Trauma Update is published for friends of BryanLGH Medical Center. Your comments and suggestions are welcome. Direct correspondence to the Public Relations Department at BryanLGH, or telephone the editor at 402-481-8674.
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TRAUMAUPDATE News from the Trauma Center at BryanLGH
Kimberly Russel, President, BryanLGH Health System; John Woodrich, President, BryanLGH Medical Center; Edgar Bumanis, Director, Public Relations; Paul Hadley, Editor.
FALL 2011
Story of summertime crash has happy ending for Monnich
F We’re preparing for Level 2 reverification It’s reverification time for BryanLGH — the only ACS (American College of Surgeons) Level 2 Trauma Center in Eastern Nebraska. Whether it is respiratory therapy, trauma registrar, radiology, nursing staff or the many others who play a role, dedication from the entire BryanLGH family is required to maintain this status. As a result, we take a lot of pride in our care for the injured patient. Our goal is to provide the most efficient and optimal care possible. We have applied for reverification and expect the process to occur this spring. Surveyors will review the 2011 year, making this year pivotal in our quest to maintain verification. The program underwent many personnel changes this year, welcoming a new trauma program manager and midlevel providers. The team has changed, but our care has remained constant — exhibiting the same efficiency and skill we’ve always provided. Being prepared to handle trauma is a basic service of a lead trauma center; being able to handle any trauma well is what makes us unique. We hope the ACS will agree during their evaluation. Watch for updates on how you can assist in preparing for our review.
Oct. 14 Symposium has pediatric focus
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his year’s Trauma Symposium is Friday, Oct. 14, in the Conference Center at BryanLGH West. Keynote speaker Don Moores, MD, chief of pediatric surgery at Loma Linda (Calif.) University Children’s Hospital, will present Recognition of Child Abuse at 8:15 a.m. and a breakout session, Pediatric Abdominal Compartment Syndrome, at 2:10 p.m. Other addresses include:
Pre-hospital Pediatric Trauma at 9:30 a.m. by featured speaker Elisabeth Abel, RN, educator and flight nurse from AirLife of Denver, Colo. She also is presenting General Pediatric Trauma Care from a Nursing Perspective at 1 p.m.
PTSD: Putting Together the Pieces by Mary Kathryn Hunsberger, PhD, is at 10:30 a.m. Dr. Hunsberger is with BryanLGH Counseling Center. Preparation of Trauma Patient for Transfer begins at 2:10 p.m. Emergency medicine physician Tadd Delozier, MD, presents this breakout session. For more information about the Trauma Symposium from BryanLGH Medical Center and StarCare Air Ambulance, contact medical education coordinator Carol Brandl at 402-481-5674. Register today! Go to www.bryanlgh.org, then click on Classes and Screenings, then the Continuing Education calendar.
red Monnich’s world changed position in the vehicle and our desire not to suddenly one evening in late July. move him more than we had to, the fire crew The senior account manager for began removing the top of the vehicle.” NRG Media in Lincoln was on his This proved difficult to accomplish, way back to Eagle, driving to despite the crew’s attempts to stabilize the meet some friends for dessert, when his SUV SUV. and another vehicle collided at the Uridil says, “During this time, I covered intersection of Highways 63 and 34. Fred with a blanket to protect him from Rescue Captain Joe Uridil — who’s also an broken glass and other debris.” Emergency Department manager at The crew was able to remove some of the BryanLGH — recalls when his Eagle Volunteer Fire & Crash survivor Fred Monnich, who lives south of Eagle, is thankful his neighbors include volunteers from the local Rescue crew mates arrived fire and rescue squad. Some on that squad are Fire Captain at the scene at about 9 p.m. John Sedlachek, left, Asst. Chief Nick Glanz, Lt. Captain Dan “We and Southeast Fire Meier, Chief Rick Weyers, Traci & Rescue responded,” he Harrington, Rescue Captain Joe Uridil and Susan Sedlachek. says. “Fred’s vehicle was Sedlachek perched precariously on an embankment, leaning on its passenger side. He was conscious, but it was obvious both by the mechanism of injury and the tremendous amount of damage to the vehicle that there was a very high index of suspicion that Fred had suffered severe injuries.” The 65-year-old patient was disoriented, and his head was contorted at such an angle that responders suspected a neck injury. “I made entry into the vehicle through the back window and completed an initial assessment,” says Uridil. “Because of his
rear seating through the back of the vehicle, so ultimately the decision was made to extricate Monnich through the rear of the SUV. BryanLGH StarCare arrived and assisted with the extrication. Monnich was secured to a long spine board, additional assessments were completed, and he was transferred to the helicopter’s stretcher and prepared for rapid transport to BryanLGH West. “I don’t remember a lot about that evening,” says Monnich. “I didn’t even realize I’d been in a crash; I woke up in the helicopter, asked ‘Where am I?’ and went back to sleep.” He was treated by the BryanLGH Trauma Team, then transferred to the intensive care unit. “I had some bumps and bruises and was in the ICU before they moved me to rehab on the 3rd floor,” he continues. “Altogether I was at BryanLGH about three weeks, and everybody was really top notch.” He says the crash broke his 2nd cervical vertebra: “I’m told that can control your breathing and heart, so Dr. Robert Vande Guchte (orthopedic spine surgeon) secured the (Please turn to Page 2.)
