Bryan Trauma Update | Spring 2015

TRAUMA UPDATE

News from the Trauma Center at Bryan Medical Center SPRING 2015

Victim appreciates care after crash

Reuben Yoder was killed when a car struck his family’s buggy, but his sister, Fannie, survived by receiving care from the Statewide Trauma System.

“I can’t put into words how appreciative my family and I are to EMS, Pawnee County Memorial Hospital, the Bryan Medical Center Emergency Department and Bryan acute inpatient rehabilitation unit during the loss of our son Reuben in the accident and hospitalization of our daughter Fannie.”

— Edwin Yoder

By Heather Talbott, MSN, RN, Trauma Outreach and Injury Prevention Coordinator

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n July 21, 2013, Fannie Yoder, 20, and her brother Reuben, 17, were riding in their horse-drawn buggy near Pawnee City, Nebraska, on their way to church when the unthinkable happened. The buggy was struck from behind by a car going highway speeds. First responders immediately called 911 and assessed the situation.

Fannie lay in the middle of the road

with blood pooling behind her head, and Reuben was partially in the buggy, where he was pronounced deceased.

When the Pawnee County EMS crew arrived, they yelled to have the hospital call for a helicopter; however, because of the nature of the crash, nurses had already activated air transport when the 911 call came across.

Fannie was transported to Pawnee County Memorial Hospital. By the time Edwin and Mattie Yoder arrived, their daughter already had been assessed and transferred to a cart and was being wheeled to the helicopter.

Fannie was transported by StarCare

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Fannie Yoder survives crash air ambulance and arrived at the Bryan Trauma Center as a Level I trauma activation. Upon arrival, Fannie had a Glasgow Coma Scale (GCS) of 3. She was quickly assessed and found to have a right subdural hematoma with shift, multiple skull fractures, cerebral contusions, facial fractures, left pneumothorax, left clavicle fracture and pelvic fractures. She was emergently taken to the operating room by the neurosurgery team led by Benjamin Gelber, MD. Dr. Gelber performed a right craniectomy and placed the bone flap in her abdomen. In addition to the emergent craniectomy, the trauma team leader placed a cooling line in Fannie to lower her body temperature, which would reduce the risk of brain damage.

Fannie’s parents arrived at the Trauma Center at 12:30 p.m. while Fannie was in surgery.

They were allowed to see her after she was admitted to the intensive care unit at about 2:30 p.m. Fannie’s father did not recognize his daughter when he entered her room. Fannie spent the next 12 days in the ICU and required

several operations and interventions to keep her alive. Once she was stable, she was transferred to the acute inpatient rehabilitation unit on the Bryan West Campus.

During Fannie’s 28-day stay in the inpatient rehabilitation unit, she started to wake up. Her first memory is opening her eyes and realizing she was in a hospital and asking her mother why she was there. Fannie quickly started making memories with her care team on the unit as she relearned how to walk while keeping weight off her broken pelvis.

Physical therapist Rachel Beckmann had to get creative and brought in a pink squeaky toy pig. She secured the pig to the bottom of Fannie’s nonweight bearing leg so when Fannie stepped down on it, the toy’s squeak would remind Fannie that she shouldn’t put weight on that leg.

Interestingly, Fannie enjoyed making the noise and stepped on the pig frequently!

Fannie celebrated her 21st birthday in the inpatient rehabilitation unit with her family by her side. By the end of

her stay, she was playing tricks on the therapists and nurses not only in the rehabilitation unit but also the ICU team.

Fannie is back living in Pawnee City.

She married Chris on Sept. 17, 2014.

The newlyweds live in their own home, where she enjoys baking cookies for the family store, sewing, gardening and helping care for her nieces and nephews.

Fannie and her family would like to express how thankful they are for everything. From the first responders at the scene to the off-duty nurse in Pawnee City who drove Fannie’s parents to the Bryan Trauma Center to be by their daughter’s side, to the couple from Lincoln that read about Fannie in the Lincoln Journal Star and came each night to sit with the family just because.

There are no words to describe the appreciation. The Yoders feel extremely blessed to live in the community of Pawnee City where they were supported in so many ways.

