BryanLGH Trauma Update, Summer 2011

TRAUMAUPDATE News from the Trauma Center at BryanLGH

SUMMER 2011

Teamwork helps Sierra get back in the game

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trapped under the front of a 3/4 ton pickup. After the collision, ierra Hatcher is the 10-year-old daughter of Teresa and she had been dragged more than 20 feet.

Noah Hatcher of Hebron. Like many children, her “The bicycle was bent over, pinning her between the concrete summer days center around playing softball with street and the truck,” Linton recalls. “The truck was quickly raised friends and riding her bike to the community swimand rolled back while EMTs stabilized Sierra — we were amazed ming pool. to find her still conscious But one such trip on June and asking for help.”

16, 2010, led to injuries The Hebron ambuserious enough that Sierra lance rushed her to the needed months of recovery local hospital, Thayer and the combined efforts of County Health Services, a team of healthcare where she was evaluated providers from Lincoln and and treated. The need for Hebron. higher level trauma care “She was headed to the was identified, so swimming pool on her bike StarCare air ambulance — one of the few times she’s was called to take Sierra ever gone out without her to the Trauma Center at helmet — and stopped at the BryanLGH West. corner of 8th and Jefferson, “She had lots of road where it’s not as easy to see rash and a broken right other traffic,” Teresa says. As collarbone, and her left she pedaled through the knee was what they call intersection, a truck collided degloved — there was with her. just bone and exposed The crash occurred about tendons where the skin two blocks from the Hebron had been torn away,” Volunteer Fire Department says Teresa. headquarters.

Sierra was hospitalSafety Officer William ized at BryanLGH West Linton Sr. notes, “That street from June 16 until July 7. and intersection become During those 21 days, very busy in the summer she was a patient in the months as it’s a direct route pediatric unit on 2nd to the Hebron sports floor. complex and swimming pool Unit manager Lisa in the south part of town.”

Latham, RN, notes that When the rescue squad A year after a bicycle/truck collision, fully recovered Sierra Hatcher trauma surgeon John reached the scene, the first (center) is playing softball again and enjoying summer with her family Continued on Page 2. responders found Sierra (from left) — Kelsianna, 6, Teresa Hatcher, Noah Hatcher and Cole, 3.

Teamwork helps Sierra return to favorite activities Continued from front page.

Cordova, MD, admitted Sierra to the trauma service. Orthopedic surgeon David Samani, MD, and plastic surgeons Mitchell Henry, MD, and Cassidy Mitchell, MD, also treated her.

According to the Hatchers, Sierra underwent 37 surgical procedures in Lincoln and received physical therapy at the hospital in Hebron.

“While she was our patient at BryanLGH, she was taken frequently to surgery for irrigation and debridement and application of a wound VAC for her left knee avulsion,” Latham notes.

Trauma Specialty Clinic manager Sharon Hagelgantz, RN, explains, “This was done in the surgery department to assure pain management during the VAC dressing changes. After her dismissal, Sierra returned for a series of follow-up

visits to BryanLGH, including seven times to the Specialty Clinic for skin graft and donor site assessments between November 2010 and March 2011.”

Teresa says, “Dr. Henry provided much of the wound therapy, and we just loved the nurses, too! I’d like to nominate several of them for the Daisy Award — we made a point to visit them every time we were in Lincoln, and the staff always was so happy to see us again.”

Noah adds, “The care Sierra received at BryanLGH was world class.”

A year after the crash, the Hatchers report that Sierra is nearly back to normal.

“Sierra has a little bit of a limp when she runs, but she’s coping with everything fine and back to swimming and playing softball, like always,” says her mother.

Thanks to coordinated efforts, Sierra Hatcher is back in the game.

Hebron squad has long history of service

By William Linton Sr., Safety Officer and former Chief, Hebron Volunteer Fire Department

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y 1874, the village of Hebron had grown to include homes as well as three or four places of business, so there was a call for fire fighters, and a bucket brigade was formed.