Eagle Fire & Rescue team counts on volunteers
E
agle Volunteer Fire & Rescue Department is a 100 percent volunteer agency, serving a 74square-mile area of Lancaster, Otoe and Cass counties. The crew, under the direction of Fire Chief Rick Weyers, Assistant Chief Nick Glanz, Fire Captain John Sedlachek, Fire Lt. Dan Meier and Rescue Captain Joe Uridil, has 24 volunteers who have training as firefighters and/or EMTs. The team also includes paramedics and nurses, and emergency medicine specialist Peter Davidson, MD, is the medical director.
Eagle Volunteer Fire & Rescue often works closely with the StarCare team when responding to calls for 911 assistance. Uridil — an Emergency Department manager at BryanLGH — notes that Eagle Volunteer Fire & Rescue is state certified as an Advanced Life Support (ALS) Transport Service. “Besides responding to calls for 911
Firefighters and paramedics from Eagle Volunteer Fire & Rescue pitch in to help other local departments respond to emergencies in a three-county area. service in three counties, we also are called upon for ALS intercept with other departments,” he says. “We have a call volume of 100-300 calls per year.” Calls come from 911 Centers in Lincoln and Plattsmouth. The EagleAlvo Rural Fire District is governed by a five-member Fire Board. The village of Eagle’s fire station is located on the corner of 1st and F Street. The agency has a pair of ALS ambulances and uses a fleet of two fire engines, two fire tankers, two grass rigs and an air supply trailer. Eagle Volunteer Fire & Rescue also houses a mass casualty response unit for Lancaster County Emergency Management.
Trauma patient appreciates response (Continued from Page 1.) vertebra with a titanium screw piece.” Monnich received a comprehensive rehabilitation program at BryanLGH before being dismissed. Two months after the collision, he’s in good spirits, continuing outpatient rehab and preparing for a follow-up visit to his physician. “I suppose I’ll be wearing this little appliance
2
(brace) around my neck for a few more weeks, and I’m relying on my wife to drive me, but everything’s working out for the best,” he concludes. “I was blessed to have such a talented rescue squad as my neighbor, and I couldn’t ask for better care than I received at BryanLGH.”
You’re invited to Trauma Grand Rounds BryanLGH Trauma Program presents monthly telehealth Trauma Grand Rounds in an effort to provide education to all disciplines involved in caring for the injured patient. Expert speakers present every fourth Friday from noon to 1 p.m. Topics range from detailed injury treatment to general practice guidelines and case studies. Rural hospitals throughout the state have been joining via interactive videoconferencing. Trauma Grand Rounds have become a huge success in-house at BryanLGH Medical Center. EMS providers, firefighters, nurses, physicians and a multitude of participants from other disciplines regularly attend these presentations. Dr. Stanley Okosun, who chairs the program, strives to incorporate topics vital to all aspects of trauma care, from pre-hospital evaluation to rehab involvement. Those interested in participating in Trauma Grand Rounds may contact medical education coordinator Carol Brandl by calling 402-481-5674, emailing carol.brandl@bryanlgh.org or making a request online at www.netelehealth.net. Past Trauma Grand Rounds presentations are available online for review and CME credit. Topics include Pain Management, Abdominal Compartment Syndrome, Pupillary Assessment in the Critical Care Setting, Acute and Chronic Subdural Hematoma, Pediatric Facial Trauma and more. To view these topics, go to www. bryanlgh.com/TraumaGrandRounds.
