WE ARE ONE PROVIDING RESOURCES, EDUCATION, OUTREACH AND SUPPORT TO OUR VALUED EMS TEAM MEMBERS IN THE FIELD
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Upstate: the only Comprehensive Stroke Center in CNY EMS Teaching Day A Look Back, A Look Ahead - page 3 Support In the Field EMS Physicians on Scene - page 4 New ED Directors - page 8 GEM Care - Specialized to Treat Active Seniors - page 14 All About Kids Dedicated Pediatric ED - page 15 We're Verified - Trauma Receives National Accreditation - page 16 Clark Burn Center - Region's Only Burn Center - page 18
Stroke survivor Warren Darby
WE ARE ONE.
At Upstate University Hospital, we recognize, appreciate and salute our EMS providers and the work they do. We salute their dedication and commitment to making lives better and we recognize them as valuable members of the Upstate team. These providers, both volunteer and paid, have committed themselves to helping others. And Upstate is committed to be there for them. We Are One is a formal Upstate initiative that launched in spring 2013 as a way to recognize these valuable team members and provide them with resources, education, feedback, and support. “As the region’s only academic medical center, we are responding to the needs of the region to ensure that people throughout Central New York have the very best in care when first responders arrive on the scene,” said Derek
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Cooney, MD, director of Upstate’s Fellowship Program for EMS and Disaster Medicine. We Are One now includes this publication and a 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 agencies and organizations that may be spread miles apart, our goal is the same – to provide outstanding medical care as quickly as possible. At Upstate, we value our EMS providers as an integral part of our team. At Upstate, we recognize We Are One.
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WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
UPSTATE PREHOSPITAL MEDICINE & TRAUMA The second Annual Prehospital Medicine and Trauma Teaching Day will be held May 18 at Onondaga Community College. Last year's free event – a joint venture between Upstate Medical University's EMS Programs and Emergency Medicine, Upstate University Hospital's Adult and Pediatric Trauma Center and SUNY Onondaga Community College – drew nearly 200 attendees and gave EMS providers a daylong conference and 4.5 hours of CMEs.
TEACHING DAY
similar to last year's. Attendees were able to select five of 15 sessions to attend throughout the day, taught by a variety of guest speakers and experts from the staff of Upstate Medical University. This year's event will include breakfast and lunch. To learn more, log on to www.upstate.edu/weareone
Trauma Center
THANK YOU TO OUR 2014 SPONSORS PrESEnTing SPonSorS
If you'd like to register, or are interested in a sponsorship package, please contact Rose More at 315-464-6197 or by email at morer@upstate.edu •
The structure of this year's conference is expected to be
SAVE THE DATE
MAY 18
SuPPorTing SPonSorS
MONDAY, MAY 18
For the Second Annual Upstate Prehospital Medicine & Trauma Teaching Day For more details as they become available, log on to www.upstate.edu/weareone
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
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Support in the field UPSTATE UNIVERSITY POLICE DEPARTMENT’S PHYSICIAN RESPONSE TEAM Meet the Team: Upstate Squad 1; David Landsberg, MD; Christian Knutsen, MD; Derek R. Cooney, MD; Chris Tanski, MD and Jeremy Joslin, MD.
It was around 2:40 a.m. Nov. 6, when Onondaga County's 911 center activated the pagers of Upstate University Police Department's Physician Response Team. It was a mass casualty incident, or MCI. A Trailways bus carrying 52 passengers had just struck a disabled vehicle and tractor-trailer on Interstate 81 near Nedrow. Dozens were injured and the bus driver was trapped. Drs. Christopher Tanski, David Landsberg, Jeremy Joslin, and Erin Wirths all jumped from their beds and responded. While Tanski, Landsberg and Wirths responded to the scene, Joslin headed to the Emergency Department to handle the influx of patients expected from the crash. The team – which provides field response by specially qualified EMS physicians – is the result of a joint collaboration between Upstate’s Department of Emergency Medicine, Upstate
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University Hospital, SUNY Upstate Medical University, and the University Police Department. While they typically respond to MCIs, such as the bus accident, team members are also available for any number of scenarios from a big fire or building collapse to manmade and natural disasters. EMS, law enforcement and fire agencies may also call for the on-call EMS physician to respond to assist with unusual or difficult calls. “During an MCI or critical entrapment scenario, prehospital providers can practice in a more efficient and advanced manner when the EMS physician arrives due to the fact that all the Physician Response Team members have been specially authorized by the Regional Medical Director to provide onscene medical direction,” said Dr. Derek Cooney, a physician response team member as well as Upstate’s director of Emergency Medical Services and Disaster Medicine. “When the patient cannot WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
new Emergency Medicine physicians can expand their training to sub-specialize in EMS and Disaster Medicine. upstate is one of the very first ACgME-Accredited fellowship programs and offers a wide range of clinical, research and administrative opportunities. our fellowship includes both ground and air medical transport training with a variety of different agencies. Photo by David Lassman | syracuse.com
be transported immediately to the hospital, the team brings specialized care to the field. The team also provides tactical medical support during planned and unplanned operations.” The Team operates a specially equipped vehicle – Upstate Squad 1 – to allow for safe and efficient response of the on-call EMS physician. The vehicle can deliver multiple physicians if necessary and is equipped with UHF/VHF and digital truncated radios. Upstate Squad 1 (US1) carries equipment, medications, and specialized gear for the EMS physician to perform advanced emergency procedures in the field. Team members rotate so that one always has US1. During their recent activation, Tanski and Landsberg drove their personal vehicles to the scene while Wirths, who was assigned to the vehicle that day, met them at the scene in US1. When they arrived, Tanski said they checked in with the Incident Command to get an update and determine where they were needed.
