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TRAUMA UPDATE

News from the Trauma Center at Bryan Medical Center WINTER 2013

Bryan StarCare has provided regional air ambulance service for more than 20 years.

New logo – same great services! By Jan Shaner, RN, Bryan StarCare Manager In November, BryanLGH Health System became Bryan Health; StarCare remains part of the Bryan system, providing the same safe, high-quality service that we have for more than 20 years. We will continue to work closely with our highly trained physicians, who educate our staff about the latest treatments and help us provide the best possible critical care, including

STO2 monitoring and cooling for traumatic brain injuries. Our helicopter is a BK-117 twin engine aircraft with night vision goggle capabilities. It is large enough to carry our crew and two patients, neonatal isolettes or IABP transports when needed. Safety and providing the best quality patient care is our No. 1 priority. We look forward to continuing to serve our communities for years to come. Call 402-481-5008 to learn more about Bryan StarCare. n

Tribute to Trauma Champions salutes patients and caregivers Hundreds will gather Thursday, April 4, 2013, for the annual Tribute to Trauma Champions at Lincoln’s Rococo Theatre. This year’s event will recognize two remarkable trauma survivors — Adam Koenig of Lincoln and Derek Stromp of Greeley. Dedicated professionals from across the continuum of trauma care also will be honored for life-saving efforts. The Bryan Trauma Program is committed to providing high-quality care through all aspects of the trauma system, which includes emergency services and rural trauma center personnel, physicians and staff at Bryan Health, and those who provide ongoing care to injured persons. Tickets go on sale March 5 — to find out more about the event or to purchase tickets, go to bryanhealth.org. n

Adam Koenig

Derek Stromp


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Remembering Dr. Paul, a Nebraska trauma pioneer Chester “Chet” Paul, MD, died Dec. 14 at age 70. He will be remembered by the Nebraska Trauma System as an early pioneer whose contributions were critical to breaking new ground for the statewide trauma system. This Lincoln High School alumnus earned a pre-med degree at the Nebraska Wesleyan University, Lincoln, in 1964. He graduated with highest distinction in 1969 from the University of Nebraska Medical Center College of Medicine, Omaha, and, following his residency, completed fellowships in vascular surgery at Baptist Memorial in Memphis, Tenn., and in burn treatment at Brook Army Burn Center, San Antonio, and at Harborview Hospital, Seattle. “Dr. Paul had a passion for patient care, education and the medical profession,” says Dean Cole, State of Nebraska EMS and Trauma Programs administrator. “He made everyone feel as though their role in the Chester Paul, MD care of trauma patients was important; he made us all feel like professionals.” Dr. Paul enjoyed sharing his expertise in medicine. He served as clinical professor of surgery at UNMC, the Creighton University Medical School, Omaha, and the Lincoln Medical Education Partnership. A Fellow of the American College of Surgeons, Dr. Paul was instrumental as a co-author for the Advanced Trauma Life Support® course that still is used by trauma practitioners worldwide. Mary Ellen Hook, APRN, clinical nurse specialist at Bryan Health, had the opportunity to work with Dr. Paul and described him as being “instrumental in the formation of our Trauma Program at Bryan Health. He helped set us apart as the hospital in Lincoln that specialized in trauma.” “Chet” and his accomplishments throughout the region will be forever remembered. n

Dr. Burton receives neurocritical care board certification Congratulations to Reginald Burton, MD, FACS, director of trauma and surgical critical care at Bryan Medical Center, for becoming the first physician in Nebraska to be board certified in neurocritical care by the United Council for Neurologic Specialists. The medical subspecialty of neurocritical care is devoted to the comprehensive, multi-system care of the critically ill neurological patient. In addition to medical critical care management, neurocritical care subspecialists are trained to manage neurologic disease states, such as ischemic and hemorrhagic strokes, neurotrauma, seizures, neurooncology and encephalopathy. Neurologically injured patients Reginald Burton, MD represent a large percentage of the trauma patients treated at Bryan Medical Center. Additional training and expertise in these areas allow the Bryan Trauma Team to provide the most up to date evidence-based care for trauma patients across the continuum. There were only 174 board certified neurocritical care subspecialists prior to the exam taken in December 2011, and there were no board certified neurocritical care subspecialists in Nebraska, Iowa or Wyoming. n

