Non-profit Org.U.S. PostagePAID

Permit No. 267Lincoln, NE

Trauma Update is published for friends ofBryanLGHMedical Center. Your commentsand suggestions are welcome. Directcorrespondence to the AdvancementDepartment at BryanLGH, or telephone theeditor at 402-481-8674.

Kimberly Russel, President, BryanLGH HealthSystem; John Woodrich, President, BryanLGHMedical Center; Edgar Bumanis, Director,Public Relations; Paul Hadley, Editor.

Address service requested.

BryanLGH Medical Center West2300 S. 16th St., Lincoln, NE 68502-3704

TRAUMAUPDATE

News from the Trauma Center at BryanLGH WINTER 2012TRAUMAUPDATE

rothers Gordon andKeith Christensen ofChristensen Con-struction were

shingling a new house in theirhometown of St. Paul on Nov.9, 2011, when Gordon

suddenly tripped.Gordon recalls that it was a

windy afternoon, and he thinksa shingle caught his foot whilehe was working, causing him totumble off the roof and hit two

(Please turn to Page 2.)

He rebuilds lifeafter fall from roof

B

Kim Reinhardt, RN, reviewscharts with Gordon Christensenduring a follow-up visit to theSpecialty Clinic at BryanLGH West.

Hundreds will gather Thursday, April 12, for theannual Tribute to Trauma Champions at the RococoTheatre in Lincoln.The event will recognize Elizabeth Canas Luong of

Crete and Bill Wimmers of Lincoln — two remarkabletrauma survivors — and honor the dedicatedprofessionals who were involved in saving their lives.

These include individuals from all aspects of thetrauma system, such as EMS providers, rural traumacenter personnel, StarCare, physicians and BryanLGHstaff members, as well as family members and thosewho provide ongoing care.Watch our www.bryanlghtrauma.org website for an

announcement about Tribute to Trauma Champions.

Mark your calendar

Trauma Champions shine April 12

According to the Centers for Disease Controland Prevention (CDC), falls are the leading causeof injury deaths for adults ages 65 and older.BryanLGH Trauma Center data reveal that 41percent of all injured patients evaluated at thecenter presented secondary to a fall.Consistent with the CDC data, the majority (77

percent) at BryanLGH were over 50 years of age.This population of patients often required a

continuum of care past the acute care phase.BryanLGH registry data show that almost half (45percent) of these patients required rehab orskilled nursing post discharge.Falls can result in a variety of injuries

rendering patients in need of continued care,from extremity fractures, rib fractures and solidorgan injury to head trauma. A study completedby the CDC in 2000 concluded that falls are themost common cause of traumatic brain injuries,and 46 percent of fall-related traumatic braininjuries were fatal. National data coupled withlocal registry data depict a significant patientpopulation in need of preventative medicine/fall prevention.

A focus review evaluating the registry data forthe fall-population at BryanLGH discovered therewas a need for change within the trauma systemregarding trauma activation criteria.The team divided fall data into categories,

separated by distance fallen. What the team foundwas that injured patients who suffered groundlevel falls (to include one step or curb) had anaverage age of 74. Injury Severity Score for thispopulation was 12 and length of stay was 4.42

(Please turn to Page 2.)

Falls rising amongolder Americans

Tribute to Trauma Champions is an opportunity to recognize trauma survivors and those who care for them.

www.bryanlghtrauma.org

2 7

Gordan’s storyhas happy ending(Continued from Page 1.)

sets of scaffolding on the way to theground. Keith drove Gordon to theHoward County Medical Center emer-gency department in his pickup truck.

Gordon didn’t think calling for anambulance was necessary; in fact, afterhis 14-foot fall, the 58-year-olddescribed his pain as “only a littlediscomfort.”

Despite Gordon Christensen’s stoicnature, the emergency physician at thelocal hospital recognized the potentialfor significant injury following a fallfrom height. He ordered severalradiologic and laboratory tests andarranged transfer to the BryanLGHTrauma Center via a Grand Islandambulance. Fall from height is CategoryII activation criteria at BryanLGH, so theCode Trauma was paged.

“We’re lucky that St. Paul has apretty good outfit. They knew what todo. They were able to assess me and fixme right up, so that I was ready fortransport to Lincoln,” Christensen says.

Trauma surgeon John Cordova, MD,and the trauma team met Gordon in thetrauma bay shortly after his ambulancearrived at BryanLGH West.

He had suffered six rib fractures, apneumothorax, pelvic fractures, sacralfractures and transverse processfractures in his lumbar area. Hedescribed having “slight discomfort,” yetGordon had sustained significantfractures that would need managing.Following further evaluation, Dr.Cordova made arrangements with DavidSamani, MD, the orthopedic surgeon oncall, for evaluation and treatment ofGordon’s orthopedic injuries.

Fortunately, his pelvic fractures didnot require surgery. He was able tomove around with toe-touch weight

bearing to his right leg. His rib fractureswere troublesome, and he received anepidural for pain control. It wasn’t longbefore Gordon was making improve-ments. Rehab care was recommended,and Gordon and his wife, Jennifer, chosethe Rehabilitation Unit at BryanLGHWest.

Physiatrist Jude Cook, MD, assumedcare of Gordon while he continued towork on recovering. Gordon spent 14days at BryanLGH, including five days inthe Rehabilitation Unit, before he wasready to return home with Jennifer.

