Trauma Update, Winter 2011

TRAUMAUPDATE News from the Trauma Center at BryanLGH

WINTER 2011

EMS protocol makes difference for injured Nebraska teen

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ept. 28, 2010 was a beautiful fall day — perfect squirrel-hunting weather, according to 14-year-old Hayden Albers.

That’s what he and a friend were doing that Thursday afternoon, when the unimaginable happened.

“They took off on their 4-wheelers to go hunting squirrels near the creek on the edge of our property, like they’d done dozens of times before,” recalled Hayden’s mother, Carrie Albers of rural Gage County.

“Our phone rang, and it was Hayden’s friend calling from his cell phone. He sounded totally in a panic and said he’d accidentally shot Hayden.”

She rushed to the scene.

Finding help quickly

After a hunting accident, Lewiston eighthgrader Hayden Albers benefited when his local rescue crew followed triage protocol to rush him to the Trauma Center.

“When I got there, Hayden was pressing a T-shirt against his groin,” Carrie said. “I’ve had some medical training and was immediately concerned that he’d been hit in a major artery. I tried to stay composed for the boys, but I was thinking ‘We might lose him.’

“It’s a parent’s worst nightmare. Luckily he wasn’t bleeding a lot, which calmed me at least a bit.”

Albers drove the boys back to her house, where she called the emergency department at Beatrice Community Hospital to alert them about her family’s emergency.

“We live about 30 miles from Beatrice, in a very rural part of the county, so I didn’t think we could wait for an ambulance to come to the farm,” Carrie continued.

“Instead the Beatrice Fire and Rescue crew met us at the gas station near Filley.”

The paramedics immediately recognized the urgency of the situation: A penetrating

wound to the abdomen can be life-threatening. The National Trauma Triage Protocol identifies such injuries to the head, neck or torso as criteria for determining when to transport a patient to a trauma center.

Protocol speeds transfer Following this protocol, the crew contacted StarCare from the field. According to Trauma Program Manager Sheila Uridil, this prompt and effective pre-hospital triage set in motion the time-sensitive transfer process so that Hayden received the appropriate level of care as soon as possible.

As a Level 2 Trauma Center, BryanLGH Medical Center serves as a regional receiving center. The trauma team has been encouraging early EMS and hospital notification and requests for StarCare air ambulance service, followed by immediate transfer to a trauma center, Uridil pointed out.

“Beatrice Fire and Rescue is an active participant,” she added. “They have a reputation for being proactive and efficient in triaging patients for transfer in a timely fashion. They’re responsible for the prompt delivery of many critically injured patients, and their efforts have not gone unnoticed.

“Our trauma service commends their efforts and encourages all rescue teams to continue this process.”

StarCare Program Manager Jan Shaner added, “StarCare works closely with area rescue squads, providing education and training to assist teams in the early triage process. This includes the ability to recognize patients who would benefit from air transport — such as Hayden.

“Once StarCare was notified, our team Continued on page 2.

Timely teamwork speeds transfer to Trauma Center

Chaplains help meet spiritual needs

Continued from the front page.

By Chaplain Dennis Smith

worked closely with Beatrice Fire and Rescue to transfer care. A pre-determined landing site at the Beatrice Municipal Airport made the transition flow smoothly. After only four minutes on the ground, StarCare was en route to the BryanLGH Trauma Center, where Hayden was assessed by the trauma team.”

The Albers family has the best of memories regarding the first responders’ care.

“They were so good!” said Carrie Albers.

“They calmed down Hayden and loaded him in the ambulance and told me they’d already called StarCare, so they were driving Hayden to the airport and that the helicopter would fly him to BryanLGH West.”

Carrie was able to fly with Hayden, whose vital signs remained stable the entire time.

“We made it quickly to the Trauma Center, and he had X-rays and tests. He’s a very, very lucky boy!” she added.

The .22 caliber bullet had grazed Hayden’s pelvic bone, fracturing it before continuing in an arc and lodging next to his coccyx.

According to Carrie and her husband Todd Albers, physicians left the projectile inside Hayden because attempting to remove it might create more issues.

He spent three nights in the ICU at BryanLGH West so that the staff could watch for possible internal bleeding. His recovery during the following weeks went well.