Congratulations to Schleiger Deb Schleiger is the trauma registrar at Bryan Medical Center and for Region 2 in Nebraska. She passed the certification examination for trauma registrars in October 2012. Schleiger has been designated a Certified Specialist in Trauma Registry (CSTR) by the American Trauma Society (ATS). She is the second person in Nebraska to receive this certification. Schleiger has been in this trauma registry position since 2002 and is a 36-year employee of Bryan Health. As the trauma registrar, Schleiger assists the 23 hospitals in Region 2 with registry questions, and more than half of the facilities are involved in submitting patient data to the regional trauma registry. n


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Attention, texters and phoners:

Distracted drivers pose dangers to us all By Brenda Lieske, RN, Program Manager, Bryan Neuroscience and Orthopedics

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river distraction is a leading factor in many crashes, and cell phone use and texting are two of the most common distractions. Distracted driving refers to any activity that could divert a person’s attention away from the primary task of driving. All distractions endanger drivers, passengers and bystanders. Examples of distractions include texting, using a cell phone or smartphone, eating and drinking or watching a video while driving. Text messaging is by far the most alarming distraction because it requires the driver’s visual, manual and cognitive attention.

In 2011, the Nebraska Office of Highway Safety reported there were more than 1,100 cell phone related crashes from 2002-2010. Within that time frame, there were 484 injuries and six deaths. Teenage drivers were involved in greater than 30 percent of these crashes. More than 80 crash cases that occurred were tied to the use of cell phones in the first six months of 2011.

Current Nebraska law •

National statistics •

Nebraska Statistics

In 2010, 3,092 people were killed in crashes involving a distracted driver, and an estimated 416,000 more were injured in motor vehicle crashes involving a distracted driver. 11 percent of all drivers under the age of 20 involved in fatal crashes were reported as distracted at the time of the crash. Sending or receiving a text takes a driver’s eyes from the road for an average of 4.6 seconds; at 55 mph, that’s equal to driving the length of an entire football field — blind.

Under legislation that became effective July 1, 2010: Text messaging is outlawed for all drivers on Nebraska’s roads and highways. Fines: $200-$500, plus three points against driver’s license (secondary enforcement). Drivers under age 18 with learner’s permits or other intermediate licenses are prohibited from using cell phones (secondary enforcement). Visit www.distraction.gov for additional information. n

Seat belts reduce seriousness of crash-related injuries By Angela McCown, RN, Ortho/Trauma Nurse Manager The Centers for Disease Control reports motor vehicle crashes are the leading cause of death in the United States among those ages 5-34. Seat belt use is the most effective way to save lives and reduce injury in crashes — yet millions of adults don’t wear their seat belts. Seat belts reduce serious crash-related injuries and death by about 50 percent. Bryan Medical Center statistics support what the CDC has reported.

Data from October 2011 through September 2012 show: Total MVC – 406 Belted – 181 (44 percent) Unbelted – 169 (42 percent) Unknown – 56 (14 percent) Unbelted by age Number 02-24 074 25-34 029 35-44 017 45-54 018 55-64 016 65-74 007 75-84 003 >85 005 Total 169

Don’t become a statistic — use your seat belt on every trip, no matter how short. Encourage everyone in the car to buckle up, including those in the back seat. n


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Trauma Symposium brings hundreds of m By Jan Shaner, RN, Bryan StarCare Manager The 10th annual Trauma Symposium was held Sept. 28 at the Bryan West Campus. It was well attended by pre-hospital and hospital personnel from all over the region. Keynote speaker Mark Cipolle, MD, chief of trauma surgery at Christina Care Health System, Wilmington, Del., discussed anticoagulation issues and how to balance the risk of thromboemoblic and bleeding risk. He emphasized the importance of reversing anticoagulation when possible in injured patients. Amy Vertin, MD, of Crete Area Medical Center gave us a taste of what it is like to manage the trauma patient in a rural setting. From resource allocation to early activation of transport, she provided a picture of how many in southeast Nebraska work with the trauma system to ensure optimal patient outcomes. Lincoln Fire and Rescue discussed HAZMAT and how to use a decontamination tent. StarCare and the Center for Excellence in Clinical Simulation used a simulation mannequin to demonstrate a response by a trauma team. Daniel Tomes, MD, of Lincoln reminded all of how dangerous concussions can be and discussed new safety regulations that are being applied to sports-related head injuries. The afternoon concluded with case reviews by Stanley Okosun, MD, and Reginald Burton, MD, of the Bryan Trauma Center. Thanks to all of our partners for their continued support. We look forward to seeing you at next year’s Trauma Symposium — mark your calendar for Oct. 25, 2013. n