Fannie is living proof that the Statewide Trauma System is saving lives. n

HOSPITAL HIGHLIGHT: PAWNEE COUNTY MEMORIAL HOSPITAL

Trauma designation has impact Pawnee County Memorial Hospital is a 17-bed critical access hospital in Pawnee City, which is in the southeast corner of Nebraska. The hospital has been a state designated basic trauma hospital since May 7, 2008. They average 35 trauma activations each year.

Trauma Nurse Coordinator Donna Nider, Director of Nursing Kris Meyer and hospital administrator Jim Kubik were interviewed for this article.

What impact has state designation had on your hospital and team?

Being state designated is a formal way of evaluating our trauma care from pre-hospital to the emergency room and all the way to transferring the patient to a higher level trauma center.

This process has given the entire trauma team (EMS, lab, X-ray, nursing and physicians) more awareness of specific needs of the trauma patient in comparison to other emergency room patients.

We have improved and revised existing

trauma physician orders, history and physicals, and nurse’s notes and combined them into a “trauma packet” to be easily accessed for the trauma patient.

We now have standing lab orders for traumas so lab doesn’t have to wait for the physician to do computer order entry. We are proficient in evaluating the Glasgow Coma Scale (GCS) on all trauma patients from EMS to the ER because this tool predicts probability of survival. We have achieved 100 percent competency for our nurses to obtain

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goal is teamwork to give the best possible outcome to the patient.

Dr. Reginald Burton of Bryan Health (far right) poses with Pawnee County Memorial Hospital’s Trauma Team. their Trauma Nurse Core Course (TNCC) and renewal, as well as our physicians to obtain their Advanced Trauma Life Support (ATLS). Our locum tenen physicians have to have their ATLS as well. The designation process has made us better team players because we all know what our role is in taking care of the trauma patient.

What impact has being state designated had on your community?

The impact on the community is simple: tragedy can happen anywhere — even in a small rural town. Because of the knowledge we’ve gained, we are assuring the community that their loved ones receive the highest level of care.

What is the most rewarding about earning this designation?

The most rewarding part of being a state designated trauma hospital is knowing we are properly trained to take care of the most critically injured trauma patients to give them the best outcome after a tragedy. Seeing patients like Fannie in the community brings a tear to your eye knowing you made a difference.

What’s the most challenging aspect of being a designated trauma hospital?

As a trauma coordinator the most challenging part of being state designated is continuing to educate EMS, nurses, and physicians regarding the performance improvement (PI) indicators and why they are important.

When we started this process, just documenting the GCS at the scene and then assessing it frequently in the ER was a huge undertaking. It can seem repetitive to keep re-educating these indicators and explain their importance, but in the end, the result is rewarding because we are monitoring things that ensure we are giving excellent trauma care. Also, at trauma committee meetings we discuss what needs to be improved upon and but we ALWAYS discuss what went well, too. We never point fingers!

Has the designation helped your relationship with the EMS providers you work with?

Designation has strengthened our relationship with EMS, but it has also opened up the lines of communication between pre-hospital personnel and the ER nurses and physicians. The overall

How do you prepare for a trauma patient like Fannie Yoder when the 911 call comes across?

When that 911 call comes across, your initial reaction is to prepare for the worst but hope for the best! Because of the training and education we’ve received, evaluating the mechanism of injury has helped us decide when to activate air transport or have them standby.

Fannie’s crash occurred on a Sunday morning, so extra staff weren’t in house to help, but it is an unwritten rule that “extra hands” can be called in to help.

EMS is always helpful as well in the ER when RN coverage is low if there are multiple victims or critically injured like Fannie was. Tragedies in small communities can be emotionally stressful on all health care professionals who take care of the trauma patient.

Anyone involved can ask for a “Trauma Debrief” where there is a non-judgmental, open meeting held the Wednesday after any trauma to discuss concerns, emotions or what went well during the trauma. This has been an extremely positive tool to help those involved deal with a difficult situation.

Kris and Jim, administratively why do you feel hospitals in the state of Nebraska should strive to become or maintain state trauma designation?

Kris: Being a state designated trauma hospital opens up so many resources and accountability that we would otherwise not have access to. From the educational requirements of our nurses and providers, critique of each trauma, trauma debriefs, accountability of EMS and hospital staff — these all contribute to providing the best possible care for our patients in their time of need.

