Trauma Update - Spring 2013

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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TRAUMA UPDATE

News from the Trauma Center at Bryan Medical Center SPRING 2013

Lincoln Fire and Rescue team responds to Adam’s emergency By Robbie Dumond, RN, Trauma Program manager

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One mission. One team.

Happy EMS Week! Thanks for all you do! We are proud to partner with you in our common mission to save lives.

Oct. 25 Symposium at Bryan addresses traumatic injuries among elderly

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ave the date for the 2013 Bryan Trauma Symposium! Our 11th annual symposium will be Friday, Oct, 25, in the conference center at Bryan West Campus. Traumatic Injuries in the Elderly Population is this year’s focus. Packed with expert speakers, the symposium has something for every discipline, from rural rescue squads to primary care physicians and trauma team members. This year’s event features two nationally recognized speakers: E. Wesley Ely, MD, MPH, will present New Frontiers in Critical Care, and Alicia Mangram, MD, FACS, will present Traumatic Injury in the Elderly Population. Dr. Ely is a professor at Vanderbilt University School of Medicine, Nashville, Tenn. He is a subspecialist in pulmonary and critical care medicine with a focus on geriatrics and serves as associate director of aging research for the VA Tennessee Dr. E. Wesley Ely

Valley Geriatric Research and Education Clinical Center. Dr. Mangram is director of trauma services for the John C. Lincoln Health Network and medical director of the Level I Trauma Center at John C. Lincoln North Mountain Hospital, Phoenix, Ariz. Other highlights of this year’s event will be a didactic simulation and skills session featuring simulation devices from the Center for Excellence in Clinical Simulation. Bryan Trauma Program medical director Reginald Burton, MD, will provide an update on current trends, and Bryan trauma surgeon Stanley Okosun, MD, will present an exciting case review. Registration details will be available soon. For more information about the symposium, contact Bryan Trauma Program manager Robbie Dumond at 402-481-5150, or email him at robbie.dumond@ bryanhealth.org. n Dr. Alicia Mangram

n April 4, 2013, Bryan Health honored trauma survivor Adam Koenig at the Tribute to Trauma Champions. Adam’s road to recovery is a remarkable story that started with the care he received from pre-hospital providers with Lincoln Fire and Rescue. Adam was involved in a crash while driving his motorcycle on May 25, 2012, in which he sustained life-threatening injuries. Paramedic Josias Robinson was one of the first people on the scene that day and recalls that bystanders had initiated CPR. This was continued until Adam regained pulses, and then other life-saving advanced life support care was initiated during transport to the Trauma Center at Bryan West Campus. Lincoln Fire and Rescue Medic 6 had a six-minute scene time during which Adam was placed on a long spine board and moved to the ambulance, and transport to the Trauma Center was initiated. After an extended hospitalization with numerous lifesaving measures including being placed on Extracoporeal Membrane Oxygenation (ECMO), Adam was able to hear his story and have an opportunity to meet the individuals who were honored as champions in his care. Among these champions were members of Lincoln Fire

Trauma survivor Adam Koenig (center) is flanked by some of the first responders to his crash scene: Josias Robinson, Nationally Registered Paramedic (left), Mark Davis, EMT-B, Gregg Fisher, Nationally Registered Paramedic, and Jamie Bray, EMT-B, of Lincoln Fire and Rescue. and Rescue Engine 4 and Medic 6 “C” shift. Lincoln Fire and Rescue responded to approximately 16,347 emergency medical calls in 2012. Lincoln Fire and Rescue EMS providers train continuously on the care of sick and traumatically injured patients. In total, there are six front line ambulances and five ready reserve ambulances that provide service to the city of Lincoln. Front line ambulances are staffed 24 hours a day, and the ready reserve ambulances are available to be placed into service when the system becomes busy. Currently Lincoln Fire and Rescue employs 78 paramedics who stand ready to serve at a moment’s notice. Outcomes such as Adam’s are directly related to the valuable working relationships between Lincoln Fire and Rescue and the Bryan Trauma Team. n There’s more! Look inside to read about ECMO and see photos from this year’s Tribute to Trauma Champions event, which saluted those who helped Adam Koenig and Derek Stromp recover from their life-threatening injuries.

