Bryan Trauma Update | Winter 2015

TRAUMA UPDATE

News from the Trauma Center at Bryan Medical Center WINTER 2015

Designated trauma care facilities crucial to Nebraska successful statewide system Hospital Trauma Centers Nebraska Hospital Trauma Centers

Scotts Bluff

Grant

Scottsbluff (308) 635-3711 ext.234

Banner

Box Butte

Hooker

Thomas

Ord (308) 728-3211

Arthur

McPherson

Logan

Broken Bow (308) 872-4100

Morrill

Bridgeport (308) 262-1616

Banner

North Platte (308) 696-8000

Ogallala (308) 284-4011

Deuel

Grant

Garden

Kimball

Hayes

Hitchcock

Benkelman (308) 423-2204

Jefferson

Custer

Valley

Johnson

Gage

Genoa (402) 993-2279

Auburn (402) 274-4366

Nance

Pawnee City Richardson Falls City (402) 852-2231 (402) 245-2428

St. Paul

(308) 754-4421 Pawnee

Sherman

Howard

Central City (308) 946-3015

S 36TH ST

Franklin

HARRISON ST

GILES RD

Webster

(308) 423-2204

5 WY 7

Harlan

Clay

US H

Furnas

S 10TH ST

Cambridge (308) 697-3329

F ST

Thurston

West Point Stanton (402) 372-2404 Burt Oakland (402) 685-5601 Cuming

Nuckolls

Colfax

Platte

Columbus (402) 564-7118

Polk

Dodge

W as hi

Saunders Butler

Osceola (402) 747-2031

Wahoo (402) 443-4191

Seward

York

Lancaster Saline

Thayer

Jefferson

Memorial Community Hospital (402) 426-2182

to n

Omaha Children's Hospital 402-955-5400 Omaha (402) 449-4686 Omaha (402) 559-9156

Sarpy Cass Nebraska City 402-873-3321

Otoe Syracuse (402) 269-2011

Crete 402-826-2102

Fillmore

ng

Douglas

Lincoln (402) 475-1011

Hastings (402) 463-4521

Adams I 80

I 80 Phelps I STKearney US HWY 275 Q ST

S 48TH ST

STMcCook AT 345-2650 (308) E HW

Y2 Hitchcock YANKEE HILL RD Benkelman Red Willow

Kearney PACIFIC ST Holdrege 308-832-3400 (308) 995-2211 STATE HWY 38

N 24TH ST

Gosper

S 168TH ST

S 84TH ST

Frontier

N 50TH ST

VAN DORN ST

US HWY 6

N 72ND ST

A ST

STATE HWY 133

Lincoln Vicinity

(308) 872-4100

Thayer

Nebraska City 402-873-3321

Greeley Nemaha

(402) 269-2011

Merrick REDICK AVE IDA ST Gothenburg Buffalo (308) 537-3661 Hall FORT ST AMES AVE Cozad Grand Island Kearney (308) 784-2261 STATE HWY 64 (308) 384-4600 Hamilton (308) 865-7100 Lexington Dawson (308) BLONDO ST 324-5651 S 98TH ST