Jim: Administratively it gives us a mark to shoot for at least at a minimum level that we know has credibility with the people who work with trauma as the majority of their business. It makes us continually strive to improve the quality of our service. n

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New surgical simulator is teaching tool

Foundation supports Trauma Center with TraumaMan purchase

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he Bryan Foundation has a mission that rings true with its support of the Bryan Trauma Center: to provide needed financial support to Bryan Health so that it can offer the best in health care to the patients and their families we have the pleasure to serve.

As a Trauma Center we are continuously looking at process improvements within our own organization, as well as providing education to outside facilities to ensure patients get the best care.

In December 2014 with the support of the Bryan Foundation, the Trauma Center purchased a TraumaMan. This a surgical simulator approved for use in Advanced Trauma Life Support by the American College of Surgeons and is the most widely used surgical simulator in the world. The

TraumaMan System allows students to road to rural facilities to provide mock practice several advanced surgical protrauma experiences in a safe, noncedures, including threatening, cricothyroidotomy, teaching percutaneous traenvironcheostomy, needle ment. decompression and If you chest tube inserare intertion. In addition to ested in the TraumaMan, learning the Trauma Center more about also purchased the education F.A.S.T. Module. that can According to be offered Simulab, the at your module provides organizaSoftware allows any computer to simulate the an excellent tool tion please ultrasound machine. to learn to read contact a F.A.S.T. (Focused Assessment with Trauma Outreach and Injury Sonography for Trauma) exam.

Prevention Coordinator Heather Talbott The goal of the Bryan Trauma at 402-481-4087, or email her at Center is to take TraumaMan out on the heather.talbott@bryanhealth.org. n

Thanks to the Bryan Foundation, a TraumaMan helps teach caregivers.

Cricothyroidotomy simulation is one of many available scenarios.

Chest tube insertion includes bleeding tissues for added realism.

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Robert Wergin, MD, FAAFP, President of the American Academy of Family Physicians, endorses the use of TraumaMan. “As an ATLS instructor and more importantly as a rural family physician, I was pleased to hear of Bryan Health’s purchase of the TraumaMan System. With this mannequin, providers can have a hands-on experience with procedures that can be life saving. This system will be utilized across the state in a mock trauma scenario. Physicians then can get a hands-on experience with chest tube insertion, cricothyroidotomy, pericardiocentesis, diagnostic peritoneal lavage, and percutaneous tracheostomy. In my travels as the current president of the AAFP, I am asked, ‘Why would you put a chest tube in?’ My response is because I have to in these situations.

It can be the difference between life and death for our traumatized patient.

Systems like TraumaMan give our rural community physicians experience with these procedures and the confidence to do what you have to do when the situation calls for it. Ultimately it is for our patients, to improve their care in trauma situations and improve their outcomes. Bravo to the trauma team at Bryan to think of us and the challenges we face in rural Nebraska.“

Family physician Robert Wergin, MD, of Milford

Tribute to Trauma Champions Wednesday, April 22, beginning at 6:30 p.m. at the Embassy Suites, 1040 P St. Cost is $30. To learn more or to register, go to bryanhealth.org/calendar, under community events.

You’re invited!

This year we recognize trauma survivors Nicholas Boruch of Osceola and Taylor Graham of Lincoln and honor the dedicated professionals from throughout the statewide trauma system who were involved in saving Nicholas and Taylor.

Hear their remarkable stories and salute their caregivers at this annual event. n

Nicholas Boruch

Taylor Graham

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Reunion at Bryan

Team helps acute inpatient rehabilitation patients move beyond traumatic events

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n September, the Bryan acute inpatient rehabilitation unit hosted a luncheon on Bryan West Campus to reunite former patients with the staff that helped care for them. During the celebration, patients shared stories of hope, achievement and successful rehabilitation from life-altering events.

The Rehabilitation Reunion celebration promotes the value of rehabilitation, highlights capabilities of people with life-altering events, salutes professionals who provide services to our community and renews our commitment to meet the needs of people who require our services.

Jake Farwell of Humboldt shared his appreciation for the EMS squad that found him, ejected from his vehicle, shivering and unconscious.