“I really enjoy fishing and outdooractivities, so it was especially painful toknow all my neighbors were clearing mysnow back in St. Paul, and I couldn’thelp,” the former patient says.

He made the most of his time inrehab.

“Everyone at the hospital was reallygood to me. Even the student nurseswere so nice, energetic and eager tohelp,” he notes. “One thing I liked aboutrehab is they have participants eat theirmeals and do things together. I evenlearned to bake a pumpkin pie fortherapy!”

By the time he left, Gordon was ableto independently transfer himself andget around without the assistance ofothers, a good thing for an active mansuch as himself. Gordon has beendischarged but will continue to followup with the trauma team and Dr.Samani until full recovery is reached.Gordon’s story speaks to the success ofthe entire trauma system, from HowardCounty Medical Center to BryanLGHTrauma Center and the RehabilitationUnit at BryanLGH West.

Gordon states that he is “veryappreciative of the care of everyoneinvolved.”

(Continued from Page 1.)

days. This length of stay waslonger than our average length ofstay.Perhaps more telling was that

patients who suffered ground levelfalls were comparable in injuryseverity scores to other falls up to14 steps. After 14 steps, the injuryseverity score increased beyondground level falls. Interestingly,the length of stay remained longerfor ground level falls than for the14-step or greater category offalls. This data, coupled with datafor anticoagulation, spurred theteam to re-evaluate its activationcriteria. Based upon national andregistry data, the activationcriteria was changed to includeground level falls withaccompanying anticoagulationand/or a loss of consciousness(age >50 with a loss of conscious-ness or on anticoagulation).Anticoagulants, such as

Coumadin®, Plavix® andPradaxa®, are becomingincreasingly common in the olderpatient population. The TraumaCenter has met with local rescuedepartments encouraging themto consistently requestclarification of anticoagulantmedications in patientspresenting for evaluation.Twenty-eight percent of our

fall-population arrives fromoutside referral facilities. Weexpect that number to continueto increase as the elderlypopulation increases andawareness of the potential forsignificant injury becomes betterunderstood.

Most of us know the song: “Theweather outside is frightful, but thefire is so delightful, and since we’veno place to go, Let It Snow! Let ItSnow! Let It Snow!”

If we really had no place to go,these lyrics are probably good advice— stay home and keep warm.

But we seem to always havesomeplace to go. When the weather isfrightful and roads and walkways haveturned slick, and you need to drive orwalk in winter weather conditions, doso safely.

Here are a few things you can domake travel safer:

Keep an emergency kit in yourvehicle. Include these items:� Warm gloves.� Warm hat.� Hand warmers.� Boots.� Water.� Emergency food supply, candy

bars or energy bars.� Flashlight with extra batteries.� Blanket.� Shovel.� Kitty litter or sand for traction.� Windshield scraper.

Prepare your vehicle for travel,and follow these driving guidelines:� If you have a cell phone, take it

with you, along with a car charger.� Keep your tank close to full.� Check the antifreeze level.� Keep windshield washer fluid

topped off.� Brush the snow off your vehicle,

including your lights, before youdrive.

� Make certain your tires haveadequate tread and are properlyinflated.

� Increase your following distance to8-10 seconds when the roads arewet and it is snowing.

� Do not use cruise control whendriving on a potentially slipperysurface (wet, ice, sand).

� Accelerate and decelerate slowly.Remember: It takes longer to slowdown on icy roads.

� Don’t pass snow plows andsanding trucks. The drivers havelimited visibility, and you’re likelyto find the road in front of themworse than the road behind.

� Don’t assume your vehicle canhandle all conditions. Even four-wheel and front-wheel drivevehicles can encounter trouble onwinter roads.

� Be familiar with how your brakeswork; anti-lock needs to be appliedwith steady pressure (you will feela pulsing which is normal).

To help prevent falls on slipperysurfaces while you are walking, takethese precautions:� Expect surfaces to be slick,

including building entries.� Always inspect the surface where

you are walking.� Do not hurry, take your time.� Avoid routes that have not been

cleared or appear to be iced over.� Pay particular attention to surfaces

in the parking garages and lots.� Wear flat shoes with slip resistant

soles or rain/snow boots, maybeuse slip on traction aids.

� Take short, flat steps.� Clean snow and ice from your

shoes when entering buildings,before leaving carpeted areas andmoving onto tiled surfaces.

� When possible, use the coveredwalkways and park in coveredgarages.

Taking preventive actions is yourbest defense against having problemswhile traveling in winter conditions. Ifyou prepare your vehicle in advanceand observe safety precautions duringwinter weather, you can reduce therisk of weather related injuries.

So, when the weather is frightful,stay home and keep warm — but ifyou travel, do so as safely as possible.

poisoning in industrial nations. This addedcapability will benefit our residents andfirefighters for detection after exposure tocarbon monoxide.

The department’s overall Advanced LifeSupport project also will assist in the rapidresponse to medical emergencies to theeast between Waverly, Eagle and Waltonand to the southeast between Lincoln andBennet, and may be utilized by thecommunities and rural areas of Hickmanand Firth.

In the fall of 2011, SEFD beganconstruction of an addition to the HoldregeStation. This addition consists of a largetraining room, kitchen, office andrestrooms along with fire and EMS storagerooms. Other plans in 2012 are for anaddition to be added to the Pine LakeStation, as well, to accommodate largescale training events and ALS storage.

