.org
In Washington, D.C., for example, the
prenotification rate was 19.7%, compared with
93.4% in Montana, the investigators said (J.
Am. Heart Assoc. 2012 July 10 [doi: 10.1161/
jaha.112.002345]).
Patient factors associated with increased
likelihood of prenotification were younger age,
white race, past history of atrial fibrillation,
no medical history of previous stroke or
transient ischemic attack, diabetes mellitus, and
peripheral vascular disease.
“In particular, black patients had
decreased odds [of EMS prenotification]
when compared to their white counterparts,
with adjusted odds ratio of 0.94,” the
investigators noted.
Hospital factors associated with reduced
likelihood of prenotification were academic
affiliation, location in the northeastern U.S., and
lower annual volume of TPA administration.
Rates of prenotification did increase
modestly and significantly over time, from
58% to 67% between 2003 and 2011, with
a high of 71.1% in 2008, followed by a
decline to about 65% in 2009 and 2010, and
an increase to 67.3% in 2011, but targeted
improvements in rates of EMS prenotification
are needed, they said.
“These findings demonstrate gaps
in the quality of stroke care provided and
support the need for initiatives targeted to
improve [EMS prenotification rates] on a
national level,” they concluded, explaining
that a systems approach is needed involving
increasing symptom recognition and rapid
activation of EMS, adequate training of
EMS staff in proper use of stroke-screening
instruments and the need for hospital
prenotification, and implementation of
systems of care in receiving hospitals.
A stroke system-of-care process measure
reporting the use of EMS prenotification
should be considered, they said.
The Get With the Guidelines (GWTG)–
Stroke program is provided by the AHA/
ASA and is supported in part by a charitable
contribution from the Bristol-Myers Squibb/
Sanofi Pharmaceuticals Partnership and
the AHA Pharmaceutical Roundtable. Past
support has been provided by Boehringer
Ingelheim and Merck. Ms. Lin reported
having no relevant conflicts of interest.
Several coauthors have worked with GWTG
committees, and some have received
research grant support from pharmaceutical
companies. Some researchers are employees
of the University of California, which holds a
patent on retriever devices for stroke.
NEuRO/STROkE
Want to share your story? [email protected]
Saint alphonSuS | emS newSletter
I am excited to share some news about a
completely new concept in Emergency
Medicine—the Senior ER. Saint Alphonsus
has developed specialized care for our elder
patients in all of our Emergency Departments
in the region, and the Eagle ER has been
chosen as the flagship site. The Senior ER
at Eagle is incorporated into the existing
Emergency Department, which will continue
to care for patients of all ages.
Seniors are the fastest growing segment
of the population. The number of seniors in
the country is expected to double between 2005
and 2050 according to the Pew Forum. A study
from George Washington University Medical
Center documented a 34-percent increase in
emergency room visits by the elderly in the
last decade. According to 2012 census data, of
Idaho’s current population of 1.5 million, 12.4
percent is over the age of 65, and climbing.
Studies also indicate that the hustle and
bustle of the main emergency room makes
some seniors uneasy. Seniors react differently
to noise levels, light levels, and shadows.
They sometimes have impaired hearing or
vision, and they often give subtler cues than
younger patients.
Most emergency rooms are geared toward
a younger population, with rapid diagnosis
and disposition, and a focus on an efficient,
high-tech experience. An environment that is
well-suited to handling crises, like car crashes
or gunshot wounds, may not be as effective at
unraveling the subtleties older patients arrive
with, like multiple conditions, medications,
caregivers and health care providers.
The Senior ER is a calmer, less-
stimulating environment where seniors can
feel secure getting their questions answered
with a family-member or caregiver nearby to
advocate for them.
We have upgraded our Eagle facility
with improvements like pressure-reducing
mattresses, quieter patient-areas, and non-
glare, non-skid flooring to help make seniors
more physically comfortable. Other upgrades
are meant to bridge the gap for seniors who
are visually or hearing impaired, like indirect
lighting, larger clocks and call buttons, and
hearing-assistance devices.
In standard ERs, the staff works to treat
the immediate medical issue. At the Senior
ER, we try to find the root causes in order to
see a more complete picture of the patient’s
health. We have developed more sophisticated
processes to screen patients over the age of
65, and we can now detect and address risks
of illness, injury, or adverse events related
to medications.
All Saint Alphonsus Senior ER nurses
have completed Geriatric Nursing Education
(GENE) through the Emergency Nurses
Association. This course alerts them to
differences in diagnosing and treating older
patients as well as the pitfalls of ageism in the
medical industry and how to avoid them.
We have connected with community
resources, and we have a dedicated resource
manager to coordinate safe discharge and high-
quality outpatient care. The majority of patients
will be contacted after discharge to facilitate care
and compliance with discharge instructions.
So far, families and patients have been
very satisfied with the care provided in the
Senior ER. And they appreciate that, when
admission is required, they will be transported
free-of-charge to their local hospital of choice.