“Honestly, he doesn’t have any problems now – he’s playing basketball and running around so that you’d never know he’d been injured,” she said. “This happened on a Thursday afternoon, and he was back at school the next week, using crutches to keep weight off the injured side.

“It’s a miracle. He’s 100 percent. Honestly, we had nothing but good experiences with everybody who took care of Hayden – and the boys’ friendship is probably even stronger after going through all this.”

To learn more about transporting patients to the Trauma Center, call Jan Shaner at (402) 481-5006 or Sheila Uridil at (402) 481-5150.

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Greetings, I’m Dennis Smith, the newest member of the BryanLGH Pastoral Care Department. I am one of four full-time chaplains, and our department also has three chaplains serving in part-time positions. At any hour, every day of the year, a chaplain is on call to serve when needed.

Our first priority is to connect with hospital staff to assess immediate needs and concerns. Initially there may be notifications to be made and family members to be guided to waiting areas. Ongoing updates will be made to minimize anxieties and facilitate good communication. An assessment will be made to determine which support systems are available for the patient and loved ones.

It may be determined that clergy and a faith community are important to a patient, and our chaplains work hard

to engage one’s own faith community if this is desired.

As the patient’s course of treatment is determined, we will assist the family to new areas of the medical center. We work to get family and friends connected as soon as possible.

Meeting spiritual needs is a unique piece that chaplains on the Trauma Team provide. For example, assisting people as they deal with difficult issues such as purpose/meaning, forgiveness, hope, comfort, the Divine and the Eternal. Please note: Chaplains are here to augment, not replace, a patient’s own clergy.

I consider it a privilege to work with such an amazing team and incredible facility. Assisting with people in the midst of their trauma journey is truly a sacred experience, and I feel honored to be part of such a service.

Pastoral Care at BryanLGH includes manager Dennis Rock, left, Tom Webb, Janice Blackmon and Dennis Smith. Chaplains are integral members of the trauma team at the medical center.

Trauma Symposium speakers address combat medicine, disaster response and more

By Sheila Uridil, BSN, RN, Trauma Program Manager

O Dr. Reginald Burton was among the presenters at the annual Trauma Symposium at Southeast High School.

ct. 29, 2010 was the date for the Annual Trauma Symposium hosted

by BryanLGH. Nurses, physicians, EMS providers and other healthcare partners earned continuing education credits during sessions which addressed the most current trauma trends.

Similar to past symposiums, the 2010 event at Lincoln Southeast High School was packed with expert speakers and intriguing topics. Filling the day included topics such as combat medicine, disaster response, transfer guidelines and excited delirium.

Speakers from around the country were in attendance to share their knowledge and expertise.

Greg Beilman, MD, chief of Surgical/ Critical Care Trauma and professor of surgery at the University of Minnesota, was

the keynote speaker. He shared his knowledge of metabolic changes in shock and advances in combat casualty care.

Assistant SWAT Team Leader and Training Sgt. Jason Stille of the Lincoln Police Department discussed the use of TASERs for managing excited delirium.

BryanLGH trauma and surgical critical care director Reginald Burton, MD, concluded the day with case reviews involving past trauma patients.

The Trauma Symposium is held every autumn. Speakers focus on current treatment trends and advances in caring for the injured patient.

For more details about Trauma Symposium 2011, watch for an upcoming edition of the Trauma Update newsletter.

We salute Trauma Champions

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undreds will gather April 28 for the third Tribute to Trauma Champions. This BryanLGH event at the Rococo Theatre in downtown Lincoln will recognize two remarkable trauma survivors and honor dedicated professionals involved in saving their lives.

Our trauma survivors are Jason Kort of Hastings and Cody Van Pelt of Lincoln.

Tribute to Trauma Trauma survivors Jason Kort and Cody Van Pelt will salute Champions honors those who their Trauma Champions during an April 28 tribute event. exemplify teamwork, dedication and expertise in providing care to trauma patients.

Honorees include individuals from all aspects of the trauma system involved in their care, including EMS providers, rural trauma center personnel, physicians, BryanLGH staff members and rehabilitation professionals, as well as families, community members and ongoing care providers.