The average volunteer puts in about150-plus hours each year. Many memberstake additional classes across the state toimprove their skills, and several membersare requested instructors for otherdepartments. SEFD personnel have beenactive in both the Nebraska State VolunteerFire Fighters Association and the NebraskaFire Chiefs Association. SEFD has beenrepresented at every NSVFA and NFCAannual meeting since 1970.

The Southeast Rural Fire District hascome a long way since its inception in1962. The current area encompassed is lessthan one half the original area; however,the population served is more than doublewhat it was at the beginning. Much of thearea appears to be more suburban thanrural, but fire department personnel are still100 percent volunteers, Walton still isunincorporated, and many gravel roads andhistoric farmsteads still exist.

Although the calls we receive continueto increase, the fires seem bigger and thewrecks seem more severe, our dedicationto serve and protect the residents of thedistrict is just as strong today as it was 50years ago.

Be a safe traveler this winterFalls onthe rise

Southeast Fire Department celebrates 50 years of service

6 3

By Kelsey Selting, PT,DPT, BryanLGHRehabilitation Services

ixty percent ofAmericans willhave a balance

problem sometime intheir lives. Balance issuescan result in falls whichmay lead to life-threatening injuries.Balance is a very complexprocess that includessensory, visual and motorelements. For individualswho are experiencingbalance issues — andespecially those who havehad multiple falls — athorough evaluation by aphysical therapist isbeneficial. Because of thecomplexity of the balancesystem, the use oftechnology and advancedcomputer software mayprovide the bestmechanism for deter-mining the cause of thebalance issue, which inturn can improve theoutcomes of therapy for the patients.

Physical therapists at BryanLGH Medical Center havereceived specialized training to evaluate balance impairments.Therapists use the NeuroCom SMART EquiTest and BalanceMaster System to help determine specific impairments thatare the underlying cause of an individual’s balanceimpairment.

The NeuroCom Balance Master uses an innovative forceplate technology and advance computerized software systemthat allows a therapist to objectively differentiate theimpairments associated with balance problems. The system

relies on dynamic testconditions designed to reflectthe challenges of balance indaily life.

With visual biofeedback oneither a stable or unstablesupport surface and in a stableor dynamic visual environment,the physical therapist canassess the patient’s performingtask ranging from essentialdaily living activity throughhigh-level athletic skills. Theobjective data aids in thedesign of effective treatmentand/or training programsfocused on the specific sensoryand motor componentsunderlying patients’ functionalimpairments. The testingprovides for accurateidentification of which elementof the system is impaired.

Clinical observation alonemakes it very challenging todifferentiate among the varioussensory and motorimpairments. This specializedtechnology is used by thetherapist to more rapidly andaccurately identify theunderlying problem and

intervene to prevent future falls.Currently, BryanLGH is one of three facilities in Nebraska

that have balance experts who provide assessment and designeffect treatments using the NeuroCom SMART EquiTest andBalance Master System.

Individuals experiencing falls can be referred by theirprimary care provider to one of our balance experts atBryanLGH Outpatient Therapy by calling 402-481-5121. Oncean evaluation is completed and the underlying cause isdetermined, the patient will be referred back to theircommunity for treatment.

High-tech evaluations at BryanLGHhelp pinpoint causes of balance issuesBy John Porter, SEFD Chief

outheast Fire Department (SEFD)proudly celebrates its 50thanniversary in 2012. SEFD protectsmore than 7,500 people living in an

area of approximately 25 square miles onthe southern and eastern side of the city ofLincoln. We operate out of two stations thatprotect a primarily suburban to rural area.Our department is a public departmentconsisting of 36 volunteers.

The district was formed in 1962 toprovide fire protection to the area ofLancaster County directly southeast ofLincoln. This also included the incorporatedvillage of Walton.

In 1968, the department built the firststation at Pine Lake Road and NebraskaHighway 2. This was near one of two majorhighways in the district. In 1975, thedepartment began offering Basic LifeSupport (BLS) services and started weeklytraining/business meetings which continuetoday. In 1994, the department’s needsgrew, so a second station was built atHoldrege and 84th Street.

The mission of the SEFD is to providethe best possible care to the patients fromour response area as well as to those we

transport who are visitors to our area and tothose who are in our mutual aidorganization. By having the capability toprovide accurate diagnostics to thereceiving hospital prior to arrival, we can bebetter prepared to assist our patients.

SEFD is equipped to handle HazmatLevel 1 response. The department offersheavy rescue service for vehicle extricationand has search and rescue capabilities. Thedepartment runs two engines, twoambulances, two grass rigs, a heavy rescuevehicle and four tankers. Because most ofthe district is composed of acreages and issemi-rural, SEFD maintains the largest fleetof tankers in the county and has 12,500gallons of water ready to roll. Thedepartment also has a Lancaster Countydecontamination trailer.

The department provides fire protectionand rescue operations out of both its PineLake Station and Holdrege Station.

In 2008, SEFD upgraded from a QRT(Quick Response Team) type EMS service tosupplying BLS transport. Over the last fewyears the number of calls for our serviceshas dramatically increased. In 2007, thedepartment ran 98 fire and EMS calls. In2011, the department was called for service225 times.