First responders provide Psychological First Aid By David Miers, PhD, BryanLGH Mental Health Services Manager
F
irst responders are called on to provide assistance for individuals in crisis on a daily basis. In addition to the medical first aid skills, first responders are looked to as a source of emotional support. Psychological First Aid is an approach designed to help first responders provide this initial emotional support and is an evidenced-based approach and intervention to help survivors in the immediate aftermath
of a traumatic event, crisis or natural disaster. It is an avenue to provide comfort and reassurance to victims and to ensure they get the resources they need. It is not to be confused with psychological assessment or treatment, both of which can only be provided by trained professionals. Individuals in crisis may display reactions of confusion, fear, hopelessness, sleeplessness, anxiety, grief, shock, guilt, shame and loss of confidence in themselves and others. First responders’ early contact with individuals in crisis can help lessen
Promote calm • Listen to people who wish to share their stories and emotions, and remember that there is no right or wrong way to feel. • Be friendly and compassionate even if people are being difficult. • To help victims understand the situation, offer accurate information about the disaster or trauma and
http://www.nctsn.org/content/ psychological-first-aid. The goal in providing Psychological First Aid is to promote an environment of safety, calm, connectedness, self-efficacy, empowerment and hope.
Do not
Do Promote safety • Help people meet basic needs for food and shelter and obtain emergency medical attention. • Provide repeated, simple and accurate information on how to get those needs met.
their painful emotional response. The National Child Traumatic Stress Network and the National Center for Post Traumatic Stress Disorder developed the Second Edition of Psychological First Aid Field Operations Guide; it’s available at:
• Force people to share their stories with you, especially very personal details. • Give simple reassurances, such as, “Everything will be OK” or “At least you survived.” • Tell people what you think they should be feeling, thinking or how they should have acted earlier. • Tell people why you think they have suffered by alluding to personal behaviors or beliefs of victims. • Make promises that may not be kept.
relief efforts under way. Promote connectedness • Help people contact friends and loved ones. • Keep families together. Keep children with parents or other close relatives whenever possible. Promote self-efficacy • Give practical suggestions that steer people toward helping themselves. • Engage people in meeting their own needs. Promote help • Know types and locations of services, and direct people to them. • When people express fear or worry, remind them (if you know) that more help and services are on the way.
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Sources: SAMHSA News May/June 2007, Volume 15, No. 3 SAMHSA Publication NMH05-0210 Psychological First Aid for First Responders
Eagle Fire & Rescue team counts on volunteers
E
agle Volunteer Fire & Rescue Department is a 100 percent volunteer agency, serving a 74square-mile area of Lancaster, Otoe and Cass counties. The crew, under the direction of Fire Chief Rick Weyers, Assistant Chief Nick Glanz, Fire Captain John Sedlachek, Fire Lt. Dan Meier and Rescue Captain Joe Uridil, has 24 volunteers who have training as firefighters and/or EMTs. The team also includes paramedics and nurses, and emergency medicine specialist Peter Davidson, MD, is the medical director.
Eagle Volunteer Fire & Rescue often works closely with the StarCare team when responding to calls for 911 assistance. Uridil — an Emergency Department manager at BryanLGH — notes that Eagle Volunteer Fire & Rescue is state certified as an Advanced Life Support (ALS) Transport Service. “Besides responding to calls for 911
Firefighters and paramedics from Eagle Volunteer Fire & Rescue pitch in to help other local departments respond to emergencies in a three-county area. service in three counties, we also are called upon for ALS intercept with other departments,” he says. “We have a call volume of 100-300 calls per year.” Calls come from 911 Centers in Lincoln and Plattsmouth. The EagleAlvo Rural Fire District is governed by a five-member Fire Board. The village of Eagle’s fire station is located on the corner of 1st and F Street. The agency has a pair of ALS ambulances and uses a fleet of two fire engines, two fire tankers, two grass rigs and an air supply trailer. Eagle Volunteer Fire & Rescue also houses a mass casualty response unit for Lancaster County Emergency Management.
Trauma patient appreciates response (Continued from Page 1.) vertebra with a titanium screw piece.” Monnich received a comprehensive rehabilitation program at BryanLGH before being dismissed. Two months after the collision, he’s in good spirits, continuing outpatient rehab and preparing for a follow-up visit to his physician. “I suppose I’ll be wearing this little appliance
2
(brace) around my neck for a few more weeks, and I’m relying on my wife to drive me, but everything’s working out for the best,” he concludes. “I was blessed to have such a talented rescue squad as my neighbor, and I couldn’t ask for better care than I received at BryanLGH.”