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Investigators on scene of an MCI in Nedrow on Nov. 6. Early that morning a bus carrying 52 passengers struck a disabled vehicle and tractor-trailer on Interstate 81. The crash injured dozens and trapped the driver in the wreckage for two hours.
“When I got on scene, many of the passengers, who luckily were not seriously injured, were waiting for another bus to arrive to take them to area hospitals,” Tanski said. “So the focus turned toward the driver who was pinned in the wreckage and was critically injured.”
As members of the Physician response Team, the fellows have the opportunity to interact with multiple Fire and EMS agencies during MCis and other challenging calls. The fellows work directly with upstate faculty to prepare for all types of prehospital scenarios, including training to provide important field surgical techniques. Erin Wirths, 2014 EMS Fellow
Emergency responders spent 2 hours working to free the driver from the wreckage. Team physicians provided medical care during that time and once he was freed, a response team physician rode in the ambulance with the injured bus driver. Tanski, a fellowship-trained EMS physician, joined Upstate on July 1. The bus MCI was the newest team member's first on-scene call. “This team is a great resource for first responders in the community,” Tanski said. “If they ever need additional assistance at a scene, we're here for them.” •
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Upstate is Active IN THE EMS COMMUNITY TO ACCESS UPSTATE SQUAD 1 (US1) IN AN EMERGENCY, CALL ONONDAGA COUNTY 911.
Upstate University Police Department’s Physician Response Team are active members of the EMS community and provide medical direction and physician support services to a number of agencies and organizations in our community.
EMS PHYSICIAN RADIO IDENTIFIERS:
Derek R. Cooney, MD, FF/NREMT-P, FACEP
DR. DEREK COONEY UPSTATE MD-1
• Program Director of the EMS
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
• The Medical Director for the
Physician Response Team.
(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
Medicine Fellowship Program. • Completed his EMS fellowship
Jeremy Joslin, MD, FACEP, FAWM
training at the Texas A&M Health Science Center /Scott & White. • Joined the faculty at Upstate in 2007. • Currently serves on the New York State EMS Council, the Board of Directors of the National Association of EMS Physicians, and is the acting-President of the Central New York EMS Council. • He is firefighter/paramedic and is trained as a HAZMAT technician.
* Completed his EMS specialty training at SUNY Upstate * Medical Director of the Emergency Department at Upstate University Hospital’s Downtown Campus * Program director of the Wilderness & Expedition Medicine fellowship training program.
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
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
• Cazenovia Fire Department
• Dysfunctional Family BBQ Music Festival
• City of Oswego Fire Department
• Empire State Marathon
• DeWitt Fire District
• Ironman Syracuse
• East Syracuse Fire Department
• K-Rockathon Music Festival
• Mattydale Fire Department
• Moe.down Music Festival
• Onondaga Hill Fire Department
• New York State Fair Infirmary
• Southwood Fire Department
• Syracuse Festival of Races
• Taunton Volunteer Fire Department
• Syracuse Half Marathon
• Williamstown Fire Department
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Law Enforcement Agencies • Albany Field Office, Federal Bureau of Investigation
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WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
At right, Upstate public safety officers — and volunteer firefighters — front (l-r) Dominick Albanese, William O’Connor; back (l-r): Jess Brown and Stephen Mauser.
