Trauma Update Summer 2012 by Bryan Health

TRAUMAUPDATE News from the Trauma Center at BryanLGH

SUMMER 2012

Derek’s on the mend following treatment for crash injuries

erek Stromp and his family know all too well how dangerous utility terrain vehicles (UTVs) can be. Derek, age 14, was riding a Yamaha Rhino UTV with his cousin on April 7, 2012. Unlike many fourwheelers, this style has a top, windshield and roll cage. Around 1:30 in the afternoon the joy ride ended. While details behind the crash remain a mystery, it is suspected that speed followed by a sharp turn caused the UTV to roll and send its passengers flying. Derek landed face down in the dirt, with the Rhino coming to rest on top of him. His cousin, Allie, was ejected, too. She woke to a devastating realization: Derek was trapped underneath the vehicle. She wasn’t sure how long she had been unconscious or how long Derek had been on the ground. Gathering her thoughts, she made frantic calls on her cell phone to get help. She stood on top of a hill so Derek’s father, Dennis Stromp, and brother, Adam, could find her, and she showed them the way to Derek. Horror set in when they pulled the UTV off Derek — they could see he wasn’t breathing. His lips were blue, his face purple, and he lay motionless. Quick thinking, coupled with adrenaline, took over, and Adam and Dennis began CPR. Dan Stromp (Derek’s uncle and Allie’s father) arrived and took over CPR for Adam, who went to the road to wait for the Spalding Rescue crew. Teamwork makes the difference They tried desperately to revive Derek; then, the Spalding team assumed resuscitation efforts and took off towards the hospital in Albion. Altogether, three fire trucks and about 15 volunteer firefighters responded to the scene. The family learned later that during the transport, Derek required two shocks, continual CPR and assisted breathing before finally regaining signs of life. The ambulance arrived at Boone County Health Center at 2:13 p.m. — for the family, a long 45 minutes after the crash. Dr. Anthony Kusek identified Continued on Page 2.

Derek and his parents, Donna and Dennis Stromp of Greeley, are thankful for the coordinated care he received.

Hypothermia treatment helps Derek Continued from Page 1.

immediately that Derek would need a higher level of care than what Boone County could provide. Initiating the essentials, the hospital crew established a definitive airway, IV access and fluid resuscitation while they prepared for air transport. They also began cooling measures per request of Dr. Reginald Burton at the BryanLGH Trauma Center. Elective hypothermia for head injuries is just one of the innovative treatments Dr. Burton’s Surgical Critical Care Trauma Team implements. The cooling is an

attempt to slow the patient’s metabolic demands, decreasing the needs of the cells and helping to minimize the

secondary insult that the brain suffers after initial injury and resuscitation. Derek was flown to the Trauma Center at BryanLGH West, where he was met by the Trauma Team. Upon arrival, Derek was at 91.6 degrees Fahrenheit. The goal for hypothermia treatment is 89.6-91.4 degrees, so the aggressive cooling measures taken by the hospital staff at Albion and the transport crew were successful in reaching the hypothermia goal quickly.

This Yamaha Rhino is similar to the Stromps’ vehicle.

Slowing his metabolism A cooling line was placed in his Continued on Page 3.

ATV awareness reduces injuries

f you venture very far in Nebraska, there are several things you may find: corn and wheat, friendly smiles, cattle and ATVs (all-terrain vehicles). ATVs are increasing in popularity, especially among farmers. The four-wheeled motorized vehicles make checking on livestock, crops and irrigation equipment ideal. Additionally, they are fun to ride and are welcomed by youth who do not need to obtain a motorcycle license to experience a thrill-producing ride. As with many recreational activities, ATVs pose a significant injury risk. In an attempt to reduce that risk, the U.S. Consumer Product Safety Commission published guidelines that they recommend every time a person rides. Many parents are unaware of these guidelines exist. They are: • Children and young people under the age of 16 should not ride adult-sized ATVs. • ATV users should take a hands-on safety training course. • Always wear a helmet and safety gear such as boots and gloves while on an ATV. • Never drive an ATV on paved roads. • Never drive while under the influence of drugs or alcohol. • Passengers on tandem ATVs should be at least 12. Not surprisingly, these rules are often neglected and disregarded. According to the Journal of Pediatric Surgery,