During the event, their stories of tragedy and triumph, dedication and teamwork will be told.

Watch for more information in the next edition of this newsletter!

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Outreach

Team from Bryan helps Nebraska C

By Jan Shaner, RN, StarCare Manager

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ural hospitals preparing for trauma designation visits have a new ally — the outreach education team from StarCare and the BryanLGH Center for Excellence in Clinical Simulation.

St. Mary’s Community Hospital in Nebraska City was the first to benefit from BryanLGH’s pilot program. In anticipation of a thorough review by site surveyors, programs such as St. Mary’s are evaluating staffing response, training and education, along with performance improvement.

While preparing for their site visit, St. Mary’s officials identified a need for more education in hands-on patient assessment and practice scenarios. Chief Nursing Officer Kay Kiechel-White, RN, said St. Mary’s contacted StarCare to see if they could help fill this void.

StarCare took on the challenge, working with BryanLGH College of Health Sciences and Nebraska City Fire & Rescue to create a pilot education program.

A team from BryanLGH spent Sept. 21 with Nebraska City healthcare providers. Chad Poggemeyer, RRT, of StarCare and BryanLGH Assistant Prof. Jodi Nelson, RN, traveled to the hospital to provide outreach education.

Participants included physicians, nurses and ancillary staff from radiology, the lab, respiratory care and other areas. They got to work with equipment such as the Pleuro-Vac chest tube system, and they were exposed to situations involving critical assessment and intervention of pediatric trauma and burns.

Thanks in part to StarCare’s aggressive outreach education program, when a trauma patient arrives at St. Mary’s, the team will be ready to respond. Equipped with the necessary skills and educational tools, they can provide rapid and effective care.

For more information about outreach education from BryanLGH, contact the Center for Continuing Education at (402) 481-9909. There is a fee to use the simulation mannequins.

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The educational seminar brought together co-workers from throughout St. Mary’s Community Hospital and the local rescue team. Simulation mannequins added authenticity to the scenarios.

In the photo above, trauma medical director Dr. Jonathan Stelling intubates a “pretend” pediatrics patient, while Vance Kraeger, RN, does compressions, and Michelle Snyder, RRT, assists.

nLGH City prepare for designation visit

In the photo above, Denise Husen, CRNA, performs a cric to secure an adult mannequin’s airway. Assisting are, from left, Nebraska City Fire & Rescue paramedic manager Rodney Turpel, EMTP; Francine Remacle, RN; Tricia Womochil, RN; (Husen); Doug Langemeier, PA-C; and Jerilyn Wilkinson, RN. In the photo at left, Tammy Osborne, RN, (left) Husen and Tara Gowing, RT, “log roll” the patient into position for an X-ray.

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Asleep at the wheel CBT-I treatment addresses insomnia

According to a recent AAA Foundation study that focused on drowsy driving, 40 percent of Americans admit they have fallen asleep while at the wheel. Nearly 17 percent of all fatal crashes involve a drowsy driver.

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By David Miers, PhD, Mental Health Services Manager

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he National Sleep Foundation’s 2005 Sleep in America poll indicates that 60 percent of adult drivers say they have driven a vehicle while feeling drowsy in the past year, and more than one-third have actually fallen asleep at the wheel. Four percent admit they have had an accident or near accident because they dozed off or were too tired to drive. Like alcohol and drugs, sleep loss or fatigue impairs driving skills such as hand-eye coordination, reaction time, vision, awareness of surroundings, decision-making, judgment and inhibition.

One of the causes of sleep-related accidents is a condition called insomnia.

Insomnia is a condition where a person experiences poor sleep or has trouble sleeping. Insomnia can include symptoms such as difficulty falling asleep, difficulty staying asleep without necessarily having difficulty falling asleep, waking up too early in the morning or not feeling refreshed after a night’s sleep.

Insomnia affects more than 70 million Americans, and more and more people are taking sleep medications.

