we are one

WE ARE ONEPROVIDING RESOURCES, EDUCATION, OUTREACH AND SUPPORT TO OUR VALUED EMS TEAM MEMBERS IN THE FIELD

SPRING 2015

EMS Teaching Day A Look Back, A Look Ahead - page 3

Support In the FieldEMS Physicians on Scene - page 4

New ED Directors - page 8

GEM Care - Specialized to TreatActive Seniors - page 14

All About KidsDedicated Pediatric ED - page 15

We're Verified - Trauma ReceivesNational Accreditation - page 16

Clark Burn Center - Region's OnlyBurn Center - page 18

Upstate: the onlyComprehensiveStroke Center in

CNY

Stroke survivorWarren Darby

2 SPRING 2015 WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL

At Upstate University Hospital, werecognize, appreciate and salute our EMS providers and the work they do.

We salute their dedication and commitment to making lives better and we recognize themas valuable members of the Upstate team.These providers, both volunteer and paid, havecommitted themselves to helping others. AndUpstate is committed to be there for them.

We Are One is a formal Upstate initiative thatlaunched in spring 2013 as a way to recognizethese valuable team members and providethem with resources, education, feedback, and support.

“As the region’s only academic medical center,we are responding to the needs of the region toensure that people throughout Central NewYork have the very best in care when firstresponders arrive on the scene,” said Derek

Cooney, MD, director of Upstate’s FellowshipProgram for EMS and Disaster Medicine.

We Are One now includes this publication anda sister website www.upstate.edu/weareone

From feature stories to upcoming classes,courses and conferences, this publication and website will provide EMS personnel with relevant and valuable information from departments and services within Upstate University Hospital.

While we may represent different agenciesand organizations that may be spread milesapart, our goal is the same – to provideoutstanding medical care as quickly aspossible. At Upstate, we value our EMSproviders as an integral part of our team.

At Upstate, we recognize We Are One. •

WE ARE ONE.

THANK YOU TO OUR 2014 SPONSORSPrESEnTing SPonSorS

SuPPorTing SPonSorS

Trauma Center

WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL SPRING 2015 3

TEACHING DAYThe second Annual PrehospitalMedicine and Trauma TeachingDay will be held May 18 atOnondaga Community College.

Last year's free event – a jointventure between Upstate MedicalUniversity's EMS Programs andEmergency Medicine, UpstateUniversity Hospital's Adult andPediatric Trauma Center andSUNY Onondaga CommunityCollege – drew nearly 200attendees and gave EMS providersa daylong conference and 4.5hours of CMEs.

The structure of this year'sconference is expected to be

similar to last year's. Attendeeswere able to select five of 15sessions to attend throughout the day, taught by a variety of guest speakers and experts from the staff of Upstate MedicalUniversity. This year's event will include breakfast and lunch. To learn more, log on towww.upstate.edu/weareone

If you'd like to register, or areinterested in a sponsorshippackage, please contact Rose Moreat 315-464-6197 or by email [email protected] •

SAVE THE DATE MONDAY, MAY 18For the Second Annual Upstate PrehospitalMedicine & Trauma Teaching Day

For more details as they become available,log on to www.upstate.edu/weareone

UPSTATE PREHOSPITALMEDICINE & TRAUMA

MAY 18


It was around 2:40 a.m. Nov. 6, whenOnondaga County's 911 center activated thepagers of Upstate University PoliceDepartment's Physician Response Team.

It was a mass casualty incident, or MCI. ATrailways bus carrying 52 passengers had juststruck a disabled vehicle and tractor-trailer onInterstate 81 near Nedrow. Dozens wereinjured and the bus driver was trapped.

Drs. Christopher Tanski, David Landsberg,Jeremy Joslin, and Erin Wirths all jumped fromtheir beds and responded. While Tanski,Landsberg and Wirths responded to the scene,Joslin headed to the Emergency Department tohandle the influx of patients expected from thecrash.

The team – which provides field response byspecially qualified EMS physicians – is theresult of a joint collaboration between Upstate’sDepartment of Emergency Medicine, Upstate

University Hospital, SUNY Upstate MedicalUniversity, and the University PoliceDepartment. While they typically respond toMCIs, such as the bus accident, team membersare also available for any number of scenariosfrom a big fire or building collapse to manmadeand natural disasters. EMS, law enforcementand fire agencies may also call for the on-callEMS physician to respond to assist withunusual or difficult calls.

“During an MCI or critical entrapmentscenario, prehospital providers can practice in amore efficient and advanced manner when theEMS physician arrives due to the fact that allthe Physician Response Team members havebeen specially authorized by the RegionalMedical Director to provide onscene medicaldirection,” said Dr. Derek Cooney, a physicianresponse team member as well as Upstate’sdirector of Emergency Medical Services andDisaster Medicine. “When the patient cannot

Support inthe field

Meet the Team:Upstate Squad 1; DavidLandsberg, MD;Christian Knutsen,MD; Derek R. Cooney,MD; Chris Tanski, MDand Jeremy Joslin, MD.

UPSTATE UNIVERSITY POLICE DEPARTMENT’S PHYSICIAN RESPONSE TEAM

be transported immediately to the hospital,the team brings specialized care to the field.The team also provides tactical medicalsupport during planned and unplannedoperations.”

The Team operates a specially equippedvehicle – Upstate Squad 1 – to allow for safeand efficient response of the on-call EMSphysician. The vehicle can deliver multiplephysicians if necessary and is equipped withUHF/VHF and digital truncated radios.Upstate Squad 1 (US1) carries equipment,medications, and specialized gear for the EMSphysician to perform advanced emergencyprocedures in the field.

