Trauma Update Winter 2012 by Bryan Health

Trauma Update is published for friends of BryanLGH Medical Center. Your comments and suggestions are welcome. Direct correspondence to the Advancement Department at BryanLGH, or telephone the editor at 402-481-8674. Kimberly Russel, President, BryanLGH Health System; John Woodrich, President, BryanLGH Medical Center; Edgar Bumanis, Director, Public Relations; Paul Hadley, Editor.

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TRAUMAUPDATE News from the Trauma Center at BryanLGH

Falls rising among older Americans www.bryanlghtrauma.org

Mark your calendar

Trauma Champions shine April 12 Hundreds will gather Thursday, April 12, for the annual Tribute to Trauma Champions at the Rococo Theatre in Lincoln. The event will recognize Elizabeth Canas Luong of Crete and Bill Wimmers of Lincoln â&#x20AC;&#x201D; two remarkable trauma survivors â&#x20AC;&#x201D; and honor the dedicated professionals who were involved in saving their lives.

These include individuals from all aspects of the trauma system, such as EMS providers, rural trauma center personnel, StarCare, physicians and BryanLGH staff members, as well as family members and those who provide ongoing care. Watch our www.bryanlghtrauma.org website for an announcement about Tribute to Trauma Champions.

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

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury deaths for adults ages 65 and older. BryanLGH Trauma Center data reveal that 41 percent of all injured patients evaluated at the center presented secondary to a fall. Consistent with the CDC data, the majority (77 percent) at BryanLGH were over 50 years of age. This population of patients often required a continuum of care past the acute care phase. BryanLGH registry data show that almost half (45 percent) of these patients required rehab or skilled nursing post discharge. Falls can result in a variety of injuries rendering patients in need of continued care, from extremity fractures, rib fractures and solid organ injury to head trauma. A study completed by the CDC in 2000 concluded that falls are the most common cause of traumatic brain injuries, and 46 percent of fall-related traumatic brain injuries were fatal. National data coupled with local registry data depict a significant patient population in need of preventative medicine/ fall prevention. A focus review evaluating the registry data for the fall-population at BryanLGH discovered there was a need for change within the trauma system regarding trauma activation criteria. The team divided fall data into categories, separated by distance fallen. What the team found was that injured patients who suffered ground level falls (to include one step or curb) had an average age of 74. Injury Severity Score for this population was 12 and length of stay was 4.42 (Please turn to Page 2.)

WINTER 2012

He rebuilds life after fall from roof

rothers Gordon and Keith Christensen of Christensen Construction were shingling a new house in their hometown of St. Paul on Nov. 9, 2011, when Gordon

suddenly tripped. Gordon recalls that it was a windy afternoon, and he thinks a shingle caught his foot while he was working, causing him to tumble off the roof and hit two (Please turn to Page 2.)

Kim Reinhardt, RN, reviews charts with Gordon Christensen during a follow-up visit to the Specialty Clinic at BryanLGH West.

Falls on the rise

Gordan’s story has happy ending

(Continued from Page 1.)

days. This length of stay was longer than our average length of stay. Perhaps more telling was that patients who suffered ground level falls were comparable in injury severity scores to other falls up to 14 steps. After 14 steps, the injury severity score increased beyond ground level falls. Interestingly, the length of stay remained longer for ground level falls than for the 14-step or greater category of falls. This data, coupled with data for anticoagulation, spurred the team to re-evaluate its activation criteria. Based upon national and registry data, the activation criteria was changed to include ground level falls with accompanying anticoagulation and/or a loss of consciousness (age >50 with a loss of consciousness or on anticoagulation). Anticoagulants, such as Coumadin®, Plavix® and Pradaxa®, are becoming increasingly common in the older patient population. The Trauma Center has met with local rescue departments encouraging them to consistently request clarification of anticoagulant medications in patients presenting for evaluation. Twenty-eight percent of our fall-population arrives from outside referral facilities. We expect that number to continue to increase as the elderly population increases and awareness of the potential for significant injury becomes better understood.