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 EMS Fellowship at the University of Pittsburgh Medical Center * Joined the Emergency Department in 2009. * Masters in Public Health with a certificate in Disaster Preparedness, University of Pittsburgh, 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
David Landsberg, MD, FACP, FCCP, FF/EMT-P • Has over 30 years
experience in EMS including 5 years as a FDNY Paramedic as well as over 20 years in the fire service as an interior firefighter, which he continues today. • Works as a full-time Critical Care physician • Is an award winning educator of his peers holding academic ranks of Associate Professor in the Departments Medicine and Emergency Medicine here 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 Disaster Response Team) • Completed his EMS fellowship training at University of Buffalo • Joined Upstate faculty in 2014 • Mercy Flight Western (Medical Control Physician) Fire Departments/Districts • Lyncourt Fire Department
Law Enforcement Agencies • SUNY Upstate University Police Department Physician Response Team (Associate ) • Syracuse Police Department (SWAT Team Physician) WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
GIVING BACK TO THE COMMUNITY AS VOLUNTEERS Many Upstate employees extend public service into their private lives, as volunteer firefighters. Meet four public safety officers who do: Dominick Albanese, Moyers Corners Fire Department William O’Connor, Marcellus Fire Department Jess Brown, Minoa Fire Department Stephen L. Mauser, Moyers Corners Fire Department
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TWO LOCATIONS FOR
Emergency Jeremy Joslin, MD, FACEP, FAWM, Medical Director of the Emergency Department at Upstate University Hospital’s Downtown campus.
Upstate University Hospital is pleased to announce Jeremy Joslin, MD, FACEP, FAWM has been named Medical Director of the Emergency Department at Upstate University Hospital’s Downtown campus. Joslin, an Assistant Professor for the Department of Emergency Medicine at Upstate Medical University, completed his Emergency Medicine specialty training at SUNY Upstate and is the director of the Wilderness & Expedition Medicine fellowship training program. He serves as medical director for numerous large events in the region, including the New York State Fair, the Empire State Marathon, and the Ironman Syracuse. He also provides prehospital medical care and advising to organizations and events around the world, including disaster relief organizations and high-risk reality television production companies.
Joslin is interested in strengthening Upstate’s relationship with EMS agencies and prehospital providers. He hopes to do so through new initiatives and outreach. He said EMS providers should expect to see new operational processes implemented to improve throughput and return to service times. He also wants input and feedback from Upstate's valued team members in the field. He plans to initiate informal coffee-hour style gatherings where he hopes to solicit feedback and suggestions. “In addition to the outreach, I want EMS providers to know they can always email directly with any questions or concerns,” Joslin said. “I invite any EMS agency director to contact me if they’d like to meet one on one.” Dr. Joslin can be reached at joslinj@upstate.edu
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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, Director of Patient Safety and Tracy Davis, RN, ED Nurse Manageer (not pictured). 8
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WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Upstate University Hospital is pleased to announce that Jay Brenner, MD, FACEP is the new Medical Director of the Emergency Department at Upstate University Hospital's Community Campus.
Care
Dr. Brenner joined the Upstate faculty in 2008 and has served as the Assistant Medical Director since 2011. He is a graduate of The George Washington University School of Medicine and is currently an Associate Professor of Emergency Medicine and Bioethics and Humanities at Upstate. Dr. Brenner is pleased to accept the new position and, like his counterpart Jeremy Joslin, MD, FACEP, FAWM, in the Downtown Emergency Department, hopes to strengthen his relationship with EMS – but for different reasons. “I think there are some folks in the EMS community who are still unaware of the extensive and comprehensive services we offer at this location,” Brenner said. Brenner said the Community Campus ED has 24/7/365 coverage by board-certified and board-eligible emergency physicians.
upstate university Hospital’s Downtown and Community Campus Emergency Departments have begun distributing “Welcome Cards” thanking EMS providers and providing contact information for feedback on care provided, follow-up on patient status and any other questions or comments they have about their experience bringing patients to upstate’s Emergency Department.
“Additionally, we have physician consultation services including hospitalist medicine, general surgery, orthopedic surgery, obstetrics and gynecology, cardiology, urology, vascular surgery, colorectal surgery, plastic surgery, psychiatry, neurology, hematology/oncology, neurosurgery, critical care, and gastroenterology,” he said. “Our ancillary services include social work, pharmacy, physical therapy, occupational therapy, respiratory therapy, and case management.” Brenner said first responders have seen, and will continue to see some changes in the coming months. Dr. Thomas Weidman, as one of the assistant residency directors, is now overseeing the Emergency Medicine resident rotation at the Community Campus ED as of July 1 2014. The first-and third-year residents engage in
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
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Jay Brenner, MD, FACEP is the new Medical Director of the Emergency Department at Upstate University Hospital’s Community Campus.