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ECMO proves to be life saver

Neuro Trauma welcomes manager

By Richard Thomas, Trauma research assistant

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By Kelli Klopfenstein, RN, Neuro Trauma Critical Care manager

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echnology is ever-changing in the world of medicine, and we are fortunate to have access to advanced equipment and to be able to implement life-saving procedures as part of the trauma program on the Neuro Trauma Critical Care Unit at Bryan West Campus. An example of this available technology is the ECMO for severe lung injury in the trauma population. ECMO stands for Extracorporeal Membrane Oxygenation and is implemented after a breathing machine, or ventilator, has failed to improve the trauma patient’s breathing status. The patient remains on the ventilator during ECMO therapy. The ECMO machine does the work of the heart and/or lungs when they are unable to provide enough oxygen to vital organs. This is the same heart-lung machine used for cardiac bypass surgery. A tube is placed into a vessel and sends the patient’s blood through the ECMO machine. ECMO adds oxygen to the blood, which is then returned through a different vessel to the patient for circulation. These patients are dependent on ECMO as their life support. Patients on ECMO are staffed differently by hospital personnel because of the critical condition of these patients. ECMO trauma patients will have a trauma nurse, a cardiac nurse, a perfusionist (specialist for the ECMO machine), a trauma surgeon and possibly many other specialists caring for them. The patient is weaned off the ECMO machine as his or her condition improves and the lungs are able to deliver oxygen efficiently. Though used rarely in our trauma population, ECMO can be life saving and a final option for these critical patients. n

The ECMO (above and at left) machine is a system which delivers life-saving oxygen into the blood stream of a trauma patient, like motorcycle crash survivor Adam Koenig.

Diabetes drug glyburide also treats brain swelling

Kelli Klopfenstein, RN Congratulations to Kelli Klopfenstein, RN, BSN, on her appointment to manager of the Neuro Trauma Critical Care Unit at Bryan West Campus. Klopfenstein has been a nurse for 15 years, with the last seven of those in this patient care unit on 2 South. “I work with a tremendous staff and look forward to leading the team through new challenges in health care,” she says. “Our medical team accomplishes absolutely amazing results every day, and I’m honored to have a small part in that.” She earned an Associate’s Degree in Nursing at Southeast Community College in 1997 and a Bachelor’s from the University of Nebraska Medical Center in 2002 and is enrolled in the Master’s program at Nebraska Wesleyan University.

esearchers have found an interesting side effect to an old diabetes drug. Glyburide, an oral medication used to lower blood sugar, has been found to decrease brain swelling after injury from a traumatic event or from stroke. The secret to glyburide’s beneficial side effect is its interaction with a special sulfonylurea receptor in neural tissue called SUR1. Glyburide effectively blocks the action of SUR1 receptors, leading to significant reduction in the prevalence of edema in patients with an acute central nervous system (CNS) injury. Additional studies conducted on laboratory rodents have shown that those rodents treated with low doses of glyburide have only slightly reduced serum glucose, but show significant reduction in cerebral edema, infarct volume, mortality and neurological function. The results of these rodent studies, along with human studies currently under way, suggest that glyburide has the potential to reduce hemorrhage size, lesion volume and capillary fragmentation in patients with acute CNS injury. These promising findings mean that glyburide may soon become much more common in trauma departments around the country. Patients with brain and spine

injuries often have high blood glucose levels secondary to their injury. Because of the promising studies with glyburide, the Bryan Trauma Program is using glyburide at the outset to treat hyperglycemia in the hope that the beneficial CNS side effects will lead to better outcomes. n

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B The cross section of a laboratory rodent brain treated with saline (Photo A) two days after middle cerebral artery blockage shows much more damage — light-colored tissue indicates damaged areas — than a similar rodent brain (Photo B) treated with glyburide.