Team members rotate so that one always hasUS1. During their recent activation, Tanskiand Landsberg drove their personal vehiclesto the scene while Wirths, who was assignedto the vehicle that day, met them at the scenein US1.

When they arrived, Tanski said they checkedin with the Incident Command to get anupdate and determine where they wereneeded.

“When I got on scene, many of the passengers,who luckily were not seriously injured, werewaiting for another bus to arrive to take themto area hospitals,” Tanski said. “So the focusturned toward the driver who was pinned inthe wreckage and was critically injured.”

Emergency responders spent 2 hours workingto free the driver from the wreckage. Teamphysicians provided medical care during thattime and once he was freed, a response teamphysician rode in the ambulance with theinjured bus driver.

Tanski, a fellowship-trained EMS physician,joined Upstate on July 1. The bus MCI wasthe newest team member's first on-scene call.

“This team is a great resource for firstresponders in the community,” Tanski said. “If they ever need additional assistance at ascene, we're here for them.” •

Investigators on scene of an MCI in Nedrow on Nov. 6. Early that morning a bus

carrying 52 passengers struck a disabledvehicle and tractor-trailer on Interstate 81.

The crash injured dozens and trapped thedriver in the wreckage for two hours.

Photo by David Lassman | syracuse.com

new Emergency Medicinephysicians can expand theirtraining to sub-specialize inEMS and Disaster Medicine.upstate is one of the very firstACgME-Accredited fellowshipprograms and offers a widerange of clinical, research andadministrative opportunities.our fellowship includes bothground and air medicaltransport training with avariety of different agencies.

As members of the Physicianresponse Team, the fellowshave the opportunity tointeract with multiple Fire andEMS agencies during MCis andother challenging calls. Thefellows work directly withupstate faculty to prepare forall types of prehospitalscenarios, including trainingto provide important fieldsurgical techniques.

Erin Wirths, 2014 EMSFellow



Upstate University Police Department’sPhysician Response Team are active members of the EMS community and provide medicaldirection and physician support services to anumber of agencies and organizations in ourcommunity.

Derek R. Cooney, MD, FF/NREMT-P,FACEP• The Medical Director for the

Physician Response Team. • Program Director of the EMS

Medicine Fellowship Program. • Completed his EMS fellowship

training at the Texas A&MHealth Science Center /Scott& White.

• Joined the faculty at Upstate in2007.

• Currently serves on the New York State EMS Council, theBoard of Directors of the National Association of EMSPhysicians, and is the acting-President of the Central NewYork EMS Council.

• He is firefighter/paramedic and is trained as a HAZMATtechnician.

EMS Agencies (Medical Director)• Cazenovia Area Volunteer Ambulance Corps • East Area Volunteer Emergency Services • Mercy Flight Central (Chief )• Northern Oswego County Ambulance • Rural Metro Medical Services – Central New York • Student Association Volunteer Ambulance Corps - SUNY

Oswego

Fire Departments/Districts• Cazenovia Fire Department • City of Oswego Fire Department• DeWitt Fire District • East Syracuse Fire Department • Mattydale Fire Department• Onondaga Hill Fire Department • Southwood Fire Department • Taunton Volunteer Fire Department • Williamstown Fire Department

Law Enforcement Agencies• Albany Field Office, Federal Bureau of Investigation

(Tactical Medical Support Physician)• SUNY Upstate University Police Department Physician

Response Team • Syracuse Police Department (SWAT Team Physician)

County Emergency Management• Oswego County Emergency Management and e-911 Center

Corporate Medical Support• Nine Mile Point Nuclear Power Station (Nuclear Response

Physician)• Oswego Speedway

Jeremy Joslin, MD, FACEP, FAWM* Completed his EMS specialty training

at SUNY Upstate * Medical Director of the Emergency

Department at Upstate UniversityHospital’s Downtown Campus

* Program director of the Wilderness &Expedition Medicine fellowshiptraining program.

EMS Agencies (Medical Director)East Area Volunteer Emergency Services

(Associate)

Fire Departments/Districts• Cicero Fire Department • Cleveland Fire Department • Northbay Fire Department• Sylvan Beach Fire Department

Law Enforcement Agencies• Town of Manlius Police Department (Department

Physician)

Event /Mass Gathering Medical Coverage • Dysfunctional Family BBQ Music Festival • Empire State Marathon • Ironman Syracuse • K-Rockathon Music Festival • Moe.down Music Festival • New York State Fair Infirmary • Syracuse Festival of Races • Syracuse Half Marathon

Upstate is Active IN THE EMS COMMUNITY

EMS PHYSICIANRADIO IDENTIFIERS:

DR. DEREK COONEY UPSTATE MD-1

DR. CHRIS KNUTSEN UPSTATE MD-2

DR. JEREMY JOSLIN UPSTATE MD-3

DR. DAVID LANDSBERG UPSTATE MD-4

DR. CHRIS TANSKI UPSTATE MD-5

EMS FELLOW (DR. ERIN WIRTHS)UPSTATE MD-20

TO ACCESSUPSTATE SQUAD 1(US1) IN ANEMERGENCY, CALL ONONDAGACOUNTY 911.