mock codes, and the third-year residents now take some overnight shifts to round out their experience. “While EMS ought to divert patients meeting CVA criteria to a designated Stroke Center, many patients inadvertently arrive at the Community Campus ED with symptoms that end up being secondary to a CVA,” Brenner said. “As a result, the Community Campus ED is rolling out a more efficient CVA protocol in the coming months to meet this need in coordination with the stroke neurology service.” Brenner said there will be some new faces, too. Physician Assistants Jeffrey Sattora and Cassidy Callahan will be coming on board full-time, joining Anthony Stirpe, PA, also full-time. Nurse Practitioners Bill Linsky and Valerie Reap, as well as Jamie Winslow, PA, will be coming over from Upstate's Downtown ED to help cover shifts. The Advanced Practice Providers team will also include David Bailey, PA, Cara Holohan, PA, Sherradyn Mack, PA, and Raymond McGinn, NP, all on per diem status. •
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After Stroke DARBY’S ROAD TO RECOVERY oxygen and nutrients to the brain ruptures or becomes blocked by a clot. High blood pressure is one of the leading causes of stroke and the most important controllable risk factor.
Just months after suffering a stroke, Undersheriff Warren Darby waves to the crowd as he marches in Syracuse's 2014 St. Patrick's Day Parade.
W
hen 70-year-old Warren Darby officially retired Jan. 1, he wrapped up his 53rd year of public service – the past 20 of which were spent as, among other things, Onondaga County’s Undersheriff. Those years have been filled with many accolades and successes. And, as in any career – especially one involving oversight of a 650-person department – there have been challenges. But none of those professional challenges were as difficult as the personal challenge he faced on a July morning in 2013. He did not immediately think “stroke.” As his symptoms became more clear Darby began to realize he needed to hurry to the hospital. Not just any hospital. A designated stroke center: Upstate University Hospital. Word spread quickly about Darby’s medical crisis. Friends feared the worst. Darby says, “The Lord had other ideas,” as he recalls that day and the months that followed into his recovery. As blood leaked from a tiny vessel in Darby’s brain, he was at the mercy of a system of medical care that he helped create, a system in which the state Department of Health designates certain hospitals as stroke centers to improve quick access to definitive care for anyone suffering what appears to be a stroke. Now Darby depended on that system. Stroke is a leading cause of disability in the United States and the fifth most prevalent cause of death. It happens when a blood vessel carrying
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“For all strokes, the sooner you get to the hospital, the greater your chances that something can be done,” says Gene Latorre, MD, the associate professor of neurology at Upstate who took care of Darby.
Symptoms Start Darby’s day began as it usually did, with breakfast around 7 a.m. and the medication he has taken for 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 felt off balance. He steadied himself and carefully walked into his office at the sheriff ’s headquarters in downtown Syracuse. He sat at his desk doing some paperwork before a planned police detail later in the day. About 45 minutes later, he stood and felt the same imbalanced sensation. He called his wife, Joan, a nurse. He recognized something was wrong, and he did not believe he should drive. She drove into Syracuse and called his cell phone when she arrived. When Darby stood up a third time, he felt imbalanced, and his left leg felt asleep. “That made me think, this is possibly a stroke,” recalls Darby. Joan drove him to his physician’s office. “Dr. Mitchell Brodey examined me, and the next thing I know, I was in an ambulance on the way to the stroke center.” Darby’s career in public service included leadership roles in emergency medical services, fire services and law enforcement. For 16 years he served as president of the Central New York WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Darby poses with his doctor, Gene Latorre, MD, associate professor of neurology at Upstate.
Regional Emergency Medical Services Council, and represented the local council on the New York State Emergency Medical Services Council. That’s how he was involved in the New York State stroke center designations. Upstate University Hospital was the first designated stroke center in Central New York, and its staff provide stroke care that is not available elsewhere. Darby felt confident as paramedics wheeled him into the downtown hospital.
Darby’s Stroke Team A team of providers had already been mobilized and was ready for him. Quickly it was determined that Darby had a small bleed on the right side of his brain, which made sense, given the symptoms he experienced on his left side. Next, they searched for the cause. The neurologist, Latorre, told Darby that 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 lasting debilitation, but first the team had to get the bleeding to stop. Typically, the larger blood vessel will shut off the bleeding capillary, as long as the blood pressure is brought under control and the swelling managed. This is done chiefly through medication.
stroke affected Darby’s left leg and threw his balance off, but he suffered no cognitive deficits. “I still think with time, God willing, I may lose all of the debilitation that I have,” he says. He was discharged with a walker. Through weeks of rehabilitation at the Upstate University Hospital Physical Medicine and Rehabilitation Center, under the care of physical therapist Sara Bullock, Darby weaned himself to a cane. Now he walks carefully on his own; most people cannot tell that he suffered a stroke. He continues to deal with fatigue, which doctors say may be the longest lasting weakness from the stroke. When his body is over tired, Darby feels numbness in his left foot and up his lower leg. Doctors have told him to take a nap when that happens. “Sleep is the best way to let the body repair a brain injury,” Darby recalls. “Regaining stamina is usually the last thing to return, if it ever fully returns.”