You’re invited to Trauma Grand Rounds BryanLGH Trauma Program presents monthly telehealth Trauma Grand Rounds in an effort to provide education to all disciplines involved in caring for the injured patient. Expert speakers present every fourth Friday from noon to 1 p.m. Topics range from detailed injury treatment to general practice guidelines and case studies. Rural hospitals throughout the state have been joining via interactive videoconferencing. Trauma Grand Rounds have become a huge success in-house at BryanLGH Medical Center. EMS providers, firefighters, nurses, physicians and a multitude of participants from other disciplines regularly attend these presentations. Dr. Stanley Okosun, who chairs the program, strives to incorporate topics vital to all aspects of trauma care, from pre-hospital evaluation to rehab involvement. Those interested in participating in Trauma Grand Rounds may contact medical education coordinator Carol Brandl by calling 402-481-5674, emailing carol.brandl@bryanlgh.org or making a request online at www.netelehealth.net. Past Trauma Grand Rounds presentations are available online for review and CME credit. Topics include Pain Management, Abdominal Compartment Syndrome, Pupillary Assessment in the Critical Care Setting, Acute and Chronic Subdural Hematoma, Pediatric Facial Trauma and more. To view these topics, go to www. bryanlgh.com/TraumaGrandRounds.
First responders provide Psychological First Aid By David Miers, PhD, BryanLGH Mental Health Services Manager
F
irst responders are called on to provide assistance for individuals in crisis on a daily basis. In addition to the medical first aid skills, first responders are looked to as a source of emotional support. Psychological First Aid is an approach designed to help first responders provide this initial emotional support and is an evidenced-based approach and intervention to help survivors in the immediate aftermath
of a traumatic event, crisis or natural disaster. It is an avenue to provide comfort and reassurance to victims and to ensure they get the resources they need. It is not to be confused with psychological assessment or treatment, both of which can only be provided by trained professionals. Individuals in crisis may display reactions of confusion, fear, hopelessness, sleeplessness, anxiety, grief, shock, guilt, shame and loss of confidence in themselves and others. First responders’ early contact with individuals in crisis can help lessen
Promote calm • Listen to people who wish to share their stories and emotions, and remember that there is no right or wrong way to feel. • Be friendly and compassionate even if people are being difficult. • To help victims understand the situation, offer accurate information about the disaster or trauma and
http://www.nctsn.org/content/ psychological-first-aid. The goal in providing Psychological First Aid is to promote an environment of safety, calm, connectedness, self-efficacy, empowerment and hope.
Do not
Do Promote safety • Help people meet basic needs for food and shelter and obtain emergency medical attention. • Provide repeated, simple and accurate information on how to get those needs met.
their painful emotional response. The National Child Traumatic Stress Network and the National Center for Post Traumatic Stress Disorder developed the Second Edition of Psychological First Aid Field Operations Guide; it’s available at:
• Force people to share their stories with you, especially very personal details. • Give simple reassurances, such as, “Everything will be OK” or “At least you survived.” • Tell people what you think they should be feeling, thinking or how they should have acted earlier. • Tell people why you think they have suffered by alluding to personal behaviors or beliefs of victims. • Make promises that may not be kept.
relief efforts under way. Promote connectedness • Help people contact friends and loved ones. • Keep families together. Keep children with parents or other close relatives whenever possible. Promote self-efficacy • Give practical suggestions that steer people toward helping themselves. • Engage people in meeting their own needs. Promote help • Know types and locations of services, and direct people to them. • When people express fear or worry, remind them (if you know) that more help and services are on the way.
3
Sources: SAMHSA News May/June 2007, Volume 15, No. 3 SAMHSA Publication NMH05-0210 Psychological First Aid for First Responders
CRITICAL INCIDENT STRESS MANAGEMENT
StarCare and Simulation Center take important lessons on the road
CISM helps those who help others
By Chad Poggemeyer, RRT, BryanLGH StarCare Flight Therapist
By David Miers, PhD, BryanLGH Mental Health Services Manager Source: Nebraska CISM Council Brochure
T
he Nebraska Statewide Critical Incident Stress Management (CISM) Program provides support services to emergency responders, hospital, law enforcement and correctional personnel who have traumatic events and stressful aspects of their occupation. The CISM team provides stress management workshops and prevention programs before a stressful event occurs. This team serves as a resource and referral network for emergency personnel. The program provides tools for coping with emotional and physical after-shocks of critical incidents. It is not the function of the program to replace ongoing professional counseling or psychotherapy; CISM instead provides immediate crisis intervention. Types of interventions include: • Pre-incident management workshops. • On-scene support. • Defusings and demobilizations (short debriefings following small- and largescale events). • Critical incident stress debriefings. • Mental health referrals. • Family and significant other support. • Informal discussions.
Emotional: • Excessive irritability. • Grief. Behavioral: • Withdrawal. • Inability to relax.