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Check out these educational opportunities n Bryan Trauma 2013 ATLS® Provider and Refresher course is offered at Bryan West Campus:

Thursday-Friday, July 11 and 12, or Thursday-Friday, Sept. 5 and 6.

n Trauma Nursing Core Course® (TNCC): Monday-Tuesday, Sept. 30-Oct. 1, and Tuesday-Wednesday, Nov. 5-6. n Emergency Nurse Pediatric Course® (ENPC): Monday-Tuesday, Oct. 14-15. n Trauma Grand Rounds are held on the 4th Friday of each month, beginning at noon, in the Bryan West Campus

Conference Center.

n Mock Trauma Day is a day-long, interactive, multi-sensory educational opportunity developed to positively support

local rural care settings in current trauma treatments and processes. This is a relationship building exercise which will enhance patient care outcomes involving continuity of care between rural and urban hospitals. This program is provided by StarCare and the Bryan Trauma Program.

For more information regarding educational programs, please contact Summer Erickson at 402-481-9909 or Robbie Dumond, Trauma Program manager, at 402-481-5150. n

Keeping children safe during summertime fun With the arrival of warmer weather, our children are ready to enjoy the outdoors! According to the National Safe Kids Campaign, one in four kids age 14 and younger will sustain an injury that requires some type of medical attention. Of note, 40 percent of all injury-related emergency room visits and 42 percent of all injury deaths happen between May and August. Although these statistics may be alarming, the good news is we can prevent approximately 90 percent of these injuries by taking appropriate precautions.

Kids’ Health & Safety Fair Bryan East Campus, 1600 S. 48th St. Saturday, June 8, 10 a.m.-2 p.m.

n Children can participate in dozens of free interactive

exhibits to learn about nutrition, exercise and many other fun health topics. n Get fitted for an affordable new bike helmet! n Look inside the StarCare helicopter, a fire truck or the Fire Safety House. n Enjoy the giant inflatables and live entertainment. n Children 12 and younger get a free beach ball! n Call 402-481-8855 for details.

During a typical year, the Bryan Trauma Center at Bryan West Campus admits more than 100 seriously injured children to the hospital, and many more children receive treatment in our emergency rooms and at Bryan Urgent Care. Bicycle, pedestrian and playground injuries are the most common. Safety steps you can take Wearing a bicycle helmet is the best way to protect your child — and yourself. It is important that adults model safe behaviors by wearing a bike helmet. Need a helmet for your child? You can get a helmet fitting and purchase a helmet at a special price from the Lincoln Lancaster County Health Department at the Bryan Kids’ Health & Safety Fair on Saturday, June 8, from 10 a.m.-2 p.m. at Bryan East Campus. It is extremely important for everyone to wear a helmet, stay alert and follow the rules of the road. Teach your children how to safely cross the street by looking both ways and using crosswalks. It’s also important to teach them not to walk in between parked cars to cross the street because this makes it very difficult for drivers to see them. Choose playgrounds that have soft ground surfaces and match the developmental needs of your child. Playgrounds are meant to be a safe place for kids to expend their energy; however, children should not be left unsupervised while enjoying the playground. Many playground injuries happen when children use playground equipment inappropriately or use equipment that is not appropriate for their age or abilities. We at Bryan Health wish you and your family a safe, fun summer! n