GIVING BACK TO THE COMMUNITY AS VOLUNTEERSMany Upstate employees extendpublic service into their privatelives, as volunteer firefighters.Meet four public safety officerswho do:

Dominick Albanese, MoyersCorners Fire Department

William O’Connor, MarcellusFire Department

Jess Brown, Minoa FireDepartment

Stephen L. Mauser, MoyersCorners Fire Department


Expedition / Wilderness Medicine• Desert RATS Ultramarathon – Colorado and

Utah • Grand to Grand Ultramarathon – Utah and

Arizona • Jungle Marathon – Brazil / Vietnam (Clinical

Medical Director)• The Ancient Khmer Path – Cambodia • The Last Secret Ultramarathon – Kingdom of

Bhutan • The Wild Elephant Trail – Sri Lanka

Corporate Medical Support• All Hands Volunteers, Inc. • Brian Catalina Entertainment, Inc. • Lucky 8 TV, Inc.

Christian Knutsen, MD, MPH,FACEP

*Completed his two year EMSFellowship at the University ofPittsburgh Medical Center * Joined the EmergencyDepartment in 2009.* Masters in Public Health with

a certificate in DisasterPreparedness, University ofPittsburgh, 2014* Associate Director of the EMS& Disaster Medicine Fellowship

* Medical Director for Upstate's EMS Programs * Chair of the REMAC EMS Education

Committee

EMS Agencies (Medical Director)• Mercy Flight Central (Medical Control

Physician)

Fire Departments/Districts• Brewerton Fire Department • Fayetteville Fire Department • Lafayette Fire Department • Liverpool Fire Department

Law Enforcement Agencies• SUNY Upstate University Police Department

Physician Response Team (Associate )• Syracuse Police Department (SWAT Team

Physician)

David Landsberg, MD, FACP,FCCP, FF/EMT-P• Has over 30 years

experience in EMSincluding 5 years as aFDNY Paramedic aswell as over 20 yearsin the fire service asan interior firefighter,which he continuestoday.

• Works as a full-timeCritical Carephysician

• Is an award winning educator of his peers holdingacademic ranks of Associate Professor in theDepartments Medicine and Emergency Medicinehere at Upstate.

EMS Agencies (Medical Director)• Skaneateles Area Volunteer Emergency Services

Fire Departments/Districts• Mottville Fire Department

Law Enforcement Agencies• Skaneateles Police Department

Public Access Defibrillation Programs• Town of Skaneateles

Chris Tanski, MD, MSEd, EMT• Physician member of

DMAT NY-4(Federal DisasterResponse Team)

• Completed his EMSfellowship training atUniversity of Buffalo

• Joined Upstatefaculty in 2014

• Mercy FlightWestern (MedicalControl Physician)

Fire Departments/Districts• Lyncourt Fire Department •

At right, Upstate public safetyofficers — and volunteerfirefighters — front (l-r)

Dominick Albanese, William O’Connor;

back (l-r): Jess Brown and Stephen Mauser.


Upstate University Hospital is pleased toannounce Jeremy Joslin, MD, FACEP, FAWM hasbeen named Medical Director of the EmergencyDepartment at Upstate University Hospital’sDowntown campus.

Joslin, an Assistant Professor for the Departmentof Emergency Medicine at Upstate MedicalUniversity, completed his Emergency Medicinespecialty training at SUNY Upstate and is thedirector of the Wilderness & Expedition Medicinefellowship training program.

He serves as medical director for numerous largeevents in the region, including the New York StateFair, the Empire State Marathon, and the IronmanSyracuse. He also provides prehospital medicalcare and advising to organizations and eventsaround the world, including disaster relieforganizations and high-risk reality televisionproduction companies.

Joslin is interested in strengthening Upstate’srelationship with EMS agencies and prehospitalproviders. He hopes to do so through newinitiatives and outreach.

He said EMS providers should expect to see newoperational processes implemented to improvethroughput and return to service times.

He also wants input and feedback from Upstate'svalued team members in the field.

He plans to initiate informal coffee-hour stylegatherings where he hopes to solicit feedback andsuggestions.

“In addition to the outreach, I want EMSproviders to know they can always email directlywith any questions or concerns,” Joslin said. “Iinvite any EMS agency director to contact me ifthey’d like to meet one on one.”

Dr. Joslin can be reached at [email protected] •

Jeremy Joslin, MD, FACEP, FAWM,Medical Director of the EmergencyDepartment at Upstate UniversityHospital’s Downtown campus.

TWO LOCATIONS FOR

Emergency

Meet our new nurse managers: Michelle Zoanetti, RN, Peds

ED manager; Susan Rainbow,RN, ED Nurse Manager; Scott

Jessie, MS, RN, CCRN,Director of ED Nursing;

Loretta Johnson, RN, Directorof Patient Safety and Tracy

Davis, RN, ED NurseManageer (not pictured).


Upstate University Hospital is pleased toannounce that Jay Brenner, MD, FACEP is the new Medical Director of the EmergencyDepartment at Upstate University Hospital'sCommunity Campus.

Dr. Brenner joined the Upstate faculty in 2008and has served as the Assistant MedicalDirector since 2011. He is a graduate of TheGeorge Washington University School ofMedicine and is currently an AssociateProfessor of Emergency Medicine andBioethics and Humanities at Upstate.

Dr. Brenner is pleased to accept the newposition and, like his counterpart JeremyJoslin, MD, FACEP, FAWM, in theDowntown Emergency Department, hopes to strengthen his relationship with EMS – butfor different reasons.

“I think there are some folks in the EMScommunity who are still unaware of theextensive and comprehensive services we offerat this location,” Brenner said.

Brenner said the Community Campus ED has24/7/365 coverage by board-certified andboard-eligible emergency physicians.