Lincoln Fire and Rescue showed new tools and techniques at this year’s Trauma Symposium.

Bryan StarCare crew members and representatives from the Center for Excellence in Clinical Simulation demonstrated a system response by a trauma team. In the center photo, Dr. Stanley Okosun leads a breakout session that used one of the simulation mannequins.


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medical professionals to Bryan

Dr. Mark Cipolle emphasized the importance of reversing anticoagulation for injured patients when possible.

Lincoln Fire and Rescue Battalion Chief Bruce Sellon (left) visits with fellow speakers Dr. Reginald Burton, director of trauma and surgical critical care at Bryan, and Dr. Mark Cipolle of Wilmington, Del. During a breakout session (left), Lincoln Fire and Rescue crews show Trauma Symposium attendees at the Bryan West Campus how to use a decontamination tent.


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Republic County EMS … Our family helping yours By Don Lieb, Director, and the Republic County EMS Team

with a maximum response time of three minutes, and a second crew epublic County EMS started out that moves to the with two ambulances and two first out position if full-time personnel who lived there is a call, then at the station in Belleville, Kan. The back to second current system traces its roots to 1980 out after the call is and is a Type II ambulance service with completed. limited Type I care. Republic County Currently, Republic County EMS EMS covers a 744employs two full-time paramedics, one square mile district part-time paramedic, three full-time and is a countywide AEMTs, two full-time and 11 PRN organization EMT-Bs and one PRN EMR. separate from We have a diverse pool of the local fire knowledge, as our personnel have department. additional training as police officers, Due to Republic County’s location volunteer fire fighters, registered nurses on the Kansas/Nebraska border, we and other medical backgrounds. This have a relatively high number of gives the staff a better understanding transfers from Republic County of the types of calls that we receive Hospital, which is a Level IV Trauma and allows us to work well with staff Center from other in Belledepartments ville, to in the a higher county. level We of care should also note Republic County EMS covers a 744-square mile district. hospital that all of within a our employees have other full-time six-hour time frame. We are located in or part-time jobs in our community an area that can send patients to Lincoln, — and their employers are excellent Kansas City or Wichita to achieve that at allowing these staff members to goal. leave work to assist with caring for the One of the unique things that citizens of our community. makes Republic County EMS valuable Republic County EMS has four to the citizens of our county is that ambulances, one of which is set up as the EMS personnel live in most of a rescue/extrication/response unit and our outlying communities — and this is one of two or three services west of helps reduce response time of trained U.S. 81 that are responsible for vehicle personnel at the scene until the rescue extrication and patient care. ambulance arrives. Republic County EMS is staffed Republic County EMS staff members with a first out crew at the station, receive monthly education. Some of

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the things we practice are vehicle/ race car extrication and transport, CPR training, treatment of the OB patient, pediatrics, training on the MERGE/ Start System and what to do during an active shooting call, to name just a few. For many years, our staff base has been composed of employees who have grown up here, still live nearby and are dedicated to providing the best care possible. Republic County is blessed with skilled medical professionals who provide clinics at the Republic County Hospital. Through their efforts, a number of transfers have been to Bryan Medical Center because follow-up care can be completed by those physicians in our community. Being located at the Kansas/Nebraska line allows an ease of follow-up care and post treatment for our citizens. We’ve had an excellent experience working with the Level II trauma team at the Bryan West Campus. Republic County EMS averages about 50 transfers to Bryan every year, and StarCare air ambulance also has been used when necessary. n