sets of scaffolding on the way to the ground. Keith drove Gordon to the Howard County Medical Center emergency department in his pickup truck. Gordon didn’t think calling for an ambulance was necessary; in fact, after his 14-foot fall, the 58-year-old described his pain as “only a little discomfort.” Despite Gordon Christensen’s stoic nature, the emergency physician at the local hospital recognized the potential for significant injury following a fall from height. He ordered several radiologic and laboratory tests and arranged transfer to the BryanLGH Trauma Center via a Grand Island ambulance. Fall from height is Category II activation criteria at BryanLGH, so the Code Trauma was paged. “We’re lucky that St. Paul has a pretty good outfit. They knew what to do. They were able to assess me and fix me right up, so that I was ready for transport to Lincoln,” Christensen says. Trauma surgeon John Cordova, MD, and the trauma team met Gordon in the trauma bay shortly after his ambulance arrived at BryanLGH West. He had suffered six rib fractures, a pneumothorax, pelvic fractures, sacral fractures and transverse process fractures in his lumbar area. He described having “slight discomfort,” yet Gordon had sustained significant fractures that would need managing. Following further evaluation, Dr. Cordova made arrangements with David Samani, MD, the orthopedic surgeon on call, for evaluation and treatment of Gordon’s orthopedic injuries. Fortunately, his pelvic fractures did not require surgery. He was able to move around with toe-touch weight

bearing to his right leg. His rib fractures were troublesome, and he received an epidural for pain control. It wasn’t long before Gordon was making improvements. Rehab care was recommended, and Gordon and his wife, Jennifer, chose the Rehabilitation Unit at BryanLGH West. Physiatrist Jude Cook, MD, assumed care of Gordon while he continued to work on recovering. Gordon spent 14 days at BryanLGH, including five days in the Rehabilitation Unit, before he was ready to return home with Jennifer. “I really enjoy fishing and outdoor activities, so it was especially painful to know all my neighbors were clearing my snow back in St. Paul, and I couldn’t help,” the former patient says. He made the most of his time in rehab. “Everyone at the hospital was really good to me. Even the student nurses were so nice, energetic and eager to help,” he notes. “One thing I liked about rehab is they have participants eat their meals and do things together. I even learned to bake a pumpkin pie for therapy!” By the time he left, Gordon was able to independently transfer himself and get around without the assistance of others, a good thing for an active man such as himself. Gordon has been discharged but will continue to follow up with the trauma team and Dr. Samani until full recovery is reached. Gordon’s story speaks to the success of the entire trauma system, from Howard County Medical Center to BryanLGH Trauma Center and the Rehabilitation Unit at BryanLGH West. Gordon states that he is “very appreciative of the care of everyone involved.”

poisoning in industrial nations. This added capability will benefit our residents and firefighters for detection after exposure to carbon monoxide. The department’s overall Advanced Life Support project also will assist in the rapid response to medical emergencies to the east between Waverly, Eagle and Walton and to the southeast between Lincoln and Bennet, and may be utilized by the communities and rural areas of Hickman and Firth. In the fall of 2011, SEFD began construction of an addition to the Holdrege Station. This addition consists of a large training room, kitchen, office and restrooms along with fire and EMS storage rooms. Other plans in 2012 are for an addition to be added to the Pine Lake Station, as well, to accommodate large scale training events and ALS storage. The average volunteer puts in about 150-plus hours each year. Many members take additional classes across the state to improve their skills, and several members are requested instructors for other departments. SEFD personnel have been active in both the Nebraska State Volunteer Fire Fighters Association and the Nebraska Fire Chiefs Association. SEFD has been represented at every NSVFA and NFCA annual meeting since 1970. The Southeast Rural Fire District has come a long way since its inception in 1962. The current area encompassed is less than one half the original area; however, the population served is more than double what it was at the beginning. Much of the area appears to be more suburban than rural, but fire department personnel are still 100 percent volunteers, Walton still is unincorporated, and many gravel roads and historic farmsteads still exist. Although the calls we receive continue to increase, the fires seem bigger and the wrecks seem more severe, our dedication to serve and protect the residents of the district is just as strong today as it was 50 years ago.