“Additionally, we have physician consultationservices including hospitalist medicine, generalsurgery, orthopedic surgery, obstetrics andgynecology, cardiology, urology, vascularsurgery, colorectal surgery, plastic surgery,psychiatry, neurology, hematology/oncology,neurosurgery, critical care, and gastro-enterology,” he said. “Our ancillary servicesinclude social work, pharmacy, physicaltherapy, occupational therapy, respiratorytherapy, and case management.”

Brenner said first responders have seen, andwill continue to see some changes in thecoming months.

Dr. Thomas Weidman, as one of the assistantresidency directors, is now overseeing theEmergency Medicine resident rotation at theCommunity Campus ED as of July 1 2014.The first-and third-year residents engage in

mock codes, and the third-year residents nowtake some overnight shifts to round out theirexperience.

“While EMS ought to divert patients meetingCVA criteria to a designated Stroke Center,many patients inadvertently arrive at theCommunity Campus ED with symptoms thatend up being secondary to a CVA,” Brennersaid. “As a result, the Community Campus ED is rolling out a more efficient CVAprotocol in the coming months to meet thisneed in coordination with the strokeneurology service.”

Brenner said there will be some new faces, too.Physician Assistants Jeffrey Sattora and CassidyCallahan will be coming on board full-time,joining Anthony Stirpe, PA, also full-time.Nurse Practitioners Bill Linsky and ValerieReap, as well as Jamie Winslow, PA, will becoming over from Upstate's Downtown ED to help cover shifts. The Advanced PracticeProviders team will also include David Bailey,PA, Cara Holohan, PA, Sherradyn Mack, PA,and Raymond McGinn, NP, all on per diemstatus. •

Care

upstate university Hospital’sDowntown and CommunityCampus EmergencyDepartments have begundistributing “Welcome Cards”thanking EMS providers andproviding contactinformation for feedback oncare provided, follow-up onpatient status and any otherquestions or comments theyhave about their experiencebringing patients to upstate’sEmergency Department.

Jay Brenner, MD, FACEP is the new MedicalDirector of the Emergency Department at UpstateUniversity Hospital’s Community Campus.


After StrokeDARBY’S ROAD TO RECOVERY

Just months after sufferinga stroke, UndersheriffWarren Darby waves tothe crowd as he marchesin Syracuse's 2014 St.Patrick's Day Parade.

When 70-year-old Warren Darbyofficially retired Jan. 1, he wrappedup his 53rd year of public service –

the past 20 of which were spent as, among otherthings, Onondaga County’s Undersheriff. Thoseyears have been filled with many accolades andsuccesses. And, as in any career – especially one involving oversight of a 650-persondepartment – there have been challenges. Butnone of those professional challenges were asdifficult as the personal challenge he faced on a July morning in 2013.

He did not immediately think “stroke.”

As his symptoms became more clear Darbybegan to realize he needed to hurry to thehospital. Not just any hospital. A designatedstroke center: Upstate University Hospital.

Word spread quickly about Darby’s medicalcrisis. Friends feared the worst. Darby says, “TheLord had other ideas,” as he recalls that day andthe months that followed into his recovery. Asblood leaked from a tiny vessel in Darby’s brain,he was at the mercy of a system of medical carethat he helped create, a system in which the stateDepartment of Health designates certainhospitals as stroke centers to improve quickaccess to definitive care for anyone suffering whatappears to be a stroke. Now Darby depended onthat system.

Stroke is a leading cause of disability in theUnited States and the fifth most prevalent causeof death. It happens when a blood vessel carrying

oxygen and nutrients to the brain ruptures orbecomes blocked by a clot. High blood pressureis one of the leading causes of stroke and the mostimportant controllable risk factor.

“For all strokes, the sooner you get to the hospital,the greater your chances that something can bedone,” says Gene Latorre, MD, the associateprofessor of neurology at Upstate who took care of Darby.

Symptoms StartDarby’s day began as it usually did, with breakfastaround 7 a.m. and the medication he has takenfor 10 years to help control his blood pressure.Then he put on his uniform and drove to work.

Darby climbed out of his car about 8 a.m. He feltoff balance. He steadied himself and carefullywalked into his office at the sheriff ’s headquartersin downtown Syracuse. He sat at his desk doingsome paperwork before a planned police detaillater in the day. About 45 minutes later, he stoodand felt the same imbalanced sensation.

He called his wife, Joan, a nurse. He recognizedsomething was wrong, and he did not believe heshould drive. She drove into Syracuse and calledhis cell phone when she arrived. When Darbystood up a third time, he felt imbalanced, and hisleft leg felt asleep. “That made me think, this ispossibly a stroke,” recalls Darby.

Joan drove him to his physician’s office. “Dr.Mitchell Brodey examined me, and the nextthing I know, I was in an ambulance on the wayto the stroke center.”

Darby’s career in public service includedleadership roles in emergency medical services,fire services and law enforcement. For 16 years heserved as president of the Central New York


Regional Emergency Medical Services Council, andrepresented the local council on the New York StateEmergency Medical Services Council. That’s how he wasinvolved in the New York State stroke center designations.

Upstate University Hospital was the first designated strokecenter in Central New York, and its staff provide stroke carethat is not available elsewhere. Darby felt confident asparamedics wheeled him into the downtown hospital.