Their fire buckets were made of wood and had a tendency to fall to pieces just when needed!

The fire fighters’ uniforms were red shirts and black pants. A well at the northeast corner of 4th Street and Lincoln Avenue had a hand pump and hose to use to protect nearby buildings.

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In 1879, the company was reorganized, a hook and ladder wagon was installed, and a house for same was erected.

Continues to grow In 1891, the company was again reorganized by the city and took the name of the Hebron Volunteer Fire Department, with two new hose carts and 1,000 feet of hose, and the standpipe for a water supply.

The department has moved on down the line of time when the first ambulance was ordered and placed in service in 1950 under the leadership of Fred Bartling and Fire Chief Ed Wulfkoetter, with several Continued on Page 3.

Continued from Page 2. members taking a 12-hour first aid class.

In 1969, Hebron was one of two towns in Nebraska selected to try a new phone system designated “911.”

the StarCare helicopter and crew from BryanLGH. The enlarged photos still hang in most departments and at Thayer County Health Services and carry the caption and theme, “First there First care.”

In 2010, a 60-year open house was held with a supper and awards night for all EMTs and first responders in Thayer County and Edgar. The supper was sponsored by Thayer County Health Services and Dr. Sullivan.

County Health Services in Hebron, Fillmore County Hospital in Geneva, and Jefferson Community Health Center in Fairbury.

An agreement with Thayer County Ambulance Service also makes the Hebron squad the backup for their unit and vice versa. StarCare continues to be a valuable resource for the community, using a dedicated, lighted helicopter pad at the Thayer County Health Services and

Adopting latest technology In 1983, the rescue unit (which is part of the fire department) completed training on the KED Board and placed it in service. The next year a fund was started, and the department was able to purchase the “Jaws of Life” and place this equipment in service.

In 1991, the squad put a new digital blood pressure machine in service; later that same year after much discussion the first AED was ordered with 11 EMTs taking the training.

The department purchased an air bag rescue system in 1992 and placed it in service. In 1995, a dive rescue team was established to serve the needs of South Central Nebraska.

Then in 1998, the EMTs completed training in IVs and Airways and received one of the first licenses in Nebraska.

Due to the decline of EMTs in many of the smaller towns, the EMS director requested a Hebron Volunteer Fire Department comprises (standing, from left) Mike Crosgrove, Dan Fink, Chris Huber, meeting with the Hebron Kent Kriesel, Dave Hintz, David Asche, William (BJ) Linton Jr., Jerry Johnson, Larry Hergott, Wayne Kugel, members to ask if a tiered Chris Fangmeier, Shane Day and (bottom row, from left) Bob Dankenbring, Lenny Bowman, Tanner system could be implemented Lubben, Jerrod Wiedel and William Linton Sr. Tim Casebolt, Cory Clark and Gary McMains are not pictured. to cover the lack of medical All are EMTs except Casebolt, Clark, Dankenbring, Kriesel and Bowman, who are first responders. response in outlying designated trauma center. Both Hebron communities.

Meeting today’s needs and Deshler were among the first in Tim Sullivan, MD, who has done an Today the department has 14 EMTs Nebraska to use a grant to set up and outstanding job as the Emergency and four first responders and has seen a utilize direct communication via computer Medical director for all Thayer County recent increase in membership with 39 to the hospital and send information from squads and the Edgar squad, was able to members now in the fire department. the ZOLL defibrillator to the physician. convince Hebron to implement tiering The department today is under the The best possible care for the patient with several other towns doing the same leadership of Chief Bill Linton Jr. and is achieved through extensive squad for their area. The system began in 2005 Assistant Chief Shane Day. Both are 25training, improved communications and and continues today. year veterans of the department. transport both to the trauma center and Members continue to donate hundreds of other advanced care centers through hours to provide the best possible EMS golden anniversary StarCare services, which has a short 20equipment and service to the community.