dangerous driving behavior among children who ride ATVs is widespread, and current safety recommendations are largely ignored (Campbell, Kelliher, Borrup, Corsi, Saleheen, Bourque, Lapidus, 2010). The Consumer Product Safety Commission claims that, each year, hundreds young and old die or experience lifealtering injuries from incidents involving ATVs. In 2010, 317 deaths and 115,000 emergency room treated injuries were reported. According to the Journal of Trauma (2010), their retrospective 10-year study looking at ATV injury mortality and health care cost found the most common injuries (60 percent) included head, neck and cervical spine injuries, as well as chest and t-spine injures. Helmet use was reported to be associated with a significantly lower rate of these injuries. ATVs have evolved to be a common mode of transportation for both recreation and commercial use. Awareness is essential in preventing injuries secondary to ATV crashes. Possible roll-overs and ejections top the list of possibilities with ATVs, but there are many more. Through encouragement to use helmets and offering safety lessons and guidelines education, the trauma community can continue to be proactive in reducing the number of those affected by ATV crashes. For information, go to www.atvsafety.gov/state/nebraska.html.

groin to allow the team to continue to cool him internally. Derek’s presentation was consistent with a crushing injury: Petechia from ruptured capillaries covered his chest, neck and face with a distinct line of demarcation across his chest. A full work-up revealed Derek suffered a cardiac contusion, pneumohemothorax, a pulmonary contusion and aspiration. His liver sustained a significant laceration (Grade 4) and he had a pelvic fracture. In conjunction with a probable hypoxic injury consistent with a crushing injury and full arrest, Derek was in a fight for his life. He underwent a temporary tracheostomy and gastrostomy feeding tube placement with hopes to wean him from the ventilator. Derek had youth on his side, as well as aggressive resuscitation efforts by many. He was on the ventilator 11 days, and he was kept at 91.4 degrees for 48 hours because any elevation in the body’s core temperature following a significant head injury has been shown to decrease outcomes. After Derek eventually was warmed to 98 degrees, active normothermia was maintained. This is where active measures are taken to prevent a rebound fever. Although he was unable to coordinate his legs at first, Derek eventually was able to take walks in the hall with therapists. He continued to improve, amazing all who cared for him. He was discharged day 13 of his hospital stay to rehab. Dr. Burton speaks to the value of the hypothermia treatment utilized for Derek and praises all those who intervened prior to his arrival at BryanLGH. He suffered a tragic injury; one that for all practical purposes should have claimed his life or left him with permanent and severe injury. On April 24, Derek walked unassisted back in to the Trauma Center for his follow-up Trauma Clinic visit, a survivor. Heroes all around Derek’s story is both heart wrenching and heartwarming. His life speaks to the strength of a statewide trauma system, ready at a moment’s notice. His recovery tells of innovative and aggressive treatment by an advanced trauma team. His survival speaks to the heroes of the day: his cousin, brother, father, uncle and the volunteers whose combined actions saved his life. His parents say, “The care Derek received at BryanLGH West was exceptional. We will be eternally grateful to Dr. Burton and the other doctors, nurses, therapists and pastoral staff who took care of Derek as if he was their own child. “They kept us informed of everything that was happening. Their positive attitudes strengthened us, and our faith, family

Trauma and surgical critical care director Reginald Burton, MD, meets with Derek during a follow-up evaluation at the Trauma Clinic.

and friends sustained us throughout this miraculous journey.” The family reports that, after outpatient therapy twice a week during the summer, Derek now has a home therapy program. He has started his freshman year of high school and looks forward to getting his learner’s permit, playing basketball and spending time with friends.