“For the most part, unless the blood pressure is not controlled, it resolves on its own,” Latorre says.
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, he returned to work full-time – but took breaks for a nap when fatigue would set in.
He adds that “the size of the hemorrhage is not as important as the location.” Some patients have minimal symptoms despite large fist-sized collections of blood, and others are rendered comatose from a pea-sized bleed.
“Patience is required for recovery from a stroke, because it does not happen quickly,” he says.
The worst spot to have a stroke is in the brainstem. Darby’s stroke was in the area above the brainstem known as “deep territory.” He reacted promptly to his symptoms and got to the right designated stroke center quickly. He received medication to help bring his blood pressure down, and he was admitted to the Neuroscience Intensive Care Unit on the ninth floor. He had a headache and nausea his first night. He underwent many tests during his four-day stay as doctors monitored the bleeding and swelling. The WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
He continues to enjoy his favorite pastimes that he enjoyed before his stroke. From the first Saturday in May (walleye opening) until hunting season begins in November, Darby fishes with friends two or three times per week from the boat he 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 his wife/nurse. And he counts his blessing – and is grateful.
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Comprehensive Stroke IT TAKES A TEAM
UPSTATE AWARDED HIGHEST LEVEL OF STROKE CARE Upstate University Hospital is pleased to announce the distinction of becoming the first and only hospital in the Central New York region to be awarded DNV Comprehensive Stroke Center Certification. That designation encompasses the full spectrum of stroke care – diagnosis, treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes. Comprehensive stroke centers are typically the largest and best-equipped hospitals in a given geographical area that can treat any kind of stroke or stroke complication.
UpSTaTe offerS 24/7 acceSS anD: • 5 neurosurgeons • 3 endovascular interventionalists • 4 stroke neurologists • 2 neuro-intensivists • 23 neurologists • 8 neurorehabilitation specialists/physiatrists • Approximately 150 nurses who have special training in the care of neurological patients, some of whom have dual certification in stroke and neuroscience. 12
Brain expertise Stroke care depends on physicians, nurses, therapists and more. Patients who are wheeled into Upstate University Hospital’s emergency department suffering from stroke are likely to receive acute treatment and rehabilitative care under the same roof, followed by the same team of providers. The hospital, the first comprehensive stroke center in Central New York, features the region’s only specialized neuroscience and rehabilitation floors, with three levels of specialized nursing
care. The neurologists, neurosurgeons and emergency physicians train students and conduct research that improves our understanding of how the brain works and how best to treat stroke. They are always on call to care for patients with stroke. Since becoming a stroke center, Upstate has also taken care of hundreds of complicated stroke patients who were too sick to be cared for at other hospitals in Central New York. The hospital’s stroke team works together to determine what treatment is best for each individual patient.
MEET OUR NEWEST TEAM MEMBER Jennifer Curry is the new outreach coordinator for the upstate Comprehensive Stroke Center. She has 19 years nursing experience, with 17 years specializing in critical care and neurology specialties. in a recent letter to EMS providers she states: "i am personally committed to establishing collaborative relationships with community hospitals across the region...i look forward to telling you about the 300+ individuals here at upstate, all dedicated to stroke rescue therapies and neurologic critical care. With our recent Comprehensive designation, i can assure you our process and team is unlike any other in Central new York and we’re excited to tell you about it." To set up a meeting, Curry can be reached at (315) 464-2661 (office) or email: curryj@upstate.edu SPRING 2015
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Care TREATING A STROKE Before arrival at the eD When paramedics report a possible stroke patient, Upstate’s team is summoned to the emergency department. This includes an emergency physician, a neurologist, a stroke coordinator and emergency department nurses. In addition, the nursing supervisor alerts the pharmacy, laboratory and radiology departments. In the eD Blood tests are done as soon as the patient arrives, and a doctor conducts a neurological exam. CT or MR imaging or an arteriogram may be used in the diagnosis, along with blood flow measurements and tests to detect clots. The staff also assembles a medical history. Ischemic strokes are treated with tPA, usually intravenously. Sometimes the blood clot is too big or the patient can not be given the clot busting medication due to contraindication. Fortunately, Upstate has specialist
Amar Swarnkar, MD who can take the clot out using special catheters inserted in the patient’s groin. The treatment of a hemorrhagic stroke depends on its location and severity. Sometimes it is managed with medications to carefully control blood pressure, says Gene Latorre, MD. Other times, surgery is indicated. Surgeons may place clips at the base of the aneurysm, or they may place platinum micro-coils inside the vessel to act as a mechanical barrier to blood flow. Hypothermia is employed in the treatment of some patients. Others may undergo brain tissue oxygen monitoring.