In the fall of 2011, SEFD begantransitioning from a BLS service to anAdvanced Life Support (ALS) service andhopes to receive certification in March2012. Currently the department consists of24 EMTs and 4 Paramedics. The SoutheastFire Department’s acquisition of 12-leadEKG monitors, along with the education,training and additional supplies, means thedistrict is investing over $80,000 into theALS program. Our ALS program will greatlycompliment the needs of our residents.

SEFD is dedicated to providing astandardized higher level of care to ourpatients and community by shortening thetime from the patient’s symptoms totreatment. The patient’s odds of survival willbe vastly improved when paramedicsacquire a 12-lead EKG (electrocardiogram)while responding to chest pain emergencies.We believe the ALS service and equipmentwill significantly improve outcomes bydecreasing the time to treatment andrestoring blood flow to the heart.

One of the capabilities of our cardiacequipment will include carbon monoxide(CO) monitoring and Met Hemoglobindetection and segment trending alertsindicating changes in the patient’scondition. CO is the No. 1 cause of

SS

Patients experiencing balance issues benefit from athorough evaluation by a physical therapist.

Southeast Fire Department has 36 volunteers, with two stations that serve a 25-square-mile district.

54

ANOTHER SUCCESSFUL TRAUMA SYMPOSIUM

Symposium has pediatric focusBy Sheila Uridil, RN,Trauma ProgramManager

ryanLGH and StarCare AirAmbulance hosted the 9th annualTrauma Symposium Oct. 14 at

BryanLGH Medical Center West. This year’skeynote speaker was Don Moores, MD, chiefof pediatric surgery at Loma Linda UniversityChildren’s Hospital in California. Hispresentation highlighted pediatrics with afocus on identifying child abuse.

Speaking to the importance ofrecognition by healthcare professionals, hehighlighted key elements andresponsibilities in the healthcare providers’awareness of neglect and abuse. Inconjunction with providing education on thesubject, he shared alarming statisticsillustrating Nebraska’s abuse rate, which ishigher than California’s. Drawing on his vastexperience and knowledge of this issue, Dr.Moores’ presentation proved to be one fewwill ever forget.

Pediatric focused education continuedas Elisabeth Abel, RN, presented mid-morning. As an educator and flight nursefrom Denver, Colo., she also had numerousstories illustrating her educational

objectives. She provided informationregarding pre-hospital pediatric trauma andgeneral principles in providing pediatrictrauma care.

Providing care to injured patientsextends well beyond the initial acute injuryphase. Unfortunately, many patients go onto develop post traumatic stress disorder asa result on their traumatic injury. MaryKathryn Hunsberger, PhD, from theBryanLGH Counseling Center presented“Putting together the pieces,” aboutrecognition and treatment of post traumaticstress disorder. Nationally, PTSD makesheadlines as more of oursoldiers struggle withpost-war sequelae, butthe trauma populationoften suffers silently. Dr.Hunsberger’spresentation providedmuch needed awarenessof the disorder and thetrauma community’s rolein aiding our patients’recovery.

Lunch was providedwith tours of BryanLGHTrauma Services. The tour

included an up-close viewing of StarCare’shelicopter. Flight crew members wereavailable to explain the transport processand answer the many questions posed bythe curious onlookers. The tour alsoincluded the emergency rooms’ largesttrauma bay: “Room 5” illustrated modernequipment and supplies needed to care forthe most critically injured patients arriving atthe trauma center.

In addition to the direct patient careareas, participants were able to view theCenter for Excellence in Clinical Simulation.A mock intensive care patient was set up

B

with the simulator depicting a severe headtrauma. The tilt table was used, allowingviewers the opportunity to see firsthand theprocess taken to stand patients to treatintracranial hypertension. The mock patientalso had chest tubes, ventilator support andmany other critical adjuncts, depicting theentire process. This provided a great viewfor the symposium participants to see just

how extensive is the care for the criticalpatient.

The Plastinates also were on display.Plastinates are preserved bodies in theirentirety. Water and fat are replaced bycertain plastics, yielding specimens that donot smell or decay and retain mostproperties of the original body. BryanLGHCollege of Health Sciences is one of only

two colleges in the United States to owntheir own full body Plastinates foreducational purposes.

During the afternoon there were twobreakout sessions. One was lead by Dr.Moores on the topic of Pediatric AbdominalCompartment Syndrome. The alternatesession was lead by Tadd Delozier, MD, onpreparing trauma patients for transport. Dr.Delozier, of Nebraska Emergency Medicineat BryanLGH, is one of the many emergencydepartment physicians who assist infacilitating care for the injured patients.

The trauma symposium proved to be asuccessful day in providing education. EMSpersonnel, physicians, surgeons, nurses andmany other ancillary staff were inattendance, and just shy of 150 participantsjoined the BryanLGH staff to expand theirknowledge on caring for injured patients.

Watch for next year’s information toreserve your spot at the annual TraumaSymposium.

Trauma Symposium tours demonstrated thelatest educational tools from the BryanLGHCollege of Health Sciences, including specialcadavers known as Plastinates (in photo at left),and simulation mannequins from the Center forExcellence in Clinical Simulation helpeddemonstrate tilt table treatments (above) andpediatric injuries (at right, during breakoutpresentation by Dr. Tadd Delozier).

Keynote speaker Don Moores, MD, (above) presented“Recognition of Child Abuse” during the Symposium.

Elisabeth Abel, RN, (right) discussed pre-hospitalpediatric trauma and general pediatric trauma care.