The nature of stress Stress is a normal state of physical and psychological arousal. Without stress we would lack challenges and motivation. Stress can be difficult to manage whether it results from ongoing frustrations and demands or from a single traumatic experience. Emergency service occupations are often exciting and rewarding, but they can be emotionally difficult and physically draining. Emergency service workers are exposed to constant doses of low to moderate stress and occasional high level stress. High level stress may cause symptoms of a stress reaction.
Critical incidents A critical incident is any situation causing unusually strong emotional reactions which have the potential to interfere with a person’s ability to function during or after the event. Examples include: suicide, line of duty death or serious injury, injury to or death of a child, mass casualty incident and a prolonged event.
Who CISM serves CISM is for emergency service personnel, firefighters, law enforcement, hospital personnel, dispatchers and corrections officers.
Symptoms of stress • • • •
Physical: Fatigue. Headaches. Cognitive: Trouble concentrating, memory loss. Problem solving difficulties.
Critical incident stress debriefing (CISD) sessions A debriefing is a group interaction where a trained team of debriefers allows emergency service personnel to talk about their thoughts, actions and reactions to a stressful event. A debriefing session is not group therapy, and it is not a critique of the event. The information shared in a CISD is strictly confidential. A debriefing is an opportunity to learn what are normal, expected behaviors and feelings following
a stressful event. It’s also a change to learn ways to manage stress symptoms. Talk with the CISM team coordinator or clinical director in your area about the need for a debriefing anytime a worker is having difficulty dealing with an incident or when the nature of the incident suggests that a CISD might be useful. A debriefing may be needed if the following indicators are present: disrupted sleep patterns, mood swings, depression, anxiety and overwhelming stress symptoms within 48 hours of the event or continuation of stress symptoms 48-72 hours after event.
A
t Community Memorial Hospital in Syracuse this summer, physician assistants, nurses, and laboratory, respiratory and radiology staff members were able to practice clinical scenarios during various skill interactions with StarCare Air Ambulance staff and simulation mannequins and educators from BryanLGH College of Health Sciences. The class initially was set up with the challenges of the rural hospital in mind. It allows care givers to recognize the need for early treatment and transport of critical
patients in their hospital setting. It enables the staff to practice assessment skills along with the implementation of airway
Survival training prepares StarCare crews for emergencies
How to request a debriefing Following an incident, inform the State Patrol Troop in your area of the possible need for a CISD. The troop dispatcher records the name of the community involved, nature of the incident and the name and telephone number of the contact person. Information regarding the incident is given to the clinical director (or someone he/she designates). The clinical director calls the site to confirm the need for CISM service. If a CISD is needed, a designated CISM contact in the area is notified.
By Jason Peterson, RN, BSN, CFRN StarCare Air Ambulance crew members participated in annual survival training June 9 to comply with Commission on Accreditation of Medical Transport Services (CAMTS) requirements to prepare for a forced/emergent landing in a remote area. This exercise was conducted at Branched Oak Lake State Recreational Area. StarCare personnel routinely train with rural emergency services to ensure that EMS personnel are prepared to assist with such things as finding and preparing safe landing zones, and preparing and packaging patients; but this exercise prepared the rescuer to be rescued. StarCare often flies over open rural areas where at any time an emergency may develop and a forced landing may be needed. This type of training is clearly a departure from normal medical training. However, it is necessary to teach and practice these survival skills and practice establishing priorities in a forced landing situation that may require such skills. The training included building temporary shelters, making fires, signal-
24-hour contact information
Simulation mannequins helped the Syracuse staff practice clinical scenarios.
management, IV access and other interventions — concepts needed for the stabilization of critical care patients. These interventions are essential and need to be done before transferring the patient to a tertiary facility. After the scenarios, the hospital staff at Syracuse reevaluated their interventions. The class was developed with the collaborative efforts of StarCare Air Ambulance and the BryanLGH Center for Excellence in Clinical Simulation. If you are interested in having a similar experience at your facility, contact Summer Seuferer in BryanLGH Continuing Education Services at 402-481-9909.
Troop Headquarters: 402-471-4545. Troop A – Omaha: 402-331-3333. Troop B – Norfolk: 402-370-3456. Troop C – Grand Island: 308-385-6000. Troop D – North Platte: 308-535-8047. Troop E – Scottsbluff: 308-632-1211.
Depression screening available online BryanLGH Health System offers free, confidential screening for depression on its website. Log on to www.bryanlgh.com for details.