Dundy

Ord Otoe Lancaster (308) 728-3211 Syracuse

Bow Saline FillmoreBroken

Nuckolls

Webster

US HWY 34

S 56TH ST S 48TH ST

Chase

Hayes

Crete 402-826-2102

Madison Boone

Cass

7

A

Lincoln (402) 475-1011

Y7 HW

Pediatric Level II

W A STImperial (308) 882-7111 W VAN DORN ST

US

Level I

VINE ST

Seward

York

Wayne

Dakota

Norfolk (402) 371-4880

GarfieldSarpyWheeler

Lincoln (402) 475-1011

Pierce

Omaha (402) 449-4686 Omaha (402) 559-9156

Douglas

Wahoo (402) 443-4191

Butler Loup

Clay

Adams

ADAMS ST

S 27TH ST

Level II

US HWY 6

S FOLSOM ST

Level III

I 80

Kearney

Lincoln

Perkins

Saunders

Osceola (402) 747-2031

Hastings (402) 463-4521

North Platte (308) 696-8000

Ogallala (308) 284-4011

I 180

Level IV

Keith

Blaine Merrick

Franklin

Harlan

Furnas

Central City (308) 946-3015

Grand Island Kearney (308) 384-4600 Hamilton (308) 865-7100

Phelps

Cambridge (308) 697-3329

Howard

Antelope

Polk

Hall

Gosper

Red Willow

Grant (308) 352-7201

Buffalo

Kearney McPherson Holdrege Logan 308-832-3400 (308) 995-2211

Frontier

McCook (308) 345-2650

Dundy

Deuel

Legend

Arthur

Sherman

Thomas

Gothenburg (308) 537-3661 Cozad (308) 784-2261 Lexington Dawson (308) 324-5651

Perkins

Chase

Cheyenne

Hooker

Lincoln

Grant (308) 352-7201

Imperial (308) 882-7111

Kimball (308) 235-1951

Custer

S 40TH ST

Keith

I8 0

Cheyenne

Memorial Community Hospital W (402) 426-2182 as hi Dodge Omaha Children's Hospital ng to 402-955-5400 n

Columbus (402) 564-7118

Nance

St. Paul (308) 754-4421

Dixon

Holt

Colfax

Platte

Genoa (402) 993-2279

Greeley

Valley

Cedar

Creighton 402-358-5700

Thurston

West Point Stanton (402) 372-2404 Burt Oakland (402) 685-5601 Cuming

Boone

Alliance Garden (308) 762-6660

Knox

Atkinson (402) 925-2811

BrownMadisonRock

Wheeler

Garfield

Loup

Kimball (308) 235-1951

Kimball

Wayne Norfolk (402) 371-4880

Bridgeport (308) 262-1616

Scottsbluff (308) 635-3711 ext.234

Ainsworth Pierce (402) 387-2800 Antelope

Blaine

S 9TH ST S 17TH ST

Scotts Bluff

Morrill

Rock

Cherry

Sheridan

Dakota

I 480

Alliance (308) 762-6660

Dixon

S 72ND ST

Brown

I 680

Box Butte

Sioux

Creighton 402-358-5700

Valentine (402) 376-2525 Holt

Cherry

Boyd

Knox

Keya Paha Cedar

Atkinson (402) 925-2811

Ainsworth (402) 387-2800

Sheridan

Dawes

Boyd

Keya Paha

Valentine (402) 376-2525

S 144TH ST

Sioux

Gordon (308) 282-0401

I8 0

Chadron (308) Dawes432-3094

Gordon (308) 282-0401

Omaha Vicinity

Chadron (308) 432-3094

Nemaha Johnson Gage

Auburn (402) 274-4366

Pawnee City Richardson Falls City (402) 852-2231 (402) 245-2428

Pawnee

Source: Nebraska Department of Health and Human Services

I 480

S 72ND ST

I 680

Omaha Vicinity

I8 0

I8 0

S 9TH ST S 17TH ST

S 144TH ST

5 WY 7

S 48TH ST

7

S 36TH ST

S 40TH ST

US H

S 10TH ST

Lincoln Vicinity

N 24TH ST

N 50TH ST

Y7 HW

S 168TH ST

S 98TH ST

S 84TH ST

US

S 56TH ST S 48TH ST

S 27TH ST

S FOLSOM ST

N 72ND ST

I 180

STATE HWY 133

ICK AVE Annie Jeffrey Memorial County Health Center, Kimball Health Services, Kimball;RED Litzenberg IDA ST ccording to the National ADAMS ST T ST Osceola; Avera Creighton Hospital, Creighton; MemorialFOR Hospital, Central City; Mary Trauma Institute, trauma is S AVELanning AME 64 ST STATE HWY St. Anthony’s, Box Butte General Memorial Hospital, Hastings; McCook CommuVINEO’Neill; Legend the leading cause of death forI 80 USAvera US HWY 34 ST HWY 6 BLO Hospital, Alliance; Brown County Hospital, nity Hospital,NDO McCook; Memorial Community ages 1-46. Nebraska’s StateA ST HWY 6 W A ST Levelwide IV Trauma System is a netAinsworth; Chadron Community Hospital, Hospital,US Blair; Morrill County Community VAN DORN ST PACIFIC ST DORN ST W VAN Chadron; Chase County Community Hospital, Hospital, Bridgeport; Nebraska Medical Center, work of definitive Level III care facilities that provide STATE HWY 38 I 80 Lincoln I 80 Auburn; F ST Imperial; Cherry County Hospital, Valentine; Omaha; Nemaha County Hospital, a spectrum of care for all injured patients. It (402) 475-1011 I ST US HWY 275 Level II CHI Health Creighton University Oakland MercyQHospital, Oakland; Ogallala is essential to the development of a trauma ST Medical ST AT E N ST Pawnee County RISO H HAR care system to have designated trauma care Center, Omaha; Children’s Hospital and Community Hospital, Ogallala; Level I W Medical Y2 YANKEE HILL RD RD S GILE facilities (DHHS Nebraska, 2014).