54

ANOTHER SUCCESSFUL TRAUMA SYMPOSIUM

Symposium has pediatric focusBy Sheila Uridil, RN,Trauma ProgramManager

ryanLGH and StarCare AirAmbulance hosted the 9th annualTrauma Symposium Oct. 14 at

BryanLGH Medical Center West. This year’skeynote speaker was Don Moores, MD, chiefof pediatric surgery at Loma Linda UniversityChildren’s Hospital in California. Hispresentation highlighted pediatrics with afocus on identifying child abuse.

Speaking to the importance ofrecognition by healthcare professionals, hehighlighted key elements andresponsibilities in the healthcare providers’awareness of neglect and abuse. Inconjunction with providing education on thesubject, he shared alarming statisticsillustrating Nebraska’s abuse rate, which ishigher than California’s. Drawing on his vastexperience and knowledge of this issue, Dr.Moores’ presentation proved to be one fewwill ever forget.

Pediatric focused education continuedas Elisabeth Abel, RN, presented mid-morning. As an educator and flight nursefrom Denver, Colo., she also had numerousstories illustrating her educational

objectives. She provided informationregarding pre-hospital pediatric trauma andgeneral principles in providing pediatrictrauma care.

Providing care to injured patientsextends well beyond the initial acute injuryphase. Unfortunately, many patients go onto develop post traumatic stress disorder asa result on their traumatic injury. MaryKathryn Hunsberger, PhD, from theBryanLGH Counseling Center presented“Putting together the pieces,” aboutrecognition and treatment of post traumaticstress disorder. Nationally, PTSD makesheadlines as more of oursoldiers struggle withpost-war sequelae, butthe trauma populationoften suffers silently. Dr.Hunsberger’spresentation providedmuch needed awarenessof the disorder and thetrauma community’s rolein aiding our patients’recovery.

Lunch was providedwith tours of BryanLGHTrauma Services. The tour

included an up-close viewing of StarCare’shelicopter. Flight crew members wereavailable to explain the transport processand answer the many questions posed bythe curious onlookers. The tour alsoincluded the emergency rooms’ largesttrauma bay: “Room 5” illustrated modernequipment and supplies needed to care forthe most critically injured patients arriving atthe trauma center.

In addition to the direct patient careareas, participants were able to view theCenter for Excellence in Clinical Simulation.A mock intensive care patient was set up

B

with the simulator depicting a severe headtrauma. The tilt table was used, allowingviewers the opportunity to see firsthand theprocess taken to stand patients to treatintracranial hypertension. The mock patientalso had chest tubes, ventilator support andmany other critical adjuncts, depicting theentire process. This provided a great viewfor the symposium participants to see just

how extensive is the care for the criticalpatient.

The Plastinates also were on display.Plastinates are preserved bodies in theirentirety. Water and fat are replaced bycertain plastics, yielding specimens that donot smell or decay and retain mostproperties of the original body. BryanLGHCollege of Health Sciences is one of only

two colleges in the United States to owntheir own full body Plastinates foreducational purposes.

During the afternoon there were twobreakout sessions. One was lead by Dr.Moores on the topic of Pediatric AbdominalCompartment Syndrome. The alternatesession was lead by Tadd Delozier, MD, onpreparing trauma patients for transport. Dr.Delozier, of Nebraska Emergency Medicineat BryanLGH, is one of the many emergencydepartment physicians who assist infacilitating care for the injured patients.

The trauma symposium proved to be asuccessful day in providing education. EMSpersonnel, physicians, surgeons, nurses andmany other ancillary staff were inattendance, and just shy of 150 participantsjoined the BryanLGH staff to expand theirknowledge on caring for injured patients.

Watch for next year’s information toreserve your spot at the annual TraumaSymposium.

Trauma Symposium tours demonstrated thelatest educational tools from the BryanLGHCollege of Health Sciences, including specialcadavers known as Plastinates (in photo at left),and simulation mannequins from the Center forExcellence in Clinical Simulation helpeddemonstrate tilt table treatments (above) andpediatric injuries (at right, during breakoutpresentation by Dr. Tadd Delozier).

Keynote speaker Don Moores, MD, (above) presented“Recognition of Child Abuse” during the Symposium.

Elisabeth Abel, RN, (right) discussed pre-hospitalpediatric trauma and general pediatric trauma care.

Southeast Fire Department celebrates 50 years of service

6 3

By Kelsey Selting, PT,DPT, BryanLGHRehabilitation Services

ixty percent ofAmericans willhave a balance

problem sometime intheir lives. Balance issuescan result in falls whichmay lead to life-threatening injuries.Balance is a very complexprocess that includessensory, visual and motorelements. For individualswho are experiencingbalance issues — andespecially those who havehad multiple falls — athorough evaluation by aphysical therapist isbeneficial. Because of thecomplexity of the balancesystem, the use oftechnology and advancedcomputer software mayprovide the bestmechanism for deter-mining the cause of thebalance issue, which inturn can improve theoutcomes of therapy for the patients.

Physical therapists at BryanLGH Medical Center havereceived specialized training to evaluate balance impairments.Therapists use the NeuroCom SMART EquiTest and BalanceMaster System to help determine specific impairments thatare the underlying cause of an individual’s balanceimpairment.