4
5
StarCare crew members Mike Steffen, Jason Peterson and Margaret Woeppel prepare an emergency shelter. ing and water procurement. The techniques can be applied to anyone. During summer and fall, many families spend weekends out in the wilderness to get away from the hustle and bustle of daily life. Unfortunately tragedy can develop very rapidly and very unexpectedly, from a wandering child or a lost map to a dead battery on the GPS or cell phone. The key in avoiding what could turn out to be a tragic situation is preparedness and establishing priorities. By setting priorities in a survival situation you are positioning yourself for a positive outcome. These priorities (known as the Rule of 3’s) include: shelter, water
and food. People can perish in the elements in as little as three hours. This is why building or finding some type of shelter to get yourself out of the elements, whether wind, rain, sun or snow, is your first priority. Second priority is procuring water. Typically humans can go three days without water. Almost any environment has water present; you just have to be creative to obtain it. Rain, lakes, plants, watching wildlife movement are all sources to water. Third priority is finding food; you can survive up to three weeks without food. Plants are a valuable source of vitamins and minerals, although absolute positive identification is needed because many look-alike plants are poisonous. Not included in the Rule of 3’s but certainly a top priority is mental attitude. The U.S. Army Survival Guide (FM21-76 & FM3-05.70) says, “The key ingredient to survival is mental attitude; having survival skills is important; having the will to survive is essential.” These are some of the tools that help prepare the StarCare team to survive the elements if called for in an emergency.
CRITICAL INCIDENT STRESS MANAGEMENT
StarCare and Simulation Center take important lessons on the road
CISM helps those who help others
By Chad Poggemeyer, RRT, BryanLGH StarCare Flight Therapist
By David Miers, PhD, BryanLGH Mental Health Services Manager Source: Nebraska CISM Council Brochure
T
he Nebraska Statewide Critical Incident Stress Management (CISM) Program provides support services to emergency responders, hospital, law enforcement and correctional personnel who have traumatic events and stressful aspects of their occupation. The CISM team provides stress management workshops and prevention programs before a stressful event occurs. This team serves as a resource and referral network for emergency personnel. The program provides tools for coping with emotional and physical after-shocks of critical incidents. It is not the function of the program to replace ongoing professional counseling or psychotherapy; CISM instead provides immediate crisis intervention. Types of interventions include: • Pre-incident management workshops. • On-scene support. • Defusings and demobilizations (short debriefings following small- and largescale events). • Critical incident stress debriefings. • Mental health referrals. • Family and significant other support. • Informal discussions.
Emotional: • Excessive irritability. • Grief. Behavioral: • Withdrawal. • Inability to relax.
The nature of stress Stress is a normal state of physical and psychological arousal. Without stress we would lack challenges and motivation. Stress can be difficult to manage whether it results from ongoing frustrations and demands or from a single traumatic experience. Emergency service occupations are often exciting and rewarding, but they can be emotionally difficult and physically draining. Emergency service workers are exposed to constant doses of low to moderate stress and occasional high level stress. High level stress may cause symptoms of a stress reaction.
Critical incidents A critical incident is any situation causing unusually strong emotional reactions which have the potential to interfere with a person’s ability to function during or after the event. Examples include: suicide, line of duty death or serious injury, injury to or death of a child, mass casualty incident and a prolonged event.
Who CISM serves CISM is for emergency service personnel, firefighters, law enforcement, hospital personnel, dispatchers and corrections officers.
Symptoms of stress • • • •
Physical: Fatigue. Headaches. Cognitive: Trouble concentrating, memory loss. Problem solving difficulties.
Critical incident stress debriefing (CISD) sessions A debriefing is a group interaction where a trained team of debriefers allows emergency service personnel to talk about their thoughts, actions and reactions to a stressful event. A debriefing session is not group therapy, and it is not a critique of the event. The information shared in a CISD is strictly confidential. A debriefing is an opportunity to learn what are normal, expected behaviors and feelings following
a stressful event. It’s also a change to learn ways to manage stress symptoms. Talk with the CISM team coordinator or clinical director in your area about the need for a debriefing anytime a worker is having difficulty dealing with an incident or when the nature of the incident suggests that a CISD might be useful. A debriefing may be needed if the following indicators are present: disrupted sleep patterns, mood swings, depression, anxiety and overwhelming stress symptoms within 48 hours of the event or continuation of stress symptoms 48-72 hours after event.
A
t Community Memorial Hospital in Syracuse this summer, physician assistants, nurses, and laboratory, respiratory and radiology staff members were able to practice clinical scenarios during various skill interactions with StarCare Air Ambulance staff and simulation mannequins and educators from BryanLGH College of Health Sciences. The class initially was set up with the challenges of the rural hospital in mind. It allows care givers to recognize the need for early treatment and transport of critical
patients in their hospital setting. It enables the staff to practice assessment skills along with the implementation of airway
Survival training prepares StarCare crews for emergencies
How to request a debriefing Following an incident, inform the State Patrol Troop in your area of the possible need for a CISD. The troop dispatcher records the name of the community involved, nature of the incident and the name and telephone number of the contact person. Information regarding the incident is given to the clinical director (or someone he/she designates). The clinical director calls the site to confirm the need for CISM service. If a CISD is needed, a designated CISM contact in the area is notified.