Center, Omaha; Columbus Community Hospital, Memorial Hospital, Pawnee City; Perkins Pediatric Level II The goal is to create an integrated Columbus; Cozad Community Hospital, Cozad; County Health Services, Grant; Phelps MemoSource: Nebraska Department of Health and Human Services system of health care providers and facilCrete Area Medical Center, Crete; Dundy Counrial Health Center, Holdrege; Regional West ities throughout Nebraska to match each ty Hospital, Benkelman; Faith Regional Medical Medical Center, Scottsbluff; Saunders Medical patient’s needs to the resources of the Center, Norfolk; Genoa Community Hospital, Center, Wahoo; St. Francis Medical Center, facilities, from activation of the Emergency Genoa; Good Samaritan Hospital, Kearney; Gor- Grand Island; St. Francis Memorial Hospital, Medical Services system until their return don Memorial Hospital, Gordon; Gothenberg West Point; St. Mary’s Community Hospital, home.

Memorial Hospital, Gothenberg; Great Plains Nebraska City; Thayer County Health Services, Bryan Health commends these NebrasRegional Medical Center, North Platte; Howard Hebron; Tri-County Hospital, Lexington; Tri ka Trauma Designated Hospitals for their County Community Hospital, St. Paul; Jennie M. Valley Health Systems, Cambridge; Valley dedication to their communities and the Melham Memorial Medical Center, Broken Bow; County Hospital, Ord; and West Holt Memorial Statewide Trauma System.

Kearney County Health Services, Minden; Hospital, Atkinson.

2

The role of Emergency Medical Service providers in

SUICIDE PREVENTION

I

By David Miers, PhD, LIPC t is estimated that each year suicide takes the lives of about 38,000 Americans, and approximately 465,000 individuals are seen in hospital emergency departments for self injury (CDC,

2010).

It also is estimated that each year more than 8 million adults think seriously about taking their life, and over 1 million make an attempt (NSDUH, 2011).

Emergency Medical Service (EMS) providers are called on to respond to patients who may be at risk for suicide or who may have attempted suicide.

Therefore, it is important that EMS providers understand their role in helping to prevent suicide.

The Suicide Prevention and Resource Center (SPRC) has developed a handout, called “The Role of Emergency Medical Service Providers in Preventing Suicide,” that can be found at http:// www.sprc.org/sites/sprc.org/files/ems.

The document discusses identifying people who may be at risk, responding to patients who may be at risk for suicide or have attempted suicide, helping suicide survivors at the scene, becoming involved in suicide prevention in your organization and community, and it provides resources. It is important to review all of these topics.

This article highlights the section identifying people who may be at risk.

Identifying people who may be at risk for suicide It is important to look for signs of immediate risk for suicide. There are three behaviors that may mean a person is an immediate risk for suicide and should prompt you to take action right away:

•

•

•

Talking about wanting to die or to kill oneself.

Looking for a way to kill oneself, such as searching online or obtaining a gun.

Talking about feeling hopeless or having no reason to live.

If individuals exhibit any of these three behaviors, it is important to connect them with resources immediately so that they can be evaluated by a trained professional. Bryan West Campus has a 24/7 Mental Health Emergency Department available for individuals in crisis to determine if they meet the criteria for hospitalization.

Other behaviors may also indicate a serious risk, especially if the behavior is new, has increased and/or seems related to a painful event, loss or change.

Ask if the patient has been exhibiting these behaviors: •

• •

Talking about feeling trapped or in unbearable pain.

Talking about being a burden.

Increasing use of alcohol or drugs.

• Acting anxious or agitated; behaving recklessly.

• Sleeping too little or too much.

• Withdrawing or feeling isolated.

• Showing rage or talking about seeking revenge.

• Displaying extreme mood swings

Other problems that increase risk Certain problems may increase a person’s risk for suicide. Asking if the patients have any of the risk factors can help you assess the current situation more accurately and enable you to provide more complete information to medical staff.

Some more significant risk factors to ask about are: • • •

•

Prior suicide attempt.

Alcohol or drug abuse.

Mood or anxiety disorders, e.g., depression, post-traumatic stress disorder (PTSD).

Access to means to kill oneself, i.e., lethal means.