The NeuroCom Balance Master uses an innovative forceplate technology and advance computerized software systemthat allows a therapist to objectively differentiate theimpairments associated with balance problems. The system

relies on dynamic testconditions designed to reflectthe challenges of balance indaily life.

With visual biofeedback oneither a stable or unstablesupport surface and in a stableor dynamic visual environment,the physical therapist canassess the patient’s performingtask ranging from essentialdaily living activity throughhigh-level athletic skills. Theobjective data aids in thedesign of effective treatmentand/or training programsfocused on the specific sensoryand motor componentsunderlying patients’ functionalimpairments. The testingprovides for accurateidentification of which elementof the system is impaired.

Clinical observation alonemakes it very challenging todifferentiate among the varioussensory and motorimpairments. This specializedtechnology is used by thetherapist to more rapidly andaccurately identify theunderlying problem and

intervene to prevent future falls.Currently, BryanLGH is one of three facilities in Nebraska

that have balance experts who provide assessment and designeffect treatments using the NeuroCom SMART EquiTest andBalance Master System.

Individuals experiencing falls can be referred by theirprimary care provider to one of our balance experts atBryanLGH Outpatient Therapy by calling 402-481-5121. Oncean evaluation is completed and the underlying cause isdetermined, the patient will be referred back to theircommunity for treatment.

High-tech evaluations at BryanLGHhelp pinpoint causes of balance issuesBy John Porter, SEFD Chief

outheast Fire Department (SEFD)proudly celebrates its 50thanniversary in 2012. SEFD protectsmore than 7,500 people living in an

area of approximately 25 square miles onthe southern and eastern side of the city ofLincoln. We operate out of two stations thatprotect a primarily suburban to rural area.Our department is a public departmentconsisting of 36 volunteers.

The district was formed in 1962 toprovide fire protection to the area ofLancaster County directly southeast ofLincoln. This also included the incorporatedvillage of Walton.

In 1968, the department built the firststation at Pine Lake Road and NebraskaHighway 2. This was near one of two majorhighways in the district. In 1975, thedepartment began offering Basic LifeSupport (BLS) services and started weeklytraining/business meetings which continuetoday. In 1994, the department’s needsgrew, so a second station was built atHoldrege and 84th Street.

The mission of the SEFD is to providethe best possible care to the patients fromour response area as well as to those we

transport who are visitors to our area and tothose who are in our mutual aidorganization. By having the capability toprovide accurate diagnostics to thereceiving hospital prior to arrival, we can bebetter prepared to assist our patients.

SEFD is equipped to handle HazmatLevel 1 response. The department offersheavy rescue service for vehicle extricationand has search and rescue capabilities. Thedepartment runs two engines, twoambulances, two grass rigs, a heavy rescuevehicle and four tankers. Because most ofthe district is composed of acreages and issemi-rural, SEFD maintains the largest fleetof tankers in the county and has 12,500gallons of water ready to roll. Thedepartment also has a Lancaster Countydecontamination trailer.

The department provides fire protectionand rescue operations out of both its PineLake Station and Holdrege Station.

In 2008, SEFD upgraded from a QRT(Quick Response Team) type EMS service tosupplying BLS transport. Over the last fewyears the number of calls for our serviceshas dramatically increased. In 2007, thedepartment ran 98 fire and EMS calls. In2011, the department was called for service225 times.

In the fall of 2011, SEFD begantransitioning from a BLS service to anAdvanced Life Support (ALS) service andhopes to receive certification in March2012. Currently the department consists of24 EMTs and 4 Paramedics. The SoutheastFire Department’s acquisition of 12-leadEKG monitors, along with the education,training and additional supplies, means thedistrict is investing over $80,000 into theALS program. Our ALS program will greatlycompliment the needs of our residents.

SEFD is dedicated to providing astandardized higher level of care to ourpatients and community by shortening thetime from the patient’s symptoms totreatment. The patient’s odds of survival willbe vastly improved when paramedicsacquire a 12-lead EKG (electrocardiogram)while responding to chest pain emergencies.We believe the ALS service and equipmentwill significantly improve outcomes bydecreasing the time to treatment andrestoring blood flow to the heart.

One of the capabilities of our cardiacequipment will include carbon monoxide(CO) monitoring and Met Hemoglobindetection and segment trending alertsindicating changes in the patient’scondition. CO is the No. 1 cause of

SS

Patients experiencing balance issues benefit from athorough evaluation by a physical therapist.

Southeast Fire Department has 36 volunteers, with two stations that serve a 25-square-mile district.

2 7

Gordan’s storyhas happy ending(Continued from Page 1.)

sets of scaffolding on the way to theground. Keith drove Gordon to theHoward County Medical Center emer-gency department in his pickup truck.

Gordon didn’t think calling for anambulance was necessary; in fact, afterhis 14-foot fall, the 58-year-olddescribed his pain as “only a littlediscomfort.”

Despite Gordon Christensen’s stoicnature, the emergency physician at thelocal hospital recognized the potentialfor significant injury following a fallfrom height. He ordered severalradiologic and laboratory tests andarranged transfer to the BryanLGHTrauma Center via a Grand Islandambulance. Fall from height is CategoryII activation criteria at BryanLGH, so theCode Trauma was paged.

“We’re lucky that St. Paul has apretty good outfit. They knew what todo. They were able to assess me and fixme right up, so that I was ready fortransport to Lincoln,” Christensen says.