Be a safe traveler this winter Most of us know the song: “The weather outside is frightful, but the fire is so delightful, and since we’ve no place to go, Let It Snow! Let It Snow! Let It Snow!” If we really had no place to go, these lyrics are probably good advice — stay home and keep warm. But we seem to always have someplace to go. When the weather is frightful and roads and walkways have turned slick, and you need to drive or walk in winter weather conditions, do so safely. Here are a few things you can do make travel safer: Keep an emergency kit in your vehicle. Include these items: Warm gloves. Warm hat. Hand warmers. Boots. Water. Emergency food supply, candy bars or energy bars. Flashlight with extra batteries. Blanket. Shovel. Kitty litter or sand for traction. Windshield scraper. Prepare your vehicle for travel, and follow these driving guidelines: If you have a cell phone, take it with you, along with a car charger. Keep your tank close to full. Check the antifreeze level. Keep windshield washer fluid topped off. Brush the snow off your vehicle, including your lights, before you drive. Make certain your tires have adequate tread and are properly inflated. Increase your following distance to 8-10 seconds when the roads are wet and it is snowing. Do not use cruise control when driving on a potentially slippery surface (wet, ice, sand).

Accelerate and decelerate slowly. Remember: It takes longer to slow down on icy roads. Don’t pass snow plows and sanding trucks. The drivers have limited visibility, and you’re likely to find the road in front of them worse than the road behind. Don’t assume your vehicle can handle all conditions. Even fourwheel and front-wheel drive vehicles can encounter trouble on winter roads. Be familiar with how your brakes work; anti-lock needs to be applied with steady pressure (you will feel a pulsing which is normal). To help prevent falls on slippery surfaces while you are walking, take these precautions: Expect surfaces to be slick, including building entries. Always inspect the surface where you are walking. Do not hurry, take your time. Avoid routes that have not been cleared or appear to be iced over. Pay particular attention to surfaces in the parking garages and lots. Wear flat shoes with slip resistant soles or rain/snow boots, maybe use slip on traction aids. Take short, flat steps. Clean snow and ice from your shoes when entering buildings, before leaving carpeted areas and moving onto tiled surfaces. When possible, use the covered walkways and park in covered garages. Taking preventive actions is your best defense against having problems while traveling in winter conditions. If you prepare your vehicle in advance and observe safety precautions during winter weather, you can reduce the risk of weather related injuries. So, when the weather is frightful, stay home and keep warm — but if you travel, do so as safely as possible.

Southeast Fire Department celebrates 50 years of service By John Porter, SEFD Chief

outheast Fire Department (SEFD) proudly celebrates its 50th anniversary in 2012. SEFD protects more than 7,500 people living in an area of approximately 25 square miles on the southern and eastern side of the city of Lincoln. We operate out of two stations that protect a primarily suburban to rural area. Our department is a public department consisting of 36 volunteers. The district was formed in 1962 to provide fire protection to the area of Lancaster County directly southeast of Lincoln. This also included the incorporated village of Walton. In 1968, the department built the first station at Pine Lake Road and Nebraska Highway 2. This was near one of two major highways in the district. In 1975, the department began offering Basic Life Support (BLS) services and started weekly training/business meetings which continue today. In 1994, the department’s needs grew, so a second station was built at Holdrege and 84th Street. The mission of the SEFD is to provide the best possible care to the patients from our response area as well as to those we