By Jason Peterson, RN, BSN, CFRN StarCare Air Ambulance crew members participated in annual survival training June 9 to comply with Commission on Accreditation of Medical Transport Services (CAMTS) requirements to prepare for a forced/emergent landing in a remote area. This exercise was conducted at Branched Oak Lake State Recreational Area. StarCare personnel routinely train with rural emergency services to ensure that EMS personnel are prepared to assist with such things as finding and preparing safe landing zones, and preparing and packaging patients; but this exercise prepared the rescuer to be rescued. StarCare often flies over open rural areas where at any time an emergency may develop and a forced landing may be needed. This type of training is clearly a departure from normal medical training. However, it is necessary to teach and practice these survival skills and practice establishing priorities in a forced landing situation that may require such skills. The training included building temporary shelters, making fires, signal-
24-hour contact information
Simulation mannequins helped the Syracuse staff practice clinical scenarios.
management, IV access and other interventions — concepts needed for the stabilization of critical care patients. These interventions are essential and need to be done before transferring the patient to a tertiary facility. After the scenarios, the hospital staff at Syracuse reevaluated their interventions. The class was developed with the collaborative efforts of StarCare Air Ambulance and the BryanLGH Center for Excellence in Clinical Simulation. If you are interested in having a similar experience at your facility, contact Summer Seuferer in BryanLGH Continuing Education Services at 402-481-9909.
Troop Headquarters: 402-471-4545. Troop A – Omaha: 402-331-3333. Troop B – Norfolk: 402-370-3456. Troop C – Grand Island: 308-385-6000. Troop D – North Platte: 308-535-8047. Troop E – Scottsbluff: 308-632-1211.
Depression screening available online BryanLGH Health System offers free, confidential screening for depression on its website. Log on to www.bryanlgh.com for details.
4
5
StarCare crew members Mike Steffen, Jason Peterson and Margaret Woeppel prepare an emergency shelter. ing and water procurement. The techniques can be applied to anyone. During summer and fall, many families spend weekends out in the wilderness to get away from the hustle and bustle of daily life. Unfortunately tragedy can develop very rapidly and very unexpectedly, from a wandering child or a lost map to a dead battery on the GPS or cell phone. The key in avoiding what could turn out to be a tragic situation is preparedness and establishing priorities. By setting priorities in a survival situation you are positioning yourself for a positive outcome. These priorities (known as the Rule of 3’s) include: shelter, water
and food. People can perish in the elements in as little as three hours. This is why building or finding some type of shelter to get yourself out of the elements, whether wind, rain, sun or snow, is your first priority. Second priority is procuring water. Typically humans can go three days without water. Almost any environment has water present; you just have to be creative to obtain it. Rain, lakes, plants, watching wildlife movement are all sources to water. Third priority is finding food; you can survive up to three weeks without food. Plants are a valuable source of vitamins and minerals, although absolute positive identification is needed because many look-alike plants are poisonous. Not included in the Rule of 3’s but certainly a top priority is mental attitude. The U.S. Army Survival Guide (FM21-76 & FM3-05.70) says, “The key ingredient to survival is mental attitude; having survival skills is important; having the will to survive is essential.” These are some of the tools that help prepare the StarCare team to survive the elements if called for in an emergency.
Trauma Update is published for friends of BryanLGH Medical Center. Your comments and suggestions are welcome. Direct correspondence to the Public Relations Department at BryanLGH, or telephone the editor at 402-481-8674.
TRAUMAUPDATE BryanLGH Medical Center West 2300 S. 16th St., Lincoln, NE 68502-3704
Non-profit Org. U.S. Postage
PAID Permit No. 267 Lincoln, NE
Address service requested.
TRAUMAUPDATE News from the Trauma Center at BryanLGH
Kimberly Russel, President, BryanLGH Health System; John Woodrich, President, BryanLGH Medical Center; Edgar Bumanis, Director, Public Relations; Paul Hadley, Editor.