In the neuro IcU Upstate has a 14-bed neuroscience intensive care unit, plus 35 additional beds devoted to patients with neurological problems on other units. Nurses with neuro special training continue to monitor and implement the plan or care for each neurological patient.
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rehabilitation to follow Physical, occupational and speech therapists and a psychiatrist evaluate each stroke patient within 24 hours of admission. Rehabilitative therapy begins almost immediately. Upstate offers an inpatient rehabilitative unit, where patients may be moved once they are able to handle three hours per day of therapy. Rehabilitative counselors offer support for patients in returning to work or school. The outcome of acute stroke care is connected to how quickly appropriate emergency treatment is initiated, and the quality of the overall management provided. At Upstate, it is not unusual for patients with severe stroke to go home after three days, with minimal or no evidence of lasting stroke effects. •
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GEM Care THE SENIOR EMERGENCY DEPARTMENT GEM CARE EMERGENCY MEDICINE UNIT HAS:
GEM Care offers special emergency services to functional, active, over-65 seniors.
• Comfortable, Calming, and Quiet ED Environment
GEM Care is part of Upstate's Community Campus Emergency Department and offers a comfortable, quiet, and calming environment.
• Stretchers with thicker mattresses for comfort. Stretchers also have extra height if there is a need to move between beds.
• geriatric recliners are available for comfort and as an alternative to stretchers.
• Handrails for the patients to hold when walking and bathrooms close by for added safety.
• Lighting is adjustable with dimmer switches to encourage rest while still maintaining sufficient lighting to stay safe.
• Large font options for medication education and discharge instructions are available.
EMS PROVIDERS: for information on GEM Care, or a presentation on this specialized service, contact Dr. A. James Ciaccio at 315-492-5535 or email ciaccioa@upstate.edu
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Open since July 2013, GEM Care’s Medical Director Dr. Jamie Ciaccio, MD, is pleased with the specialized emergency department’s service and its progress. “GEM Care is staffed by doctors, physician assistants, nurses, pharmacists, social workers, and case managers who have a high level of geriatric knowledge and training and can provide a higher level of geriatric care,” Ciaccio said. “This team coordinates care with the patient’s own doctor, with the goal to return the patient home safely. And as a result of that teamwork and training, we’re meeting our clinical goals of decreasing admissions to the hospital.” Ciaccio said as people age, they become more at risk when entering the hospital setting because they may be weakened from illness or on many medications. They may have multiple health issues and be more sensitive to changes. The GEM Care team has special healthcare training and expertise related to the complexity that comes with aging people.
Improving Care for Healthsystem Elders) and pharmacists trained in geriatrics evaluate home medication lists and make recommendations. Discharge care is coordinated with outpatient services with the help of a social worker and case manager familiar with resources for seniors in the community. The team has up-to-date assessment tools and screens that match the needs of seniors. Further, Ciaccio said, they work with the primary care physician to develop a plan for each patient's continued health management. “GEM Care is a new model for health care designed to get seniors home safely and keep them out of nursing homes. It’s working.” •
For example, Ciaccio said, the nursing team members are all NICHE trained (Nurses
GEM CARE Upstate University Hospital Community Campus 4900 Broad Road, Syracuse SPRING 2015
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Dedication TO PEDIATRIC MEDICINE Dr. Cantor shares a smile with Donovan, after his visit to the Pediatric Emergency Department at Upstate University Hospital.
The Pediatric Emergency Department at Upstate University Hospital sees about 26,000 children each year. This 13-bed specialized department, located within Upstate’s Downtown Campus Emergency Department, accounts for over 60 percent of all admissions to Upstate Golisano Children’s Hospital. “We’re the only dedicated pediatric emergency department in Central New York,” said its Medical Director Richard M. Cantor, MD, FAAP, FACEP. “And we’re home to the only nationally accredited Level I Pediatric Trauma Center in New York State.” Cantor said attending coverage combines specialists Board Certified in Pediatric Emergency Medicine with Board Certified Emergency Physicians. “We’re staffed by nurses who specialize in Pediatric Emergency Care,” he added.