Darby’s Stroke TeamA team of providers had already been mobilized and was readyfor him. Quickly it was determined that Darby had a smallbleed on the right side of his brain, which made sense, giventhe symptoms he experienced on his left side. Next, theysearched for the cause. The neurologist, Latorre, told Darbythat a weakened capillary deep in his brain had burst. He was suffering a hemorrhagic stroke. It would take 6 to 8 weeks for his body to absorb the blood and reveal any lastingdebilitation, but first the team had to get the bleeding to stop. Typically, the larger blood vessel will shut off thebleeding capillary, as long as the blood pressure is broughtunder control and the swelling managed. This is done chieflythrough medication.

“For the most part, unless the blood pressure is not controlled,it resolves on its own,” Latorre says.

He adds that “the size of the hemorrhage is not as importantas the location.” Some patients have minimal symptomsdespite large fist-sized collections of blood, and others arerendered comatose from a pea-sized bleed.

The worst spot to have a stroke is in the brainstem. Darby’sstroke was in the area above the brainstem known as “deepterritory.” He reacted promptly to his symptoms and got to the right designated stroke center quickly.

He received medication to help bring his blood pressuredown, and he was admitted to the Neuroscience IntensiveCare Unit on the ninth floor. He had a headache and nauseahis first night. He underwent many tests during his four-daystay as doctors monitored the bleeding and swelling. The

stroke affected Darby’sleft leg and threw hisbalance off, but hesuffered no cognitivedeficits.

“I still think with time,God willing, I may loseall of the debilitation that I have,” he says.

He was discharged with a walker. Through weeks ofrehabilitation at the Upstate University Hospital PhysicalMedicine and Rehabilitation Center, under the care ofphysical therapist Sara Bullock, Darby weaned himself to acane. Now he walks carefully on his own; most people cannottell that he suffered a stroke.

He continues to deal with fatigue, which doctors say may bethe longest lasting weakness from the stroke. When his body is over tired, Darby feels numbness in his left foot and up hislower leg. Doctors have told him to take a nap when thathappens. “Sleep is the best way to let the body repair a braininjury,” Darby recalls. “Regaining stamina is usually the lastthing to return, if it ever fully returns.”

Just a month after his stroke he was able to return to work for a few hours a day. By October, just three months later, hereturned to work full-time – but took breaks for a nap whenfatigue would set in.

“Patience is required for recovery from a stroke, because it does not happen quickly,” he says.

He continues to enjoy his favorite pastimes that he enjoyedbefore his stroke. From the first Saturday in May (walleyeopening) until hunting season begins in November, Darbyfishes with friends two or three times per week from the boathe keeps at his Brewerton home.

In retirement he expects to keep doing just that.

Today he takes his blood pressure medicines at breakfast and after supper every night and charts his vitals with hiswife/nurse. And he counts his blessing – and is grateful.

Darby poses with hisdoctor, Gene Latorre, MD,

associate professor ofneurology at Upstate.

Comprehensive Stroke IT TAKES A TEAM

UPSTATE AWARDED HIGHEST LEVELOF STROKE CARE

Brain expertiseStroke care depends on physicians,nurses, therapists and more.

Patients who are wheeled into UpstateUniversity Hospital’s emergencydepartment suffering from stroke arelikely to receive acute treatment andrehabilitative care under the same roof,followed by the same team ofproviders.

The hospital, the first comprehensivestroke center in Central New York,features the region’s only specializedneuroscience and rehabilitation floors,with three levels of specialized nursing

care. The neurologists, neurosurgeonsand emergency physicians trainstudents and conduct research thatimproves our understanding of howthe brain works and how best to treatstroke. They are always on call to carefor patients with stroke.

Since becoming a stroke center, Upstatehas also taken care of hundreds ofcomplicated stroke patients who weretoo sick to be cared for at otherhospitals in Central New York.

The hospital’s stroke team workstogether to determine what treatmentis best for each individual patient.

Upstate University Hospital is pleasedto announce the distinction ofbecoming the first and only hospital inthe Central New York region to beawarded DNV Comprehensive StrokeCenter Certification. That designationencompasses the full spectrum ofstroke care – diagnosis, treatment,rehabilitation and education – andestablishes clear metrics to evaluateoutcomes. Comprehensive strokecenters are typically the largest andbest-equipped hospitals in a givengeographical area that can treat anykind of stroke or stroke complication.

UpSTaTe offerS 24/7 acceSS anD:

• 5 neurosurgeons

• 3 endovascularinterventionalists

• 4 stroke neurologists

• 2 neuro-intensivists

• 23 neurologists

• 8 neurorehabilitationspecialists/physiatrists

• Approximately150 nurses who have

special training in thecare of neurological

patients, some of whomhave dual certification

in stroke andneuroscience.

MEET OUR NEWEST TEAM MEMBER Jennifer Curry is the new outreach coordinatorfor the upstate Comprehensive Stroke Center.She has 19 years nursing experience, with 17 years specializing in critical care andneurology specialties. in a recent letter to EMS providers she states: "i am personallycommitted to establishing collaborativerelationships with community hospitals acrossthe region...i look forward to telling you aboutthe 300+ individuals here at upstate, alldedicated to stroke rescue therapies andneurologic critical care. With our recentComprehensive designation, i can assure you our process and team is unlike any otherin Central new York and we’re excited to tellyou about it."

To set up a meeting, Curry can be reachedat (315) 464-2661 (office) or email:[email protected]



Before arrival at the eDWhen paramedics report a possiblestroke patient, Upstate’s team issummoned to the emergencydepartment. This includes anemergency physician, a neurologist, astroke coordinator and emergencydepartment nurses. In addition, thenursing supervisor alerts the pharmacy,laboratory and radiology departments.