SPALDING SQUAD RESCUES CRASH VICTIM

The little department that could … By Sheila Uridil, APRN-NP, Trauma Program Manager

palding has fewer than 500 people. Although it is not a large metropolis it is a community rich in support. Located in central Nebraska, it’s the kind of town where you are likely to know not only your neighbor, but your entire town. It’s the love for their own that keeps the volunteers on Spalding Rescue dedicating their time and volunteering their service. As is common in small communities, rescue calls in Spalding can create emotional challenges. Chances are, you know the person in need of assistance. You may sit by them at church. Your kids most likely play together. You may even be related. Someday, you may be called on to help save

their life, and you know undoubtedly they would do the same for you — because that’s how life is in a small town. Spalding Rescue is made up of approximately 25 volunteers. Staffed primarily with EMTBs, the squad also has first responders, as well as two RNs, an LPN and a paramedic. They are a basic life support service and in early April, they had just completed their BLS refresher course, unaware how soon they would be called upon to test their skills. On April 7, Spalding was called to a UTV rollover which had crushed the driver, and CPR was in progress. The name was provided and, as in many calls, they recognized the 14-year-old in need of their help — Derek Stromp of Greeley. Stacey Bauer, EMTB, went on the call. She recalls that in this situation, knowing

who the patient was made it easier for them to prepare for the response. She explains that she was able to guesstimate Derek’s height and weight by comparing him to her own son. The squad members then were able to prepare supplies on the way to the scene. Particularly, the crew was able to pull out an adult Combitube® to place, as well as adult-sized electrodes. Arriving on scene they found Derek’s father (Dennis) and uncle (Dan) performing CPR. They quickly took over care, using the Combitube® to establish an airway, then they prepared Derek for transport. Fortunately for Derek, having bystanders perform CPR kept his heart circulating blood, which was life saving. Derek crashed approximately 26 miles

Spalding Rescue members are (front row, left) Stacey Bauer, Linda Bauer, Theresa Rolf, Katy Seamann, Cassie Molt and Ed Carlin; (middle row, left) Ed Bauer, Robert Ballweg, Julie Carraher, April Reilly, Jamie Ray, Arlene Berger, Sherri Molt, Beth Asche and (top row, left) Mark Bauer, Scott Reilly, Rob Meyer, Mark Asche, Bob Molt, Wendy Carlin, Julie Bloom and (not pictured) Mary Hemmingsen.

New law protects health care workers

…

A blown front tire didn’t keep the squad from transporting Derek Stromp as quickly as possible to the hospital in Albion.

from Boone County Health Center in Albion. The Spalding crew knew where they needed to take Derek and knew that they needed to get him there fast. The crew members continued to work diligently on Derek, performing CPR and providing the breaths he was not taking on his own. Derek also required two electric shocks. As they transported Derek, a new challenge presented itself. While Dennis and another of his sons, Andrew, were following the ambulance, it slowed — so they feared it was a sign that the crew had been unable to revive Derek. They had no idea it was because the front, passenger side tire on the ambulance blew. Driver Mark Bauer began to pull over, but the crew trying to revive Derek shouted, “Just keep going!” Knowing there was no time to spare, the crew forged on, driving the rest of the way on the rim of the wheel. Nothing was going to stop them from getting Derek where he needed to be. Call it will, call it determination … it was nothing less than miraculous. Stacey recalls how Derek’s color began changing and improving as they drove on, evidence they were

making progress — their efforts were paying off. Ironically, local priest Father Don Buhrman was in the area. He saw the ambulance fly by and offered a blessing as it passed. He was unaware of the struggle taking place until he received a desperate phone call from Dennis, who asked him to head to the hospital because Derek may be near death. When the crew arrived at the hospital — almost one hour of CPR and one flat tire later— Derek had signs of life! They had done it! They picked up a young man who was no longer breathing and in full arrest and delivered him to the hospital with a heartbeat and signs of life! The Spalding squad didn’t consider their job complete. It wasn’t enough for them just to deliver him to the hospital, they had to support him; they waited for air transport to arrive. Bauer says, “We had to send him off. We had to stay until we knew he was safely on that helicopter.” During their wait, they debriefed and de-stressed as a group. Talking through the call, going over the details, they were able to offer support to one another knowing that each may struggle with the humanity aspect of it all. It’s not easy to walk away after calls that hit close to home; there are calls that stay with you long after the run has ended. Derek’s rescue call is one few are likely to forget. The Spalding Rescue crew went out willing and eager to help, overcame the obstacles facing them and went home heroes (although undoubtedly they wouldn’t call themselves that.) Their dedication, skill and determination are to be commended. To them, seeing Derek walking, talking and back in the community is all the reward they need.