3

Suicide risk usually is greater among people who have more than one risk factor. For individuals who already are at risk, a “triggering” event causing shame or despair may make them more likely to attempt suicide. These events may include relationship problems or breakups, problems at work, financial hardships, legal difficulties and worsening health.

Even though most people with risk factors will not attempt suicide, they should be evaluated by a professional. It is important to know the resources available in your area. It also is important to prepare ahead of time and review protocols and procedures required by your organization and in your local area for responding to potential suicides and patients at risk for suicide.

Help is available Bryan Medical Center Mental Health Services has resources available to help individuals with mental health needs.

• Emergent care — The Mental Health Emergency Department (located in the main Emergency Department at Bryan West Campus) provides assessments to determine if individuals in crisis need hospitalization. Staff are available 24 hours a day, seven days a week. If outside of the Lincoln area, call 9-1-1 or go to the nearest emergency room.

• Non-emergent care — The Bryan Counseling Center is for non-emergency clients who would benefit from outpatient services. To schedule an appointment at the Counseling Center, call the Counseling Center at 402-481-5991.

• Online confidential depression, anxiety and alcohol screenings: go online to www.bryanhealth.org/ onlinescreenings.

• The Suicide Prevention Lifeline for people in suicidal crisis or emotional distress is 1-800-273-8255.

Information for this article was adapted from http://www.sprc.org/sites/sprc.org/files/ems.

Camino ICP monitors debut in NeuroTrauma Critical Care Unit The NeuroTrauma Critical Care Unit and Operating Rooms at Bryan Medical Center West Campus implemented a new intracranial pressure (ICP) monitoring system this fall.

The Camino system’s monitors allow for measurement of pressure inside the cranial vault with concurrent drainage of excess cerebral spinal fluid (CSF).

Previously these two functions could not occur simultaneously. Two additional benefits of the

new monitors are touch screen technology and a display of pressure waveforms, making it easier to interpret and report results. The monitors are simpler for the neurosurgical team to calibrate and for the intensive care staff to synchronize with the bedside monitors.

And for the first time ever, there is an ICP monitoring catheter that is MRI compatible. This will facilitate earlier MRI scans in our patients with severe head injuries and assist us in caring for them. n

Bryan Trauma Team members attend Advances in Trauma Conference Bryan Health Trauma Center members attended the 37th annual Advances in Trauma Conference Dec. 5-6 in Kansas City, Mo. This is one of only three meetings in the United States held by the American College of Surgeons Committee on Trauma.

2014 was Reginald Burton, MD’s last year as Region 7 Chair.

Dr. Burton’s leadership was Dr. Burton with Crete Area instrumental Medical Center emergency in expanding director Amy Vertin, MD, access to conwhose presentation on rural trauma care was well tinuing medical received at the conference. education for trauma surgeons, general surgeons, ED physicians, trauma program managers, nurses,

physicians assistants, EMS providers and others in health care.

Region 7 includes Nebraska, Iowa, Missouri and Kansas. As chair, Dr. Burton assembled preeminent speakers from Dr. Burton (right) helped the United bring prominent speakers States and Eu- to the conference, such as rope to lecture Demetrios Demetriades, MD, of Los Angeles County, Calif. at the annual conference.

His mission was to strengthen and advance the trauma system, from EMS and rural trauma centers to state and ACS verified trauma centers. Promoting collaboration within these systems and offering access to pertinent education helps lead to the best possible outcomes for patients.

4

2014 Bryan Trauma Symposium

Meeting your needs

O

n September 19, 2014, more than 170 participants attended the 11th annual Trauma Symposium at Bryan Medical Center West Campus.

Keynote Speaker was Bryan Cotton, MD, MPH, associate professor of surgery at the University of Texas Health Science Center in Houston. Dr. Cotton discussed Viscoelastic testing in the emergency and trauma setting, as well as practice management guidelines for pre-hospital fluid resuscitation in penetrating trauma patients.

Amy Vertin, MD, emergency medical director at Crete Area Medical Center, educated the audience on rural trauma and its challenges. She helped identify key differences between managing trauma in a rural setting versus an urban hospital, including pre-hospital care, hospital resources and staffing. Dr. Vertin also explained the role of a hospital based rural ALS intercept program in a trauma patient. Currently Crete Area Medical Center has a rural ALS intercept program in place that has proven to be a great program not only for the patients and their communities but the medical professionals that are caring for the patients.

Ron Kirschner, MD, medical director of the Nebraska Regional Poison Center and assistant professor for the Department of Emergency Medicine at the University of Nebraska Medical Center, informed the audience on: What’s New on the Street and an update on drugs of abuse.