We are proud to be the flagship for Saint
Alphonsus Senior ER, and to be a part of
the first dedicated Senior ERs in Idaho and
Oregon. We look forward to increasing our
service to the population of senior patients in
the Eagle area.
THE SENIOR ER
“we looK
forward to
IncreaSInG our
ServIce to the
populatIon of
SenIor patIentS In
the eaGle area”
ERIC ELLIOTT, mdIep/eagle er medical director
EAGLE ER
September 2012 15
sarmc.org
AwARDS & RECOGNITION
Greetings! I just wanted to take a moment
and properly thank you for taking care of
me while I was a 19 year old patient at Saint
Alphonsus Regional Medical Center. This
coming Labor Day will mark the time, 24
years ago (in 1988), when I was brought in,
via Life Flight, due to a pretty violent vehicle
accident I was in. I had a 6-inch gash in my
scalp, broke several teeth in my mouth, broke
my jaw, separated both shoulders, broke my
pelvis, punctured and collapsed both lungs,
and had cuts all over my body. The EMT’s (or
paramedics, I’m not too sure) kept my pieces
together and kept me alive until I was in your
care. I had lost a ton of blood and was in very
critical condition when I arrived. I have very
little recollection of the next couple of days as
my body clung to life.
Obviously, I survived and am alive and
well today. After my accident and recovery I
completed my undergraduate studies at the
University of Utah and received my bachelor’s
degree in Psychology. I went on to get my
master’s degree in Clinical Social Work at the
University of Utah. I have been working with
troubled youth all of my professional career. I
am married. I have 4 children and have helped
raise several foster children. Currently, I am
the Executive Director at the Family Support
Center of Washington County, in St. George,
Utah. I am also training to compete in a local
Iron Man competition next Spring. As I was
signing up for the Iron Man competition, I
stopped to reflect on the path that my life
has taken. I remembered once thinking that
I would never be able to participate in sports
or physical activities again. As I reflected
on my life, I focused on the time I spent at
Saint Alphonsus. Most of that time my body
was in great distress, but my mind and my
spirit was greatly comforted by the skill, care,
and kindness of the doctors, nurses, and
technicians. I owe all that I have accomplished
since that time: the literally thousands of
young people and their families I have had
the opportunity to help, counsel, and guide,
to those amazing staff of Saint Alphonsus
Regional Medical Center.
Saint Alphonsus Regional Medical
Center will always be the sunshine on the dark
memory of that fateful holiday 24 years ago.
Thank you!
A new report released in July by
Healthgrades, the leading provider of
information to help consumers make an
informed decision about physicians and
hospitals, found Saint Alphonsus Regional
Medical Center the only hospital in Idaho
to be both 5-Star rated and the recipient of
the Women’s Health Specialty Excellence
Award in 2012.
The study evaluated 16 women’s
medicine, cardiovascular, and bone and joint
health treatments and procedures over the
years 2008, 2009 and 2010 using data from
the federal Medicare program. Of the 4,783
acute care hospitals in the nation, Saint
Alphonsus Regional Medical Center and
175 other hospitals were identified as top
performers, worthy of this Women’s Health
Excellence Award.
The study found women’s mortality
rates were 42 percent lower than the poorest
performers, and complication rates were, on
average, 14 percent lower than the poorest
performing hospitals.
“In our study HealthGrades noted the
rate of surgical intervention for women
suffering a heart attack has increased over
the years. This is good news, especially for
patients who choose care at hospitals that
are top performers in women’s healthcare,”
said Divya Cantor, MD, MBA, HealthGrades
Senior Physician Consultant and author of
the study. “Our goal is to provide current,
independent data on clinical outcomes to
help prospective patients make informed
decisions about their providers while also
identifying hospitals that are setting national
benchmarks to which other hospitals can
aspire.”
If all of the nation’s hospitals had
patient outcomes among women at the
level of those receiving the HealthGrades
award, more than 39,000 women could have
potentially survived their hospitalization
and more than 19,000 women could have
potentially avoided a major in-hospital
complication. The HealthGrades 2012 Trends in Women’s Health in American Hospitals report, including the methodology, can be found at healthgrades.com.
SAINT ALpHONSuS AmONG TOp 5% IN NATION FoR EXCELLEnCE In WomEn’S HEALtH
24 yEAR ANNIVERSARy THANk yOu (Roger L. nelson, trauma Survivor)
BOISE 1055 n. Curtis Rd. 208.367.2121
EmERGENCy DEpTS.
BAkER CITy 3325 Pocahontas Rd. 541.523.6461
EAGLE 323 E. Riverside dr. 208.367.5300
NAmpA 1512 12th Ave. Rd. 208.463.5000
ONTARIO 351 SW 9th St. 541.881.7000
Saint Alphonsus Regional Medical Center 1055 N Curtis Road Boise, ID 83706
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