In the eDBlood tests are done as soon as thepatient arrives, and a doctor conductsa neurological exam. CT or MRimaging or an arteriogram may be usedin the diagnosis, along with blood flowmeasurements and tests to detect clots.The staff also assembles a medicalhistory.

Ischemic strokes are treated with tPA,usually intravenously. Sometimes theblood clot is too big or the patient can not be given the clot bustingmedication due to contraindication.Fortunately, Upstate has specialist

Amar Swarnkar, MD who can take theclot out using special catheters insertedin the patient’s groin.

The treatment of a hemorrhagic strokedepends on its location and severity.Sometimes it is managed withmedications to carefully control bloodpressure, says Gene Latorre, MD. Othertimes, surgery is indicated. Surgeonsmay place clips at the base of theaneurysm, or they may place platinummicro-coils inside the vessel to act as amechanical barrier to blood flow.

Hypothermia is employed in thetreatment of some patients. Others mayundergo brain tissue oxygen monitoring.

In the neuro IcUUpstate has a 14-bed neuroscienceintensive care unit, plus 35 additionalbeds devoted to patients withneurological problems on other units.Nurses with neuro special trainingcontinue to monitor and implement theplan or care for each neurological patient.

rehabilitation to followPhysical, occupational and speechtherapists and a psychiatrist evaluateeach stroke patient within 24 hours ofadmission. Rehabilitative therapybegins almost immediately.

Upstate offers an inpatient rehabilitativeunit, where patients may be moved oncethey are able to handle three hours perday of therapy.

Rehabilitative counselors offer supportfor patients in returning to work orschool.

The outcome of acute stroke care isconnected to how quickly appropriateemergency treatment is initiated, andthe quality of the overall managementprovided. At Upstate, it is not unusualfor patients with severe stroke to gohome after three days, with minimal orno evidence of lasting stroke effects. •

Care TREATING A STROKE


GEM Care offers special emergency services tofunctional, active, over-65 seniors.

GEM Care is part of Upstate's CommunityCampus Emergency Department and offers acomfortable, quiet, and calming environment.

Open since July 2013, GEM Care’s MedicalDirector Dr. Jamie Ciaccio, MD, is pleasedwith the specialized emergency department’sservice and its progress.

“GEM Care is staffed by doctors, physicianassistants, nurses, pharmacists, social workers,and case managers who have a high level ofgeriatric knowledge and training and canprovide a higher level of geriatric care,” Ciacciosaid. “This team coordinates care with thepatient’s own doctor, with the goal to returnthe patient home safely. And as a result of thatteamwork and training, we’re meeting ourclinical goals of decreasing admissions to thehospital.”

Ciaccio said as people age, they become moreat risk when entering the hospital settingbecause they may be weakened from illness oron many medications. They may have multiplehealth issues and be more sensitive to changes.The GEM Care team has special healthcaretraining and expertise related to thecomplexity that comes with aging people.

For example, Ciaccio said, the nursing teammembers are all NICHE trained (Nurses

Improving Care for Healthsystem Elders) andpharmacists trained in geriatrics evaluate homemedication lists and make recommendations.

Discharge care is coordinated with outpatientservices with the help of a social worker andcase manager familiar with resources forseniors in the community.

The team has up-to-date assessment tools andscreens that match the needs of seniors.Further, Ciaccio said, they work with theprimary care physician to develop a plan foreach patient's continued health management.

“GEM Care is a new model for health caredesigned to get seniors home safely and keepthem out of nursing homes. It’s working.” •

GEM Care THE SENIOR EMERGENCY DEPARTMENT

GEM CARE EMERGENCYMEDICINE UNIT HAS:

• Comfortable, Calming, andQuiet ED Environment

• Stretchers with thickermattresses for comfort.Stretchers also have extraheight if there is a need tomove between beds.

• geriatric recliners areavailable for comfort and asan alternative to stretchers.

• Handrails for the patients tohold when walking andbathrooms close by foradded safety.

• Lighting is adjustable withdimmer switches toencourage rest while stillmaintaining sufficientlighting to stay safe.

• Large font options formedication education anddischarge instructions areavailable.

EMS PROVIDERS: for information on GEMCare, or a presentation on this specialized service, contact Dr. A.James Ciaccio at 315-492-5535 or [email protected]

GEM CAREUpstate University Hospital

Community Campus4900 Broad Road, Syracuse


The Pediatric Emergency Department at UpstateUniversity Hospital sees about 26,000 childreneach year. This 13-bed specialized department,located within Upstate’s Downtown CampusEmergency Department, accounts for over 60percent of all admissions to Upstate GolisanoChildren’s Hospital.

“We’re the only dedicated pediatricemergency department in Central New York,”said its Medical Director Richard M. Cantor,MD, FAAP, FACEP. “And we’re home to theonly nationally accredited Level I PediatricTrauma Center in New York State.”

Cantor said attending coverage combinesspecialists Board Certified in PediatricEmergency Medicine with Board CertifiedEmergency Physicians.

“We’re staffed by nurses who specialize inPediatric Emergency Care,” he added.

Cantor is proud that his team is the region’scenter for all facets of Pediatric EmergencyEducation, including PALS Courses andUpstate’s Annual Pediatric Emergency MedicineAssembly.

He’s proud to work alongside EMS providersfrom throughout the region, who on averagedeliver 15 children each day to Upstate’sPediatric Emergency Department.

He values these team members as much as thosehe works alongside every day – and has amessage to those providers.