transport who are visitors to our area and to those who are in our mutual aid organization. By having the capability to provide accurate diagnostics to the receiving hospital prior to arrival, we can be better prepared to assist our patients. SEFD is equipped to handle Hazmat Level 1 response. The department offers heavy rescue service for vehicle extrication and has search and rescue capabilities. The department runs two engines, two ambulances, two grass rigs, a heavy rescue vehicle and four tankers. Because most of the district is composed of acreages and is semi-rural, SEFD maintains the largest fleet of tankers in the county and has 12,500 gallons of water ready to roll. The department also has a Lancaster County decontamination trailer. The department provides fire protection and rescue operations out of both its Pine Lake Station and Holdrege Station. In 2008, SEFD upgraded from a QRT (Quick Response Team) type EMS service to supplying BLS transport. Over the last few years the number of calls for our services has dramatically increased. In 2007, the department ran 98 fire and EMS calls. In 2011, the department was called for service 225 times.

In the fall of 2011, SEFD began transitioning from a BLS service to an Advanced Life Support (ALS) service and hopes to receive certification in March 2012. Currently the department consists of 24 EMTs and 4 Paramedics. The Southeast Fire Department’s acquisition of 12-lead EKG monitors, along with the education, training and additional supplies, means the district is investing over $80,000 into the ALS program. Our ALS program will greatly compliment the needs of our residents. SEFD is dedicated to providing a standardized higher level of care to our patients and community by shortening the time from the patient’s symptoms to treatment. The patient’s odds of survival will be vastly improved when paramedics acquire a 12-lead EKG (electrocardiogram) while responding to chest pain emergencies. We believe the ALS service and equipment will significantly improve outcomes by decreasing the time to treatment and restoring blood flow to the heart. One of the capabilities of our cardiac equipment will include carbon monoxide (CO) monitoring and Met Hemoglobin detection and segment trending alerts indicating changes in the patient’s condition. CO is the No. 1 cause of

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

High-tech evaluations at BryanLGH help pinpoint causes of balance issues By Kelsey Selting, PT, DPT, BryanLGH Rehabilitation Services

relies on dynamic test conditions designed to reflect the challenges of balance in daily life. ixty percent of With visual biofeedback on Americans will either a stable or unstable have a balance support surface and in a stable problem sometime in or dynamic visual environment, their lives. Balance issues the physical therapist can can result in falls which assess the patient’s performing may lead to lifetask ranging from essential threatening injuries. daily living activity through Balance is a very complex high-level athletic skills. The process that includes objective data aids in the sensory, visual and motor design of effective treatment elements. For individuals and/or training programs who are experiencing focused on the specific sensory balance issues — and and motor components especially those who have underlying patients’ functional had multiple falls — a impairments. The testing thorough evaluation by a provides for accurate physical therapist is identification of which element beneficial. Because of the of the system is impaired. complexity of the balance Clinical observation alone system, the use of makes it very challenging to technology and advanced differentiate among the various computer software may sensory and motor provide the best impairments. This specialized mechanism for detertechnology is used by the Patients experiencing balance issues benefit from a mining the cause of the therapist to more rapidly and thorough evaluation by a physical therapist. balance issue, which in accurately identify the turn can improve the underlying problem and outcomes of therapy for the patients. intervene to prevent future falls. Physical therapists at BryanLGH Medical Center have Currently, BryanLGH is one of three facilities in Nebraska received specialized training to evaluate balance impairments. that have balance experts who provide assessment and design Therapists use the NeuroCom SMART EquiTest and Balance effect treatments using the NeuroCom SMART EquiTest and Master System to help determine specific impairments that Balance Master System. are the underlying cause of an individual’s balance Individuals experiencing falls can be referred by their impairment. primary care provider to one of our balance experts at The NeuroCom Balance Master uses an innovative force BryanLGH Outpatient Therapy by calling 402-481-5121. Once plate technology and advance computerized software system an evaluation is completed and the underlying cause is that allows a therapist to objectively differentiate the determined, the patient will be referred back to their impairments associated with balance problems. The system community for treatment.