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Cantor is proud that his team is the region’s center for all facets of Pediatric Emergency Education, including PALS Courses and Upstate’s Annual Pediatric Emergency Medicine Assembly. He’s proud to work alongside EMS providers from throughout the region, who on average deliver 15 children each day to Upstate’s Pediatric Emergency Department. He values these team members as much as those he works alongside every day – and has a message to those providers. “We are the final common pathway in the Emergency care of infants and children,” he said. “You, the prehospital provider, are an extension of all that we do, and you do it well, each and every day. Please consider us your ‘home’ for all things Pediatric. After all, we are all privileged to deliver care to the children of Central New York.” •
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FIRST IN NYS TRAUMA TEAM:
We’re Verified! Last spring Upstate University Hospital and Upstate Golisano Children’s Hospital became the first in the state to receive national verification as a Level 1 trauma center by a special committee of the American College of Surgeons (ACS) in recognition of the optimal trauma care the center provides patients. Verification as Level 1 trauma centers for adults and children followed an intensive two-day onsite review by medical experts in the trauma field. They reviewed information related to patient outcomes, physician and nurse training and credentialing, facilities, trauma education and outreach, staffing and administrative functions. “The national verification as a Level 1 trauma center for adults and children signifies that Upstate has the expertise, the facility and the resources to provide optimal trauma care for all injured patients,” said Upstate University Hospital Chief Executive Officer John McCabe, MD. “The work that goes on in our trauma center to save lives throughout Central
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and Upstate New York is a testament to those employees who enter our doors everyday committed to providing the best care, even in some of the gravest of situations.” The state has previously designated trauma centers, but this action, known as verification, is the first national review of Upstate’s trauma services and the first to separately highlight the pediatric trauma service. Among items assessed by the onsite review team, was the ability of Upstate’s trauma team—emergency physicians, nurses, surgeons, respiratory therapists, lab technicians, ICU staff and social workers—to mobilize quickly when a trauma call comes into the hospital. The trauma service serves a 14-county region and facilitates transports from ambulance and first aid crews from all across the region. Additionally, the trauma service receives between 200 and 275 air transports annually. •
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Trauma Team has new leaders William Marx, DO, FACS is now the Adult Trauma Program Medical Director and Chief, Division of Trauma, Critical Care, Burn and Emergency Surgery at Upstate Medical University. Marx attended medical school on an Army scholarship and earned his medical degree from the University of Health Sciences College of Osteopathic Medicine in Kansas City, MO. He completed his General Surgery and Critical Care training at Letterman Army Medical Center in San Francisco, CA. It was there, on a trauma rotation, that Marx fell in love with trauma. “At that time I got to work with some of the world's best trauma surgeons,” Marx said. “Watching them in action was such an adrenaline rush – they were incredibly skilled, very talented – and I remember thinking ‘I want to be like them.’ And that's what did it for me.” Marx joined the faculty at Upstate Medical University in 1993. He has held multiple leadership positions in Trauma and Critical Care and has risen through the academic ranks to be appointed as Professor of Surgery at Upstate Medical University. Marx has an established track record of regional and national leadership in the care of the injured patient. He served as vice chair and chair of the NY state Committee on Trauma and the Region Chief for Region II (NY, NJ and Puerto Rico). He is a member of the American College of Surgeons National Committee on Trauma and has served on the Performance Improvement and Verification subcommittees. He has been a member of the State Trauma Advisory Committee (STAC) since 1992 and now serves as the Chair of the STAC. Jolene Kittle, MS, RN, AACNS-AG, CCRN, CEN, CFRN, is the new Trauma Program Manager. For more than 10 years Kittle has cared for trauma patients across a continuum of care including the Emergency Department, Surgical ICU, and the General Surgical/Trauma Floors at Upstate. She’s also worked as a flight RN at Mercy Flight Central.
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Her love of nursing and her desire to pursue it as a career began as a young girl. She recalled a childhood where summer days were spent with her grandmother and grandfather while her parents worked. One summer, when she was 9, her grandmother – always strong and determined – was enduring cancer treatments despite a grim prognosis. William Marx, DO, FACS has an established track Exhausted, her grandmother confided record of regional and national leadership in the care in her one day that she of the injured patient. wanted to stop treatment – but knew it would be difficult for Kittle's mother and grandfather.
“Looking back, I can see where it might seem like that was a lot to lay on a 9-year-old kid,” she said. “But I didn't see it that way. I thought to myself even then, ‘She told me this because she knew I would understand and she knew I wanted 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 being there for people at their worst moments and that I was blessed with the ability to be that person for people,” Kittle said. “It later translated into a love of caring for trauma patients. That is when people are at their worst and even more so because it is unexpected and unplanned.” •
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“I am very excited to be part of the Trauma Team at Upstate as the Trauma Program Manager,” Jolene Kittle said. “And I am so fortunate to have the opportunity to lead this already wellfunctioning team.”