“We are the final common pathway in theEmergency care of infants and children,” he said.“You, the prehospital provider, are an extension ofall that we do, and you do it well, each and everyday. Please consider us your ‘home’ for all thingsPediatric. After all, we are all privileged to delivercare to the children of Central New York.” •

Dr. Cantor shares asmile with Donovan,after his visit to thePediatric EmergencyDepartment at UpstateUniversity Hospital.

DedicationTO PEDIATRIC MEDICINE


Last spring Upstate University Hospital andUpstate Golisano Children’s Hospital becamethe first in the state to receive nationalverification as a Level 1 trauma center by aspecial committee of the American College ofSurgeons (ACS) in recognition of the optimaltrauma care the center provides patients.

Verification as Level 1 trauma centers for adultsand children followed an intensive two-dayonsite review by medical experts in the traumafield. They reviewed information related topatient outcomes, physician and nurse trainingand credentialing, facilities, trauma educationand outreach, staffing and administrativefunctions.

“The national verification as a Level 1 traumacenter for adults and children signifies thatUpstate has the expertise, the facility and theresources to provide optimal trauma care for allinjured patients,” said Upstate UniversityHospital Chief Executive Officer JohnMcCabe, MD. “The work that goes on in ourtrauma center to save lives throughout Central

and Upstate New York is a testament to thoseemployees who enter our doors everydaycommitted to providing the best care, even in some of the gravest of situations.”

The state has previously designated traumacenters, but this action, known as verification,is the first national review of Upstate’s traumaservices and the first to separately highlight thepediatric trauma service.

Among items assessed by the onsite reviewteam, was the ability of Upstate’s traumateam—emergency physicians, nurses, surgeons,respiratory therapists, lab technicians, ICUstaff and social workers—to mobilize quicklywhen a trauma call comes into the hospital.

The trauma service serves a 14-county regionand facilitates transports from ambulance and first aid crews from all across the region.Additionally, the trauma service receivesbetween 200 and 275 air transports annually. •

FIRST IN NYS TRAUMA TEAM:

We’re Verified!


William Marx, DO, FACS is now the AdultTrauma Program Medical Director and Chief,Division of Trauma, Critical Care, Burn andEmergency Surgery at Upstate Medical University.

Marx attended medical school on an Armyscholarship and earned his medical degree fromthe University of Health Sciences College ofOsteopathic Medicine in Kansas City, MO. Hecompleted his General Surgery and Critical Caretraining at Letterman Army Medical Center inSan Francisco, CA. It was there, on a traumarotation, that Marx fell in love with trauma.

“At that time I got to work with some of theworld's best trauma surgeons,” Marx said.“Watching them in action was such anadrenaline rush – they were incredibly skilled,very talented – and I remember thinking ‘I wantto be like them.’ And that's what did it for me.”

Marx joined the faculty at Upstate MedicalUniversity in 1993. He has held multipleleadership positions in Trauma and Critical Careand has risen through the academic ranks to beappointed as Professor of Surgery at UpstateMedical University. Marx has an established trackrecord of regional and national leadership in thecare of the injured patient. He served as vice chairand chair of the NY state Committee on Traumaand the Region Chief for Region II (NY, NJ andPuerto Rico). He is a member of the AmericanCollege of Surgeons National Committee onTrauma and has served on the PerformanceImprovement and Verification subcommittees.He has been a member of the State TraumaAdvisory Committee (STAC) since 1992 andnow serves as the Chair of the STAC.

Jolene Kittle, MS, RN, AACNS-AG, CCRN,CEN, CFRN, is the new Trauma ProgramManager. For more than 10 years Kittle hascared for trauma patients across a continuum of care including the Emergency Department,Surgical ICU, and the General Surgical/TraumaFloors at Upstate. She’s also worked as a flightRN at Mercy Flight Central.

Her love of nursingand her desire topursue it as a careerbegan as a young girl.She recalled achildhood wheresummer days werespent with hergrandmother andgrandfather while herparents worked. Onesummer, when she was9, her grandmother –always strong anddetermined – wasenduring cancertreatments despite agrim prognosis.

Exhausted, hergrandmother confidedin her one day that shewanted to stoptreatment – but knewit would be difficult forKittle's mother and grandfather.

“Looking back, I can see where it might seemlike that was a lot to lay on a 9-year-old kid,” shesaid. “But I didn't see it that way. I thought tomyself even then, ‘She told me this because sheknew I would understand and she knew Iwanted to be there for her that way.’”

It was at that point that Kittle made a decision.“I knew that I wanted to have a career in beingthere for people at their worst moments andthat I was blessed with the ability to be thatperson for people,” Kittle said. “It latertranslated into a love of caring for traumapatients. That is when people are at their worstand even more so because it is unexpected andunplanned.” •

Trauma Team has new leaders

“I am very excited to bepart of the Trauma Teamat Upstate as the TraumaProgram Manager,”Jolene Kittle said. “And Iam so fortunate to havethe opportunity to leadthis already well-functioning team.”

William Marx, DO, FACS has an established trackrecord of regional and national leadership in the careof the injured patient.

Upstate University Hospital’s Clark BurnCenter is a six-bed Intensive Care Unit that is a regional referral center providing state-of-the-art burn care.

The Clark Burn Center serves nearly half ofNew York State, providing care to 28 countiesfrom as far north as the St. Lawrence River tothe southern borders of New York State, andfrom Rochester to Westchester County,including the northern areas of Pennsylvaniaand parts of Canada. The Center cares for both adult and pediatric patients in theinpatient and outpatient settings.