Trauma surgeon John Cordova, MD,and the trauma team met Gordon in thetrauma bay shortly after his ambulancearrived at BryanLGH West.

He had suffered six rib fractures, apneumothorax, pelvic fractures, sacralfractures and transverse processfractures in his lumbar area. Hedescribed having “slight discomfort,” yetGordon had sustained significantfractures that would need managing.Following further evaluation, Dr.Cordova made arrangements with DavidSamani, MD, the orthopedic surgeon oncall, for evaluation and treatment ofGordon’s orthopedic injuries.

Fortunately, his pelvic fractures didnot require surgery. He was able tomove around with toe-touch weight

bearing to his right leg. His rib fractureswere troublesome, and he received anepidural for pain control. It wasn’t longbefore Gordon was making improve-ments. Rehab care was recommended,and Gordon and his wife, Jennifer, chosethe Rehabilitation Unit at BryanLGHWest.

Physiatrist Jude Cook, MD, assumedcare of Gordon while he continued towork on recovering. Gordon spent 14days at BryanLGH, including five days inthe Rehabilitation Unit, before he wasready to return home with Jennifer.

“I really enjoy fishing and outdooractivities, so it was especially painful toknow all my neighbors were clearing mysnow back in St. Paul, and I couldn’thelp,” the former patient says.

He made the most of his time inrehab.

“Everyone at the hospital was reallygood to me. Even the student nurseswere so nice, energetic and eager tohelp,” he notes. “One thing I liked aboutrehab is they have participants eat theirmeals and do things together. I evenlearned to bake a pumpkin pie fortherapy!”

By the time he left, Gordon was ableto independently transfer himself andget around without the assistance ofothers, a good thing for an active mansuch as himself. Gordon has beendischarged but will continue to followup with the trauma team and Dr.Samani until full recovery is reached.Gordon’s story speaks to the success ofthe entire trauma system, from HowardCounty Medical Center to BryanLGHTrauma Center and the RehabilitationUnit at BryanLGH West.

Gordon states that he is “veryappreciative of the care of everyoneinvolved.”

(Continued from Page 1.)

days. This length of stay waslonger than our average length ofstay.Perhaps more telling was that

patients who suffered ground levelfalls were comparable in injuryseverity scores to other falls up to14 steps. After 14 steps, the injuryseverity score increased beyondground level falls. Interestingly,the length of stay remained longerfor ground level falls than for the14-step or greater category offalls. This data, coupled with datafor anticoagulation, spurred theteam to re-evaluate its activationcriteria. Based upon national andregistry data, the activationcriteria was changed to includeground level falls withaccompanying anticoagulationand/or a loss of consciousness(age >50 with a loss of conscious-ness or on anticoagulation).Anticoagulants, such as

Coumadin®, Plavix® andPradaxa®, are becomingincreasingly common in the olderpatient population. The TraumaCenter has met with local rescuedepartments encouraging themto consistently requestclarification of anticoagulantmedications in patientspresenting for evaluation.Twenty-eight percent of our

fall-population arrives fromoutside referral facilities. Weexpect that number to continueto increase as the elderlypopulation increases andawareness of the potential forsignificant injury becomes betterunderstood.

Most of us know the song: “Theweather outside is frightful, but thefire is so delightful, and since we’veno place to go, Let It Snow! Let ItSnow! Let It Snow!”

If we really had no place to go,these lyrics are probably good advice— stay home and keep warm.

But we seem to always havesomeplace to go. When the weather isfrightful and roads and walkways haveturned slick, and you need to drive orwalk in winter weather conditions, doso safely.

Here are a few things you can domake travel safer:

Keep an emergency kit in yourvehicle. Include these items:� Warm gloves.� Warm hat.� Hand warmers.� Boots.� Water.� Emergency food supply, candy

bars or energy bars.� Flashlight with extra batteries.� Blanket.� Shovel.� Kitty litter or sand for traction.� Windshield scraper.

Prepare your vehicle for travel,and follow these driving guidelines:� If you have a cell phone, take it

with you, along with a car charger.� Keep your tank close to full.� Check the antifreeze level.� Keep windshield washer fluid

topped off.� Brush the snow off your vehicle,

including your lights, before youdrive.

� Make certain your tires haveadequate tread and are properlyinflated.

� Increase your following distance to8-10 seconds when the roads arewet and it is snowing.

� Do not use cruise control whendriving on a potentially slipperysurface (wet, ice, sand).

� Accelerate and decelerate slowly.Remember: It takes longer to slowdown on icy roads.

� Don’t pass snow plows andsanding trucks. The drivers havelimited visibility, and you’re likelyto find the road in front of themworse than the road behind.

� Don’t assume your vehicle canhandle all conditions. Even four-wheel and front-wheel drivevehicles can encounter trouble onwinter roads.

� Be familiar with how your brakeswork; anti-lock needs to be appliedwith steady pressure (you will feela pulsing which is normal).

To help prevent falls on slipperysurfaces while you are walking, takethese precautions:� Expect surfaces to be slick,

including building entries.� Always inspect the surface where

you are walking.� Do not hurry, take your time.� Avoid routes that have not been

cleared or appear to be iced over.� Pay particular attention to surfaces

in the parking garages and lots.� Wear flat shoes with slip resistant

soles or rain/snow boots, maybeuse slip on traction aids.

� Take short, flat steps.� Clean snow and ice from your

shoes when entering buildings,before leaving carpeted areas andmoving onto tiled surfaces.