In 2000, the Hebron fire department minute flight time from Lincoln to our The Squad responded to 138 calls for celebrated 50 years of EMS service with landing pad at Hebron. service in 2010 and transports to Thayer special photos of the county squads and

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Tribute to Tra Hundreds gathered April 28 at The Rococo Theatre in Lincoln for the third annual Tribute to Trauma Champions.

The event recognized Jason Kort and Cody Van Pelt, two remarkable trauma

Trauma Champions Jason Kort of Blue Hill (left) and Cody Van Pelt of York (right) pose with Reginald Burton, MD, before the gala event.

Champions all — Honorees take a bow.

BryanLGH trauma and surgical critical care director Reginald Burton, MD, congratulates Tess Lesoing, RN, this year’s Trauma Achievement Award winner.

Jason Kort shares the spotlight with some of the care givers who were first to arrive at the scene.

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uma Champions survivors, and honored dedicated professionals involved in saving their lives. Honorees comprised individuals from all aspects of the trauma system, such as EMS providers, rural trauma

center personnel, StarCare, physicians, BryanLGH staff members and rehabilitation professionals, as well as family, community members and ongoing care providers.

To view Jason’s and Cody’s stories, log on to bryanlgh.org/traumacenter or scan the QR codes on the back page with your smartphone to go directly to these videos on Facebook.

Cody Van Pelt is surrounded by those who came to his aid.

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Crete Area Medical Center earns trauma center designation

By Jody Vondra, CAMC Marketing/Development Director

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ryanLGH's Crete Area Medical Center (CAMC) is pleased to announce its recent certification as a Basic Level Trauma Center by the Nebraska Department of Health and Human Services.

"This certification gives our community confidence that when the unthinkable happens, we are here to provide the best possible care for our communities," said Carol Friesen, CAMC president and CEO. This certification places Crete Area Medical Center as an integral and elite member of the Statewide Trauma System.

This system is a network of definitive care facilities that provides a spectrum of care for all injured patients. Crete Area Medical Center joins BryanLGH West as part of this trauma system.

According to the Nebraska Department of Health and Human Services, the goal of the Statewide Trauma System is to create an integrated trauma care system that includes healthcare providers and

facilities throughout the state and to match each patient's needs to the resources of the facilities, from activation of the Emergency Medical Services system until the patient returns home.

The role of CAMC as a Basic Level Trauma Center is to stabilize, prepare and transfer all patients with potentially life threatening injuries.

As a Basic Level Trauma Center, CAMC is recognized as having trauma-trained physicians, physician assistants and nurse practitioners available within 30 minutes,

in-house trauma trained nurses and appropriate equipment for diagnostics as well as for resuscitation and stabilization.

"This certification shows our commitment to provide high quality, rapid trauma care to all patients injured in our area. Our trauma system works to constantly improve the medical care we provide — from the time of injury, to their arrival at CAMC, and then through to their transfer to BryanLGH West," says Amy Vertin, MD, director of the CAMC Emergency Department.

Electronic documentation comes to Trauma Center

By Bridgett Ojeda, Project Manager, BryanLGH Information Technology

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he BryanLGH Trauma Program began a search for an electronic documentation system by publishing a Request for Proposal in 2009. Salar Inc., a physician inpatient documentation solutions provider, started

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discussions with BryanLGH later that year, and their TeamNotes product was selected for the Trauma Program’s transition from traditional documentation methods to electronic notes.

Primary factors in the decision included the product’s ability to incorporate physician feedback into template design, the ability to capture pro-fee

charges within the notes, and the integration of clinical data from pharmacy, lab, radiology and other hospital systems.

The system went live in November, 2010, with six users and a set of seven note templates. Physicians quickly adapted to using the notes that they had Continued on Page 7.

Continued from Page 6. helped design. Dragon software was installed for physicians that prefer to use voice commands to complete their templates.

Feedback important The Trauma Program has added five new note templates over the past six months and has completed more than 4,000 total notes, averaging more than 750 for the past two months.