Tribute to Champions honors survivors and the heroes who saved them It takes innovative and aggressive treatments to bring critically injured patients back from death, and that’s just what the Nebraska Trauma System and Bryan Trauma Center celebrated April 4 at the 2013 Tribute to Trauma Champions. Fourteen-year-old Derek Stromp of Greeley lay trapped under an overturned ATV. He was not breathing, his color blue, when family and the EMS rescue squad arrived. The crew prepared him for rapid transport, but on the way to the hospital, the ambulance blew a tire. Knowing there was no time to delay, they kept driving while administering two shocks to Derek and continued CPR before seeing signs of

life. Next came aggressive hypothermia treatment and myriad additional procedures and interventions from the team at the Bryan Trauma Center, who stopped at nothing to save Derek. By all rights, Adam Koenig of Lincoln should not have survived his motorcycle crash. He owes his life and remarkable progress to the dedicated first responders and Bryan Trauma Center staff. On top of his extensive injuries from the crash, Adam suffered two cardiac arrest episodes. He is the first trauma patient at the Bryan Trauma Center to be placed on a machine that acts as an external lung. The innovative use of this Extracoporeal Membrane Oxygenation (ECMO) machine was a turning point in saving Adam’s life. More than 400 attended the event to hear stories of these patients’ survival and honor the heroic life-saving measures taken by family members, first responders, physicians and Bryan staff. n

Trauma survivors Adam Koenig (left) and Derek Stromp (right) celebrate with Reginald Burton, MD, director of trauma and surgical critical care at the Bryan Trauma Center.

Ruth Radenslaben, RN, received the 2013 Trauma Director’s Award.

To see their stories, use your smartphone’s QR application to access the code at right, or go to bryanhealth.org/ trauma-champions-2013.

There were champions from wall to wall at the Rococo Theatre April 4. Bryan saluted 149 during the annual Tribute to Trauma Champions.

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Identifying Posttraumatic Stress Disorder By David Miers, PhD, LIPC, Bryan Mental Health Services

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osttraumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Mental Health Services staff identified a primary care PTSD screening tool for Bryan Specialty Clinic nurses to use during followup visits with trauma patients. Patients who answer “Yes” to any two of the four screening questions are informed that follow-up with a trained professional is indicated, and they also receive information about PTSD and a Bryan Counseling Center brochure. Our free, confidential screening tool also can be accessed 24/7 at: www. bryanhealth.com/OnlineScreenings. Screening tools for PTSD, depression and

others are available on this website. Traumatic events that may trigger PTSD include violent personal assaults, military combat, natural or human-caused disasters, crashes and accidents. Helping the patient’s family understand PTSD is important. The person with PTSD may act differently, such as becoming angry more easily or not wanting to do things that the family used to enjoy together. Family members may have difficulty accepting changes that PTSD can bring. Anger and frustration are normal reactions, but they can hurt relationships and even lead to dangerous situations. By talking with each other, the patient and family will be better prepared for such changes. Call the Bryan Counseling Center at 402-481-5991 if interested in mental health services. How can I help someone who has PTSD?  Learn as much as you can. Knowing

how PTSD affects people can help you understand what your loved one is going through.  Offer to go to doctor visits with your family member, to help keep track of medication and therapy and to provide support.  Exercise is important for health and helps clear the mind, so do physical activities together, like walking or biking.  Encourage contact with family and friends. Support systems help people get through changes and stressful times. If your family member does not want your help, remember that withdrawal is a symptom. Give your loved one space, but tell him or her that you are always available. Things that suddenly remind the person of the traumatic event are called triggers. They can bring up stressful feelings or cause flashbacks which make the person feel as

PTSD can affect first responders

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he bombings at the 2013 Boston Marathon brought to light the crucial role of first responders — and the risks that they often take. As paramedics, police officers and civilians streamed around the marathon finish line just seconds after the duel blasts, many wondered if there would be further explosions. We felt deep concern for the physical safety of the downed victims and first responders. But physical wounds are only half the story. Posttraumatic Stress Disorder (PTSD) will likely affect some of the injured individuals, as well as any number of first responders. It doesn’t take an event as extreme as a bombing or the ensuing manhunt to trigger this disorder, but the Boston crisis did put PTSD in a stark light. Bearing in mind that PTSD is not