By Linda Stones, MS, BSN, RN, CRRN, Rehabilitation Services Director A law signed March 7 by Gov. Dave Heineman brings the same penalties for assaulting a health care provider as for attacking a police officer. In 2007, the Nebraska Workplace Violence Survey was distributed, and approximately 150 responded. This survey found 11 percent experienced physical violence while at work, and 26 percent experienced verbal abuse. The Bureau of Justice (2000) reports that up to 429,100 nurses were victims of violent crimes each year from 1993 to 1999. Erickson and Williams-Evan (2000) reported 82 percent of nurses surveyed had been assaulted during their careers. A large amount of these incidents occurred in Emergency Departments. In response to increased violence, Nebraska’s Legislature passed a law this year to protect health care workers. State Sen. Steve Lathrop of Omaha introduced LB 677, which provides penalties for assaulting health care professionals. If an individual intentionally or knowingly assaults a health care professional when the professional is on duty at a hospital or health clinic, that individual can be charged with a felony. If the incident causes serious bodily injury, it is Assault in the First Degree and is considered a Class I-D felony. If the assault involves a dangerous instrument and causes bodily harm, it is Assault in the Second Degree and is a Class II felony. If the assault causes less serious bodily injury, then it is Assault in the Third Degree and is a Class III-A felony. The law also requires hospitals or health clinics to display a sign that reads “Warning: Assaulting a health care professional who is engaged in the performance of his or her official duties is a felony.” Ultimately the hope is that this will be a deterrent to violence.

Neuro-Trauma team teaches about prevention

Intervention nurses screen for alchohol/drug issues By Dave Miers, PhD, LIPC, Mental Health Services

By Lisa Cochran, MSN/MHA, RN

he Neuro-Trauma staff from BryanLGH dedicated time in May to teach elementary students at Everett Elementary School trauma prevention strategies before summer break. Everett is a Title 1 school serving disadvantaged students; 90 percent of the students are from impoverished families. Most childhood injuries are preventable, and the staff worked to teach safety at play and on the way to school for this high-risk population.

Unintentional injury death rates for children under the age of 19 have declined by 53 percent with the help of trauma

prevention strategies (Safe Kids USA, 2009). The staff taught helmet use on skateboards, bicycles and scooters and promoted using seat belts every time. The egg cart was used to show the students benefits of seat belts keeping you inside the car and safe. About 300 students participated in the day’s activities, and 60 random students received bike helmets from an anonymous donor.

BryanLGH’s Independence Center employs intervention nurses, who screen and evaluate hospitalized patients for potential alcohol and/or drug abuse problems. Trauma Services works closely with the intervention nurses. All Trauma Center patients are screened for drugs of abuse on arrival. When a screening is positive, the Trauma Team initiates an order for an intervention nurse evaluation. About 41 percent of trauma patients ages 16-24 tested positive for drugs or alcohol in a recent BryanLGH study. Intervention nurses are skilled at interviewing, diagnosing and recommending referral options for patients suspected of complicating their medical condition with alcohol and/or drug problems. These nurses respond to physician orders for consultations from BryanLGH West and BryanLGH East, Madonna Rehabilitation Hospital and Saint Elizabeth Regional Medical Center. Chemical dependency is one of our nation’s major health care problems — yet, sadly, it often goes undetected. Lack of knowledge about the disease of chemical dependency and treatment options and how to help are just a few reasons why health care providers may hesitate to address or intervene with someone who has a possible substance abuse problem. Because of this, the Independence Center established the Chemical Dependency Intervention Nurse Program back in 1980. Currently the intervention nurses see about 1,100 patients each year. The only requirement to access this service is a physician order. Intervention nurses visit with patients who have been admitted to the hospital or in Mental Health Observation beds. The intervention nurse completes a drug/alcohol evaluation, makes recommendations for treatment if appropriate and assists the patient in accessing treatment options, if they are agreeable. Intervention nurses do not see patients within the Emergency Department or Mental Health Emergency Department until they have been admitted to a unit or Mental Health Observation. Patients who have been discharged or those in the ED will need to contact the Independence Center at 402-481-5268 to schedule an outpatient evaluation. If you need information about a possible referral, call our intervention nurses: Karen McCain, RN, at 402-481-5687 or David Dermann, RN, at 402-481-5319. Free confidential alcohol screenings are available online at www.bryanlgh.org/OnlineScreenings.