FALL 2011
Story of summertime crash has happy ending for Monnich
F We’re preparing for Level 2 reverification It’s reverification time for BryanLGH — the only ACS (American College of Surgeons) Level 2 Trauma Center in Eastern Nebraska. Whether it is respiratory therapy, trauma registrar, radiology, nursing staff or the many others who play a role, dedication from the entire BryanLGH family is required to maintain this status. As a result, we take a lot of pride in our care for the injured patient. Our goal is to provide the most efficient and optimal care possible. We have applied for reverification and expect the process to occur this spring. Surveyors will review the 2011 year, making this year pivotal in our quest to maintain verification. The program underwent many personnel changes this year, welcoming a new trauma program manager and midlevel providers. The team has changed, but our care has remained constant — exhibiting the same efficiency and skill we’ve always provided. Being prepared to handle trauma is a basic service of a lead trauma center; being able to handle any trauma well is what makes us unique. We hope the ACS will agree during their evaluation. Watch for updates on how you can assist in preparing for our review.
Oct. 14 Symposium has pediatric focus
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his year’s Trauma Symposium is Friday, Oct. 14, in the Conference Center at BryanLGH West. Keynote speaker Don Moores, MD, chief of pediatric surgery at Loma Linda (Calif.) University Children’s Hospital, will present Recognition of Child Abuse at 8:15 a.m. and a breakout session, Pediatric Abdominal Compartment Syndrome, at 2:10 p.m. Other addresses include:
Pre-hospital Pediatric Trauma at 9:30 a.m. by featured speaker Elisabeth Abel, RN, educator and flight nurse from AirLife of Denver, Colo. She also is presenting General Pediatric Trauma Care from a Nursing Perspective at 1 p.m.
PTSD: Putting Together the Pieces by Mary Kathryn Hunsberger, PhD, is at 10:30 a.m. Dr. Hunsberger is with BryanLGH Counseling Center. Preparation of Trauma Patient for Transfer begins at 2:10 p.m. Emergency medicine physician Tadd Delozier, MD, presents this breakout session. For more information about the Trauma Symposium from BryanLGH Medical Center and StarCare Air Ambulance, contact medical education coordinator Carol Brandl at 402-481-5674. Register today! Go to www.bryanlgh.org, then click on Classes and Screenings, then the Continuing Education calendar.
red Monnich’s world changed position in the vehicle and our desire not to suddenly one evening in late July. move him more than we had to, the fire crew The senior account manager for began removing the top of the vehicle.” NRG Media in Lincoln was on his This proved difficult to accomplish, way back to Eagle, driving to despite the crew’s attempts to stabilize the meet some friends for dessert, when his SUV SUV. and another vehicle collided at the Uridil says, “During this time, I covered intersection of Highways 63 and 34. Fred with a blanket to protect him from Rescue Captain Joe Uridil — who’s also an broken glass and other debris.” Emergency Department manager at The crew was able to remove some of the BryanLGH — recalls when his Eagle Volunteer Fire & Crash survivor Fred Monnich, who lives south of Eagle, is thankful his neighbors include volunteers from the local Rescue crew mates arrived fire and rescue squad. Some on that squad are Fire Captain at the scene at about 9 p.m. John Sedlachek, left, Asst. Chief Nick Glanz, Lt. Captain Dan “We and Southeast Fire Meier, Chief Rick Weyers, Traci & Rescue responded,” he Harrington, Rescue Captain Joe Uridil and Susan Sedlachek. says. “Fred’s vehicle was Sedlachek perched precariously on an embankment, leaning on its passenger side. He was conscious, but it was obvious both by the mechanism of injury and the tremendous amount of damage to the vehicle that there was a very high index of suspicion that Fred had suffered severe injuries.” The 65-year-old patient was disoriented, and his head was contorted at such an angle that responders suspected a neck injury. “I made entry into the vehicle through the back window and completed an initial assessment,” says Uridil. “Because of his
rear seating through the back of the vehicle, so ultimately the decision was made to extricate Monnich through the rear of the SUV. BryanLGH StarCare arrived and assisted with the extrication. Monnich was secured to a long spine board, additional assessments were completed, and he was transferred to the helicopter’s stretcher and prepared for rapid transport to BryanLGH West. “I don’t remember a lot about that evening,” says Monnich. “I didn’t even realize I’d been in a crash; I woke up in the helicopter, asked ‘Where am I?’ and went back to sleep.” He was treated by the BryanLGH Trauma Team, then transferred to the intensive care unit. “I had some bumps and bruises and was in the ICU before they moved me to rehab on the 3rd floor,” he continues. “Altogether I was at BryanLGH about three weeks, and everybody was really top notch.” He says the crash broke his 2nd cervical vertebra: “I’m told that can control your breathing and heart, so Dr. Robert Vande Guchte (orthopedic spine surgeon) secured the (Please turn to Page 2.)