exclusive to those who deal with guns and bombs, it is important that everyone be attentive to their mental health, especially in the wake of any kind of tragedy. This applies not only to those who were at the site of the event, but even to those who spent long periods following it on television. For first responders, trauma is almost a daily part of life; however, seeking help is not always easy. They may fear being stigmatized or seen as vulnerable by their colleagues. But this is not insurmountable. PTSD is treatable, and such treatment can result in very noticeable improvement of the patient’s condition. Some important resources: • PTSD Screening Day, one of the highlights of PTSD Awareness Month, is June 20, and June 27 is National PTSD Awareness Day. Community organizations and military

installations provide free online screenings. Bryan offers www.bryanhealth.com/ OnlineScreenings every day. • The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Disaster Distress Helpline: (or text: TalkWithUs to 66746). Sadly, PTSD can lead to suicide. First responders who are entertaining thoughts of taking their own life should call the Suicide Hotline at 1-800-273-TALK (1-800-273-8255). We should all pass on this information to first responders we know. The more people who follow these guidelines, take screenings and seek treatment, the more acceptable it will be within the first-responder ranks.

if he or she is reliving the event. It is normal to avoid things that cause stress, but staying away from activities you used to enjoy may be hard on the person who has PTSD, as well as the family. Talk about triggers, so everyone knows what causes stress and helps find ways to cope. Some common triggers include social events, sounds, even smells. For example, smoke may trigger memories in someone who was hurt in a fire; loud noises or a car backfiring can remind a veteran of combat. Even being around others who were involved in a traumatic event can be a trigger. Try to plan enjoyable activities around anniversaries of traumatic events.

Information for this article came from the website of Screening for Mental Health Inc.

How to deal with anger or violent behavior? Anger is a normal reaction to trauma, but when anger leads to violent behavior

or abuse, it is dangerous. Go to a safe place and call for help right away. Make sure children are safe, as well. Establishing a time-out system can help you talk with a person who has PTSD even when you or they are angry. For example, you may agree:  That either may call a time out.  When a time out is called, discussion stops.  On a hand signal or word to use to call a time out.  To tell each other what you will be doing during the time out and when you will return. When you come back, take turns talking about solutions — and listen without interrupting. It is likely you both will have good ideas, so be open and focus on things you both think will work. You and your family may have trouble talking about feelings, worries and everyday problems. To communicate, be clear and to the point. Stay positive because blame and negative talk will not help the situation. Teaching children about PTSD also is important. They may not understand why you or your spouse is feeling sad or why you get angry — this can be scary at any age. Kids also may blame themselves for situations that are not their fault, so make sure that they know you are not blaming them. If you are having trouble talking things over, consider trying family therapy. This type of counseling involves your whole family. A therapist helps you communicate, cope and maintain good relationships. Your health professional or a religious or social services organization can help you find a family therapist who specializes in PTSD, such as the therapists at the Bryan Counseling Center. To contact the Counseling Center, call 402-481-5991. n Information for this article came from the National Center for PTSD. For more information, email ncptsd@va.gov.

Trauma Care After Resuscitation (TCAR) on horizon Two employees of Bryan’s Neuro Trauma Critical Care Unit recently attended a two-day training session about care of the trauma patient after resuscitation. Trauma Care After Resuscitation (TCAR) provides trauma health care workers with a broad foundation of knowledge essential to the care of trauma victims. The TCAR course covers physical response of the patient to a traumatic event, mechanism of trauma associated with injuries, and in-depth case studies for the thoracic, abdominal, musculoskeletal, craniocerebral and spine/spinal cord injuries. Case studies include common injuries, assessments, complications and treatments associated with the body system affected and mechanism of injury. Most education available to trauma teams revolves around pre-hospital and emergency room care. But TCAR focuses on acute care, critical care, perioperative and rehabilitation phases of the trauma patient. TCAR is designed for nurses, although it’s applicable to other health care providers. Bryan hopes to offer this course in the near future. Watch for further information on the Bryan Health website, or contact Robbie Dumond, Trauma Program manager, at 402-481-5150. n