� When possible, use the coveredwalkways and park in coveredgarages.

Taking preventive actions is yourbest defense against having problemswhile traveling in winter conditions. Ifyou prepare your vehicle in advanceand observe safety precautions duringwinter weather, you can reduce therisk of weather related injuries.

So, when the weather is frightful,stay home and keep warm — but ifyou travel, do so as safely as possible.

poisoning in industrial nations. This addedcapability will benefit our residents andfirefighters for detection after exposure tocarbon monoxide.

The department’s overall Advanced LifeSupport project also will assist in the rapidresponse to medical emergencies to theeast between Waverly, Eagle and Waltonand to the southeast between Lincoln andBennet, and may be utilized by thecommunities and rural areas of Hickmanand Firth.

In the fall of 2011, SEFD beganconstruction of an addition to the HoldregeStation. This addition consists of a largetraining room, kitchen, office andrestrooms along with fire and EMS storagerooms. Other plans in 2012 are for anaddition to be added to the Pine LakeStation, as well, to accommodate largescale training events and ALS storage.

The average volunteer puts in about150-plus hours each year. Many memberstake additional classes across the state toimprove their skills, and several membersare requested instructors for otherdepartments. SEFD personnel have beenactive in both the Nebraska State VolunteerFire Fighters Association and the NebraskaFire Chiefs Association. SEFD has beenrepresented at every NSVFA and NFCAannual meeting since 1970.

The Southeast Rural Fire District hascome a long way since its inception in1962. The current area encompassed is lessthan one half the original area; however,the population served is more than doublewhat it was at the beginning. Much of thearea appears to be more suburban thanrural, but fire department personnel are still100 percent volunteers, Walton still isunincorporated, and many gravel roads andhistoric farmsteads still exist.

Although the calls we receive continueto increase, the fires seem bigger and thewrecks seem more severe, our dedicationto serve and protect the residents of thedistrict is just as strong today as it was 50years ago.

Be a safe traveler this winterFalls onthe rise

Non-profit Org.U.S. PostagePAID

Permit No. 267Lincoln, NE

Trauma Update is published for friends ofBryanLGHMedical Center. Your commentsand suggestions are welcome. Directcorrespondence to the AdvancementDepartment at BryanLGH, or telephone theeditor at 402-481-8674.

Kimberly Russel, President, BryanLGH HealthSystem; John Woodrich, President, BryanLGHMedical Center; Edgar Bumanis, Director,Public Relations; Paul Hadley, Editor.

Address service requested.

BryanLGH Medical Center West2300 S. 16th St., Lincoln, NE 68502-3704

TRAUMAUPDATE

News from the Trauma Center at BryanLGH WINTER 2012TRAUMAUPDATE

rothers Gordon andKeith Christensen ofChristensen Con-struction were

shingling a new house in theirhometown of St. Paul on Nov.9, 2011, when Gordon

suddenly tripped.Gordon recalls that it was a

windy afternoon, and he thinksa shingle caught his foot whilehe was working, causing him totumble off the roof and hit two

(Please turn to Page 2.)

He rebuilds lifeafter fall from roof

B

Kim Reinhardt, RN, reviewscharts with Gordon Christensenduring a follow-up visit to theSpecialty Clinic at BryanLGH West.

Hundreds will gather Thursday, April 12, for theannual Tribute to Trauma Champions at the RococoTheatre in Lincoln.The event will recognize Elizabeth Canas Luong of

Crete and Bill Wimmers of Lincoln — two remarkabletrauma survivors — and honor the dedicatedprofessionals who were involved in saving their lives.

These include individuals from all aspects of thetrauma system, such as EMS providers, rural traumacenter personnel, StarCare, physicians and BryanLGHstaff members, as well as family members and thosewho provide ongoing care.Watch our www.bryanlghtrauma.org website for an

announcement about Tribute to Trauma Champions.

Mark your calendar

Trauma Champions shine April 12

According to the Centers for Disease Controland Prevention (CDC), falls are the leading causeof injury deaths for adults ages 65 and older.BryanLGH Trauma Center data reveal that 41percent of all injured patients evaluated at thecenter presented secondary to a fall.Consistent with the CDC data, the majority (77

percent) at BryanLGH were over 50 years of age.This population of patients often required a

continuum of care past the acute care phase.BryanLGH registry data show that almost half (45percent) of these patients required rehab orskilled nursing post discharge.Falls can result in a variety of injuries

rendering patients in need of continued care,from extremity fractures, rib fractures and solidorgan injury to head trauma. A study completedby the CDC in 2000 concluded that falls are themost common cause of traumatic brain injuries,and 46 percent of fall-related traumatic braininjuries were fatal. National data coupled withlocal registry data depict a significant patientpopulation in need of preventative medicine/fall prevention.

A focus review evaluating the registry data forthe fall-population at BryanLGH discovered therewas a need for change within the trauma systemregarding trauma activation criteria.The team divided fall data into categories,

separated by distance fallen. What the team foundwas that injured patients who suffered groundlevel falls (to include one step or curb) had anaverage age of 74. Injury Severity Score for thispopulation was 12 and length of stay was 4.42

(Please turn to Page 2.)

Falls rising amongolder Americans

Tribute to Trauma Champions is an opportunity to recognize trauma survivors and those who care for them.

www.bryanlghtrauma.org