User feedback has contributed to more than 50 template updates — with no user down time — since the project kicked off, keeping the system current with department needs. TeamNotes also has enabled clinicians to capture 4,327 CPT and procedure codes and assign more than 20,000 ICD-9 diagnosis codes (more than 900 unique codes) to trauma and critical care patients.

The BryanLGH IT department was instrumental in coordinating and running the project. They worked closely with the Trauma Program staff, incorporating their feedback into template designs, training users and ensuring a successful go-live.

User feedback continues to be incorporated into the note templates for continuous workflow and efficiency improvements.

About Salar Salar delivers flexible and physiciancentric advanced electronic inpatient documentation and billing solutions.

Each Salar product provides a highly customizable physician interface that integrates easily with existing electronic medical record systems.

With Salar, physicians and hospitals achieve productivity, financial and patient safety improvements.

Here are new activation criteria The BryanLGH Trauma Program has reviewed and revised the trauma team activation criteria. The U.S. Centers for Disease Control revised its recommendations for trauma system activation criteria with representation from the American College of Surgeons and American College of Emergency Physicians. The BryanLGH Trauma Program accepted the new CDC recommendations and added criteria based on registry data focus reviews. One example was adding specific fall criteria. The trauma registry showed that a fall from any level in a patient age 50 years or older who had any change in consciousness or had any form of anticoagulation resulted in significant hospitalization and treatment needs. The trauma team used this data to expand the activation criteria for falls. It is essential for trauma systems to monitor the injury patterns in their region and respond to these changes to provide optimal care. Here are the new criteria:

Category I criteria Any injury patient with: GCS <12 Open or depressed skull fracture Paralysis or neuro deficit Systolic BP <90 (Pediatric age specific) Transfer from outside hospitals with unstable vital signs or air transport from scene Respiratory rate <10 or >20 (<20 in peds <12 months old) Flail Chest Intubation Pelvic fractures Two or more proximal long

bone fractures (femur, tibia, humerus) Limb threatening injury (crushed, degloved or mangled extremity, or time sensitive extremity injury) Amputation proximal to wrist or ankle Penetrating injuries to head, neck, torso and extremities proximal to elbow or knee Hanging Drowning Electrocution Potential of injury with burn or inhalation injury

Category II criteria GCS 12-14 Spinal column fracture without neuro deficit Fall from any height Ground level fall (age >50 with anticoagulation &/or + LOC) Isolated femur or stable pelvis fracture due to crash or fall MVC with ejection â&#x20AC;&#x201D; partial or complete MVC with death of same car occupant

High speed MVC (>45 mph) or significant vehicle damage Vehicle telemetry data consistent with high risk of injury MCC >20 mph or with separation of rider from bike Auto-pedestrian/auto-bicycle with significant impact, thrown or run over Stable transfers from outside facilities

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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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Scan these QR codes with your smartphone for videos of Trauma Champions Jason Kort (left) and Cody Van Pelt (right). See Page 4 for more.

StarCare earns CAMTS accreditation

By Jan Shaner, RN, BryanLGH StarCare Manager

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standards set forth by the commission related to quality patient care, training, education, safety and utilization of resources.

The Commission believes that the two highest priorities of an air medical

ryanLGH StarCare is proud to announce it once again has been awarded accreditation by the Commission on Accreditation of Medical Transport Systems (CAMTS).

By successfully completing the voluntary accreditation process, StarCare can verify to referral agencies that our air ambulance StarCare excels in patient care and transport safety, according to the service meets the Commission on Accreditation of Medical Transport Systems. rigorous

transport system are patient care and safety of the transport environment â&#x20AC;&#x201D; for which StarCare has excelled.

StarCare has the only team in Nebraska with a dedicated RN/RT/medic team.

We fly a BK-117 aircraft sponsored by Air Methods Inc. that can be in the air within six minutes of receiving a request for transport. Our state-of-theart safety program has night vision goggles, a terrain awareness warning system and dual system radios enhanced technology.

For more information about BryanLGH StarCare, please call 402-481-5006.