In addition to the speakers, participants attended four separate breakout sessions which included: pediatric simulation, geriatric simulation, rescue airways and trauma center follow up, as well as Public First Aid — Train the Trainer.

The day concluded with Reginald Burton, MD, speaking about What’s New in Trauma and Stanley Okosun, MD, presenting trauma case reviews. Before attendees left the symposium, Robbie Dumond, RN, EMT-I, gave An Overview of Modern Trauma Care.

Thank you to our sponsors and all who presented and attended. We are excited the symposium continues to grow, and we look forward to seeing you next year on Sept. 25, 2015.

Amy Vertin, MD, (left), Bryan Cotton, MD, and Reginald Burton, MD, made keynote presentations at the symposium.

The Bryan Trauma Symposium again was a popular destination for those interested in improving emergency and trauma services in their communities. Full houses greeted speakers, such as Dr. Cotton, (above) in the conference center at Bryan West Campus.

5

Stanley Okosun, MD, (above) uses a simulation mannequin for a mock scenario involving a chain saw incident. Elizabeth Schoemaker, MD, (below) discusses “intubating like a pro.”

Dr. Burton teaches about pediatric trauma.

We hear you

Lincoln Fire and Rescue (right) provided hands-on Back to Basic training, such as this lesson in applying tourniquets.

Participant surveys say: “This was great!”

“Another excellent symposium! Getting better every year!”

“Best conference I’ve been to in a while!”

“This is one of my favorite conferences, and I always learn so much. The staff was wonderful — very knowledgeable, practical and great senses of humor. The food was delicious.

Thanks for all the great informational handouts.”

6

Chest tube carts

Standardization is key in trauma care

A

s part of the Bryan Trauma Program’s commitment to providing excellent care to patients across the region, the Emergency Department staff and Trauma Team have worked on putting together standardized carts for the placement of chest tubes in the Emergency Department.

The carts provide a mobile supply for chest tube insertion that could essentially be performed in any room of the Emergency Department. In addition, all staff have been trained in the use of the cart and each supply that

is found in the cart.

This performance improvement led initiative is one example of the Bryan Trauma Program’s commitment to excellence in trauma care.

If you have any questions or would like to learn more about equipment and supplies related to trauma care, please contact trauma performance improvement nurse Jennifer Middlekauff at 402-481-4167 or Trauma Program manager Robbie Dumond at 402-481-5150. n

Here’s an example of the standardized carts used at Bryan Medical Center.

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

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

ATLS — April 2 and 3.

ATLS — July 30 and 31.

ATLS — Oct. 1 and 2, at Seward.

ATLS Refresher only — Nov. 13.

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.

Advanced Trauma Course for Nurses — July 30 and 31.

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.

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.

7

Decontamination training preps Bryan staff for potential incidents

T

wenty-five staff members from throughout Bryan Medical Center participated in a full-scale decontamination exercise Sept. 9-10, 2014.

This training is essential to the adequate prepara-

tion for receiving contaminated victims at Bryan.

The training was conducted with support from the Center for Preparedness of Omaha. 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

TRAUMA UPDATE Bryan West Campus 2300 S. 16th St., Lincoln, NE 68502-3704

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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.

Dumond appointed to Trauma Advisory Board

Meet Dr. Livingston, neurosurgeon

Robbie Dumond, RN, has been appointed to a three-year term to the Nebraska Department of Health and Human Services State Trauma Advisory Board.

Dumond has served as trauma and emergency preparedness manager at Bryan Medical Center since 2012. His day-to-day responsibilities include managing Bryan’s Level Two Trauma Center, as well as emergency preparedness Robbie Dumond, RN endeavors at the medical center.

He is the board’s trauma nurse representative.

For more than 25 years, Bryan has been the designated Trauma Center for southeast Nebraska. n

Neurosurgeon Andrew Livingston, MD, has joined Neurological and Spinal Surgery. He specializes in surgery of the brain, spine and peripheral nerves.

Dr. Livingston graduated cum laude in 2003 with a Bachelor of Science from Chadron State College, where he also participated in the Rural Health Opportunities Program (RHOP). He went on to receive his medical degree in 2007 from the Andrew Livingston, MD University of Nebraska Medical Center College of Medicine, Omaha.

Dr. Livingston completed a general surgery internship at Houston Methodist Hospital, Texas, where in 2014 he completed his neurosurgery residency. He has contributed to numerous publications in the areas of neuro and spinal surgery. n