That EMS team acted quickly to transfer Jake to Falls City Community Medical Center and activated the StarCare air ambulance service to Bryan West Campus.

Jake notes he would not be where he is today without the excellent care he received from the first responders, the StarCare team, Emergency Department at Falls City Community Medical Center, and the Bryan Medical Center Emergency Department, intensive care

unit and acute inpatient rehabilitation unit.

Each year the inpatient rehabilitation unit serves more than 600 persons who have suffered a life-altering event from a brain injury, stroke, limb loss, trauma or disease process.

Our outcomes are above regional and national benchmarks for the ability to return our patients to their own homes and achieve their personalized functional improvement goals, such as self-care needs, walking, getting in and out of chairs, communication, interacting with others and managing their day-to-day activities.

The Bryan acute inpatient rehabilitation unit is a 30-bed CARF accredited facility located on the Bryan West Campus of Bryan Medical Center. If you or your loved one should need our services, the preadmissions coordinators can be contacted at 402-481-9326 to determine qualification.

The Bryan rehabilitation team works to move patients forward beyond their traumatic events using highly trained and dedicated professionals working as a team. n

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Bryan Trauma Team adds mid-level providers Julie Wilkason, APRN Julie grew up in Lincoln.

She attended Union College, where she obtained her Bachelor of Science in Nursing in 2004. She worked as a post-surgical nurse for eight years before obtaining her Master of Science in Nursing degree in 2012 from Creighton University, Omaha, specializing in Acute Care.

She worked in the areas of gastroenterology, pain management and internal medicine before coming to the Bryan Trauma Center. Julie is married with 3 children. In her free time she enjoys spending time with her family and traveling. n

Bethany Berg, PA-C Bethany was raised in rural Lewiston, Nebraska.

She attended Wayne State College, where she completed a degree in Biology, and then obtained her Physician Assistant Degree at the University of Nebraska Medical Center.

Bethany practiced one year in a rural community, where she worked in a family medicine clinic, emergency department and outpatient clinic, before joining the Bryan Trauma Center. Bethany and her husband are looking forward to relocating to Lincoln, where he will practice as a physical therapist. n

Sign up for these 2015 Trauma Courses These courses are in the Conference Center at Bryan West Campus, unless noted otherwise.

ATLS — April 2 and 3.

ATLS — July 30 and 31.

ATLS — Oct. 1 and 2, at Seward.

ATLS Refresher only — Dec. 11.

TNCC — April 13 and 14.

TNCC — Nov. 2 and 3.

ENPC — March 24 and 25.

ENPC — Oct. 21 and 22.

Bryan Trauma Symposium — Sept. 25.

Trauma Grand Rounds — Fourth Friday of every month except September, November and December.

Mock Trauma — Trauma Team members come to your facility and provide Mock Trauma training in a safe, non-threatening environment.

Information about these courses can be found at bryanhealth.csod.com/LMS/catalog/Welcome.aspx.

For additional questions, contact trauma outreach and injury prevention coordinator Heather Talbott, MSN, RN, at 402-481-4087, or email heather.talbott@ bryanhealth.org.

Free continuing education available to you Contact Heather Talbott to inquire about free trauma education provided at your facility or in your community. Some of the topics earning CME credits and CEUs are Current Trends in Trauma, the Trauma System and EMS Trauma Case Reviews.

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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If you would like to be added to the Trauma Update mailing list, call Trauma Outreach and Injury Prevention Coordinator Heather Talbott at 402-481-4087, or email her at heather.talbott@bryanhealth.org.

Dr. Burton joins prestigious ACS National Committee on Trauma Reginald Burton, MD, FACS, FCCM, has been named to the American College of Surgeons National Committee on Trauma.

As a member of this elite committee, Dr. Burton will join trauma surgeons across the country who oversee a field of more than 3,500 fellows, working to develop and implement meaningful programs for trauma care in local, regional, national and international arenas.

Dr. Burton previously served as the Region 7 Chief (Nebraska, Iowa, Kansas, Missouri) of the American

College of Surgeons and also as the Chair of the American College of Surgeons Committee on Rural Trauma.

He also currently serves as the Region 2 Medical Director of the Nebraska Statewide Trauma System. n