Rescue airways

We love ‘em By Chad Poggemeyer, RRT, EMT-P, StarCare Flight Therapist

here is nothing more humbling for a health care provider than to have a routine situation or procedure that typically runs smoothly go south. Let’s face it, there are no absolutes in the medical world. So, when it comes to difficult airways, a good motto is: “Always have a Plan B!” “Rescue airways” are not only useful when endotracheal intubation is difficult, but depending on the level of care, it may be the airway of choice in some EMS communities. Fortunately for us, the medical manufacturing industry has several rescue airways at our disposal. Some of these include the Combitube® laryngeal mask airway (LMA) and the King airway, each with its own advantages and disadvantages. The King airway has been on the market for awhile and has had some advances already built in. It is a blind insertion airway in which the device passes behind the larynx and into the esophagus. The design of the distal tip and the cuff makes tracheal intubation unlikely. Proximal and distal cuffs are inflated, via the pilot balloon, with the distal cuff inflating into the esophagus. The proximal cuff inflates at the base of the tongue, leaving the glottis isolated for ventilation. The unique design has two outlets for ventilation in front of the larynx. The primary ramped opening not only serves for ventilation, but can also be utilized to pass a tube exchanger or a bronchoscope. The other distal port

The King disposable supraglottic airway has proven to be a reliable rescue airway resource.

has multiple vented openings which lie parallel to the tube and bilateral eyelets

Illustrations by King Systems.

are also present for additional supplement ventilation. Another distinguishing characteristic of this airway is that it also provides an opening for gastric tube insertion in the LTS-D model. The simplicity and ease of insertion make this device a valuable tool to EMS and other health care providers, especially if you need a Plan B. The goal in EMS when things go south is to know what to count on for your Plan B — the King airway has been a reliable resource in the airway world.

The unique design has two ventilation outlets in front of the patient’s larynx.

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

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Save the date: Sept. 28

he annual Trauma Symposium is Friday, Sept. 28, in the conference center at BryanLGH West. Enroll now to enjoy a full day of expert speakers. This year’s symposium highlights rural healthcare challenges, traumatic brain injury, concussion awareness and ImPACT testing, critical care management of the trauma patient and much more!

Keynote speaker Mark Cipolle, MD, PhD, FACS, FCCM, Chief of Trauma Surgery at Christiana Care Health System, Wilmington, Del., will address management of anticoagulation reversal and traumatic hemorrhage and resuscitation monitoring. Sign up early to assure a seat at the ever-popular symposium. To register online, go to www.bryanlgh.org/calendar.

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Bryan unveils new name Beginning Oct. 1, 2012, we will adopt Bryan Health as the name of our health system and Bryan Medical Center as the new name for the medical center in Lincoln.

Our medical center locations will be known as Bryan East Campus and Bryan West Campus. We’re adopting an easy-to-remember main number — 402-481-1111 — although previous phone numbers will remain. All 800 and direct line phone numbers, as well as FAX numbers, also stay the same. Our web address becomes bryanhealth.org, and you can access the Bryan Trauma Center website at bryanhealth.org/trauma.