ANOTHER SUCCESSFUL TRAUMA SYMPOSIUM

Symposium has pediatric focus By Sheila Uridil, RN, Trauma Program Manager

ryanLGH and StarCare Air Ambulance hosted the 9th annual Trauma Symposium Oct. 14 at BryanLGH Medical Center West. This year’s keynote speaker was Don Moores, MD, chief of pediatric surgery at Loma Linda University Children’s Hospital in California. His presentation highlighted pediatrics with a focus on identifying child abuse. Speaking to the importance of recognition by healthcare professionals, he highlighted key elements and responsibilities in the healthcare providers’ awareness of neglect and abuse. In conjunction with providing education on the subject, he shared alarming statistics illustrating Nebraska’s abuse rate, which is higher than California’s. Drawing on his vast experience and knowledge of this issue, Dr. Moores’ presentation proved to be one few will ever forget. Pediatric focused education continued as Elisabeth Abel, RN, presented midmorning. As an educator and flight nurse from Denver, Colo., she also had numerous stories illustrating her educational

objectives. She provided information regarding pre-hospital pediatric trauma and general principles in providing pediatric trauma care. Providing care to injured patients extends well beyond the initial acute injury phase. Unfortunately, many patients go on to develop post traumatic stress disorder as a result on their traumatic injury. Mary Kathryn Hunsberger, PhD, from the BryanLGH Counseling Center presented “Putting together the pieces,” about recognition and treatment of post traumatic stress disorder. Nationally, PTSD makes headlines as more of our soldiers struggle with post-war sequelae, but the trauma population often suffers silently. Dr. Hunsberger’s presentation provided much needed awareness of the disorder and the trauma community’s role in aiding our patients’ recovery. Lunch was provided with tours of BryanLGH Trauma Services. The tour

included an up-close viewing of StarCare’s helicopter. Flight crew members were available to explain the transport process and answer the many questions posed by the curious onlookers. The tour also included the emergency rooms’ largest trauma bay: “Room 5” illustrated modern equipment and supplies needed to care for the most critically injured patients arriving at the trauma center. In addition to the direct patient care areas, participants were able to view the Center for Excellence in Clinical Simulation. A mock intensive care patient was set up

Trauma Symposium tours demonstrated the latest educational tools from the BryanLGH College of Health Sciences, including special cadavers known as Plastinates (in photo at left), and simulation mannequins from the Center for Excellence in Clinical Simulation helped demonstrate tilt table treatments (above) and pediatric injuries (at right, during breakout presentation by Dr. Tadd Delozier).

Keynote speaker Don Moores, MD, (above) presented “Recognition of Child Abuse” during the Symposium. with the simulator depicting a severe head trauma. The tilt table was used, allowing viewers the opportunity to see firsthand the process taken to stand patients to treat intracranial hypertension. The mock patient also had chest tubes, ventilator support and many other critical adjuncts, depicting the entire process. This provided a great view for the symposium participants to see just

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

how extensive is the care for the critical patient. The Plastinates also were on display. Plastinates are preserved bodies in their entirety. Water and fat are replaced by certain plastics, yielding specimens that do not smell or decay and retain most properties of the original body. BryanLGH College of Health Sciences is one of only

two colleges in the United States to own their own full body Plastinates for educational purposes. During the afternoon there were two breakout sessions. One was lead by Dr. Moores on the topic of Pediatric Abdominal Compartment Syndrome. The alternate session was lead by Tadd Delozier, MD, on preparing trauma patients for transport. Dr. Delozier, of Nebraska Emergency Medicine at BryanLGH, is one of the many emergency department physicians who assist in facilitating care for the injured patients. The trauma symposium proved to be a successful day in providing education. EMS personnel, physicians, surgeons, nurses and many other ancillary staff were in attendance, and just shy of 150 participants joined the BryanLGH staff to expand their knowledge on caring for injured patients. Watch for next year’s information to reserve your spot at the annual Trauma Symposium.