This highly trained burn team, headed up byMohamed Elfar, MD, MSc, FACS, Director of Upstate's Clark Burn Center, and BurnAttending Joan Dolinak, MD, FACS, includesdedicated nurses, physician extenders, residentphysicians, burn technicians, physical therapists,occupational therapists, aides, social workers,case managers, dietitians, and spiritual carepersonnel.

This team provides state-of-the artcomprehensive care including Hubbardhydrotherapy tank, cardiovascular monitoringfor moderate sedation, and biologic dressingsfor complex, often painful outpatient burn care. The staff, who have extensive burn careexperience, provide care in a setting that affordsthem the opportunity to provide immediateburn care therapies not usually found inemergency rooms.

In addition to its extensive inpatient services,the Clark Burn Center also provides outpatientburn services.

It also provides a 24-hour phone consultationservice to emergency rooms, primary carephysicians, industry, andschools. That service isavailable by calling theUpstate UniversityHospital's Transfer Center at 315-464-5449 or 1-866-464-5449. •

ConditionsTreated/Services

Burns—thermal, chemical,electrical, and radiation

Frostbite

inhalation injury

Skin problems: epidermolysisbullosa, toxic epidermalnecrolysis (TEn), necrotizingfasciitis, Cutaneous diseases

Complex woundmanagement - chronic and acute

Upstate’s Clark Burn Center

The burn team is headed up by Mohamed Elfar,MD, MSc, FACS, Director of Upstate's Clark BurnCenter, and Burn Attending Joan Dolinak, MD,FACS (pictured below)



TrainingCalendar

CONTEMPORARY ISSuES INEMERgENCY MEDICINECONFERENCEApril 22

8:00 a.m. - 3:30 p.m.The Genesee Grande HotelThe Role of Emergency Departments inthe Diagnosis and Management ofInfectious DiseasesContact: Rose More [email protected]

ADvANCED CARDIAC LIFE SuPPORT Provider Classes April 27 - 28May 28 - 29

Refresher ClassesApril 14April 17May 1May 5June 16

PEDIATRIC ADvANCED LIFE SuPPORT Provider ClassesMay 11 - 12

Refresher ClassesApril 20 (5 p.m. class)May 7

ADvANCED TRAuMA LIFESuPPORT (ATLS)

This is a two-day program designed for physicians, nurse practitioners,physician assistants, nurses andadvanced EMTs. It focuses on thecritical first hour in the care of thetrauma patient.

Provider & Refresher CoursesApril 23 - 24

8 a.m. - 4:30 p.m.

EMT Original Start date June 24 M/W/F

Greater Baldwinsville Ambulance Corp(GBAC)11 Albert Palmer Lane, Baldwinsville, NY 13027(day classes)

PARAMEDIC CLASSESParamedic Refresher Start date: Aug. 17 - EMSTAT

For more information on this course, or to register: http://www.upstate.edu/emergency/education/emstat/courses/paramedic_refresher.php

Paramedic Original 2015-16 Application Period Opens Feb 1 - Closes July 15

ADvANCED BuRN LIFE SuPPORTMay 22Aug 14Nov 13

7 a.m. to 5 p.m.This all day course is offered four times a year. For more information, or to register for a course, contact: RebeccaWillison RN, ABLS Course Coordinator, at 315-464-2614

NEW COuRSE OFFERINg: TCAR May 19 - 20

The Trauma Care After Resuscitation(TCAR) course is created to meet thelearning needs of inpatient traumanurses. This live, 2-day educationalofferings give inpatient staff members the foundational, evidence-basedinformation and critical thinking skills necessary to meet regulatoryrequirements and provide excellent careto this challenging patient population.

Upstate offers classes, courses, seminars andconferences. Here’s a list of upcoming events.for more details on any of these events, or toregister, log on to www.upstate.edu/weareone

MONDAY, MAY 18Second Annual Upstate Prehospital Medicine &Trauma Teaching Day

For more details as they become available, log on towww.upstate.edu/weareone

DownTown campUS750 east adams Street

EMERGENCY DEPARTMENT• off ers state-of-the-art technology to care

for critically ill or injured patients.

• Handles all types of medical emergencies.

• Cares for patients transported by ground or air from throughoutCentral new York.

PEDIATRIC EMERGENCY DEPARTMENT • Located within the Downtown Campus Emergency Department.

• only dedicated pediatric emergency department and Level-onePediatric Trauma Center in the Central new York region.

• Cares for children with any illness and/or injury.

• Staff ed with physicians trained in pediatric emergencies.

SAVE THE DATEUpstate Prehospital Medicine& Trauma Teaching Day: WE ARE ONE

MONDAY, MAY 18 www.upstate.edu/weareone

Department of Emergency Medicine750 East Adams StreetSyracuse, NY 13210

commUnITy campUS4900 Broad road

EMERGENCY DEPARTMENT• Complements the downtown services in a quieter setting. Patients

brought to the Community Campus who require services fromdowntown will be moved seamlessly though our system.

• Patients who require hospitalization are admitted to eitherDowntown or the Community Campus based on their medical needs.

GEM CARE COMMUNITY CAMPUS• Located within the Community Campus Emergency Department

• Devoted to addressing the medical needs, sensibilities andbehavioral concerns of patients 65 and older

• gEM Care recognizes that traditional care models may not be aseffective in meeting the unique needs of the aging.

Upstate Emergency DepartmentsTWO LOCATIONS COVERED BY THE SAME MEDICAL STAFF

The region’s onlyLevel-oneTrauma center

we are one

Documents