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The burn team is headed up by Mohamed Elfar, MD, MSc, FACS, Director of Upstate's Clark Burn Center, and Burn Attending Joan Dolinak, MD, FACS (pictured below)
Upstate’s Clark Burn Center Conditions Treated/Services Burns—thermal, chemical, electrical, and radiation Frostbite inhalation injury Skin problems: epidermolysis bullosa, toxic epidermal necrolysis (TEn), necrotizing fasciitis, Cutaneous diseases Complex wound management - chronic and acute
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Upstate University Hospital’s Clark Burn Center is a six-bed Intensive Care Unit that is a regional referral center providing state-of-theart burn care. The Clark Burn Center serves nearly half of New York State, providing care to 28 counties from as far north as the St. Lawrence River to the southern borders of New York State, and from Rochester to Westchester County, including the northern areas of Pennsylvania and parts of Canada. The Center cares for both adult and pediatric patients in the inpatient and outpatient settings. This highly trained burn team, headed up by Mohamed Elfar, MD, MSc, FACS, Director of Upstate's Clark Burn Center, and Burn Attending Joan Dolinak, MD, FACS, includes dedicated nurses, physician extenders, resident physicians, burn technicians, physical therapists, occupational therapists, aides, social workers, case managers, dietitians, and spiritual care personnel.
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This team provides state-of-the art comprehensive care including Hubbard hydrotherapy tank, cardiovascular monitoring for moderate sedation, and biologic dressings for complex, often painful outpatient burn care. The staff, who have extensive burn care experience, provide care in a setting that affords them the opportunity to provide immediate burn care therapies not usually found in emergency rooms. In addition to its extensive inpatient services, the Clark Burn Center also provides outpatient burn services. It also provides a 24-hour phone consultation service to emergency rooms, primary care physicians, industry, and schools. That service is available by calling the Upstate University Hospital's Transfer Center at 315-464-5449 or 1-866-464-5449. •
WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
Training Calendar Upstate offers classes, courses, seminars and conferences. Here’s a list of upcoming events. for more details on any of these events, or to register, log on to www.upstate.edu/weareone
CONTEMPORARY ISSuES IN EMERgENCY MEDICINE CONFERENCE
April 22 8:00 a.m. - 3:30 p.m. The Genesee Grande Hotel The Role of Emergency Departments in the Diagnosis and Management of Infectious Diseases Contact: Rose More 315-464-6197 morer@upstate.edu
PEDIATRIC ADvANCED LIFE SuPPORT Provider Classes May 11 - 12 Refresher Classes April 20 (5 p.m. class) May 7
Provider Classes April 27 - 28 May 28 - 29
ADvANCED TRAuMA LIFE SuPPORT (ATLS) This is a two-day program designed for physicians, nurse practitioners, physician assistants, nurses and advanced EMTs. It focuses on the critical first hour in the care of the trauma patient.
Refresher Classes
Provider & Refresher Courses
ADvANCED CARDIAC LIFE SuPPORT
April 14 April 17 May 1 May 5 June 16
April 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)
MONDAY, MAY 18 Second Annual Upstate Prehospital Medicine & Trauma Teaching Day
PARAMEDIC CLASSES Paramedic 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 SuPPORT May 22 Aug 14 Nov 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: Rebecca Willison 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 the learning needs of inpatient trauma nurses. This live, 2-day educational offerings give inpatient staff members the foundational, evidence-based information and critical thinking skills necessary to meet regulatory requirements and provide excellent care to this challenging patient population.
For more details as they become available, log on to www.upstate.edu/weareone WE ARE ONE - UPSTATE UNIVERSITY HOSPITAL
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Department of Emergency Medicine 750 East Adams Street Syracuse, NY 13210
SAVE THE DATE Upstate Prehospital Medicine & Trauma Teaching Day: WE ARE ONE
MONDAY, MAY 18 www.upstate.edu/weareone
Upstate Emergency Departments TWO LOCATIONS COVERED BY THE SAME MEDICAL STAFF
DownTown campUS
commUnITy campUS
750 east adams Street
4900 Broad road
The region’s o nly Level-one Trauma center
• Handles all types of medical emergencies.
EMERGENCY DEPARTMENT • Complements the downtown services in a quieter setting. Patients brought to the Community Campus who require services from downtown will be moved seamlessly though our system.
• Cares for patients transported by ground or air from throughout Central new York.
• Patients who require hospitalization are admitted to either Downtown or the Community Campus based on their medical needs.
PEDIATRIC EMERGENCY DEPARTMENT • Located within the Downtown Campus Emergency Department.
GEM CARE COMMUNITY CAMPUS • Located within the Community Campus Emergency Department
• only dedicated pediatric emergency department and Level-one Pediatric Trauma Center in the Central new York region.
• Devoted to addressing the medical needs, sensibilities and behavioral concerns of patients 65 and older
• Cares for children with any illness and/or injury.
• gEM Care recognizes that traditional care models may not be as effective in meeting the unique needs of the aging.
EMERGENCY DEPARTMENT • offers state-of-the-art technology to care for critically ill or injured patients.
• Staffed with physicians trained in pediatric emergencies.