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VitalStim therapy helps swallowing By Cindy Nehe, MS, CCC-SLP, Bryan Rehabilitation Services

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ifteen million Americans are impacted by a medical disorder called dysphagia, or difficulty with swallowing. It is estimated that one million people annually are receiving a new diagnosis of the condition (ASHA, 1994). The Agency for Health Care

Policy and Research (AHCPR) reports that more than 60,000 Americans die from complications associated with swallowing difficulties. Aspiration pneumonia or food and liquids going down the airway and into the lungs are the most common difficulties. Dysphagia can be associated with stroke, degenerative neurological diseases and head and neck cancer. For an individual experiencing dysphagia, a thorough evaluation by a speech therapist is essential to determining the risk of aspiration, the cause of dysphagia and steps needed in rehabilitating the patient. Following a referral by a physician, a modified barium swallow (MBS), or swallowing X-ray, is completed in

conjunction with radiology. The MBS is considered the gold standard in the identification of dysphagia and is only completed in a hospital setting. Using the MBS information, the speech therapist determines if aspiration is occurring, why it is happening and what the steps are for rehabilitating the patient. These steps may include strategies to decrease the risk of aspiration (chin tuck, double swallowing), modifying foods and liquids or implementation of VitalStim® with oral/ pharyngeal strengthening tasks. Speech therapists at Bryan Medical Center have successfully completed a 26-hour VitalStim® certification course for dysphagia treatment. The VitalStim® Therapy System by Empi is FDA approved for treating dysphagia; VitalStim® uses a specialized form of neuromuscular electrical stimulation (NMES) to enhance training of the muscles used for swallowing. Speech therapists at Bryan use this technique in conjunction with other therapeutic interventions to improve patient outcomes.

The treatment sessions begin with the non-invasive, custom designed electrode placement on the skin at the specific points on the patient’s throat, identified in the MBS. Feeding practice and oral/pharyngeal strengthening tasks are performed. Therapy sessions are repeated until the patient’s swallowing patterns have been restored to the optimum level. VitalStim® therapy at Bryan is across the continuum of care and allows patients in the hospital, Bryan acute inpatient rehabilitation unit and outpatient settings to benefit from this advanced treatment for swallowing — one of life’s most basic and important functions.

Individuals experiencing dysphagia can be referred by their primary care provider to one of our speech therapists by calling the Bryan Scheduling Center at 402-481-5121. n


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

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Check out these educational opportunities Bryan Trauma 2013 ATLS dates and locations: n March 7-8 Auburn Provider and Refresher n July 11-12 Bryan West Provider and Refresher n Sept. 5-6 Bryan West Provider and Refresher Trauma Grand Rounds are held on the fourth Friday of each month, beginning at noon in the Bryan West Conference Center. Upcoming topics are Emergency Management of Common

Drug Overdose and Current Trends in Management of TBI Patients. Mock Trauma Day is an interactive, multi-sensory educational opportunity to support rural care settings in current trauma treatments and processes. For more details about these programs, please call Summer Erickson at 402-481-9909 or Bryan Trauma Program manager Robbie Dumond at 402-481-5150. n

Welcome, new Trauma Program manager

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ryan Health is pleased to announce Robbie Dumond, RN, EMT-I, is our new Trauma Program manager. Dumond began his new role in early December and brings with him a vast range of knowledge and experience in emergency medical and trauma services. Prior to joining the Bryan Health team, he served as the trauma program manager at the Creighton University Medical Center in Omaha. During his nursing career, he has worked as an emergency department nurse, pediatric intensive care unit nurse and medical liaison coordinator for NASCAR (National Association for Stock Car

Automobile Racing). Passionate about the care of trauma patients across the continuum, he looks forward to strengthening relationships with pre-hospital and referral hospital personnel. In addition, he is looking forward to improving educational opportunities available to trauma providers across the region. Dumond currently is actively involved in Advanced Trauma Life Support速 as a course coordinator and is a Trauma Nursing Core Course速 course director and instructor. You can reach him by emailing robbie.dumond@bryanhealth.org or by calling 402-481-5150. n

Robbie Dumond, RN


Trauma Update - Winter 2013