The BryanLGH Counseling Center offers a treatment solution for insomnia that research shows is equally or more effective than sleeping pills, without the

potential side effects. This new advancement is Cognitive Behavioral Therapy for Insomnia (CBT-I). Mary Kathryn Hunsberger, PhD, Kim Corner, PhD, and Patty Sandoval, LICSW, BryanLGH Counseling Center, are the first in Nebraska to receive the high degree of training and specialization needed to deliver CBT-I. CBT-I combines a number of strategies specifically designed to address factors that contribute to chronic insomnia. These strategies include cognitive therapy, relaxation training, stimulus control therapy and sleep restriction. CBT-I requires patients to be very active in the treatment process.

Criteria to determine if CBT-I is a treatment option for patients include: Patient complains of difficulty initiating

or maintaining sleep that causes significant distress and/or impacts daytime functioning.

The average time to fall asleep is 30 minutes or longer.

Patient exhibits some of the behavioral or psychological factors thought to maintain chronic insomnia such as going to bed earlier or staying in bed longer, engaging in activities other than sleep in the bedroom (e.g., watching television, reading), using alcohol and stimulants inappropriately, and/or unhealthy beliefs about sleep and sleep loss.

A physician referral is necessary for CBT-I. Upon referral, individuals may call the BryanLGH Counseling Center to obtain an intake packet. An intake appointment will be scheduled upon completion of the packet. Following the intake appointment, the referring physician will be notified of treatment recommendations.

The Counseling Center can be reached at (402) 481-5991.

Pupillometer assessment provides insight into brain injuries

By Lisa Latham, BSN, RN, BryanLGH West ICU Manager

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ne of the recent technological advances put into use at the trauma center at BryanLGH West is the NeurOptics® Pupillometer.

Pupil assessments have been used to evaluate brain injuries for more than a century. Physicians use pupil assessments to guide the treatment route of the patient; such assessments provide a window into what’s happening in the brain. A difference

of one millimeter can be a significant finding in some patients.

Traditional pupil assessments using a light source are subjective — and this subjectivity can lead to inaccuracies and inconsistencies. The Pupillometer allows the assessment to become objective.

The Pupillometer is a portable handheld device that allows a reliable measurement of both the size and the light response of the patient’s pupils. The Pupillometer is easy to use with a point and shoot approach.

The assessment is taken one step

further by creating an index reading through the use of an algorithm. This index allows providers to determine if the light response is within a normal range.

The data is stored as numeric readings, but the device also creates a video of the pupil response. This allows providers to compare each pupil and store the video for later review.

For more information about the NeurOptics® Pupillometer, contact Lisa Latham at (402) 481-9299.

Illustrations by NeurOptics®

The Pupillometer provides a window into brain injuries. A simple point-and-shoot approach is used while recording data.

Index readings help determine if the patient’s response to light is within normal limits.

Data is stored as numeric readings, and the Pupillometer creates a video for comparing each pupil.

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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.

Kimberly Russel, President, BryanLGH Health System; John Woodrich, President, BryanLGH Medical Center; Edgar Bumanis, Director, Public Relations; Paul Hadley, Editor.

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Uridil manages trauma program

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Ten years of her career were spent in e are pleased to announce that the intensive care unit Sheila Uridil, BSN, at West, caring for the RN, accepted the position of trauma program most critically injured manager in December 2010. and ill patients.

When Uridil graduated Her love for trauma from the University of grew as she served as Nebraska Medical Center charge nurse and nursing school in 1997 with preceptor in the fasther bachelors of science in paced environment of nursing, she knew she the ICU. wanted to work in the everIn 2007 she joined changing environment of the trauma service as trauma. the Trauma Nurse Care She began her career at Coordinator, assisting Lincoln General Hospital physicians and the that year and has been a nurse practitioner in Sheila Uridil, BSN, RN, BryanLGH employee ever caring for trauma Trauma Program Manager since. patients.

Uridil is enrolled in a Masters of Science Nursing Program to obtain her Adult Nurse Practitioner degree. She anticipates she will graduate in December 2011.

When the opportunity presented for Uridil to work as interim trauma coordinator, she naturally volunteered to help her team. During this period, she gained a great deal of experience and expanded her knowledge of care for the injured patient and the process that supports that care.

Uridil proudly accepted the position as trauma program manager and is excited for this opportunity to contribute.

You can contact her by calling (402) 481-5150 or e-mail her at sheila.uridil@bryanlgh.org.