March 2015 - Saint Alphonsus

NEWS FOR EMS TEAMS
HEROES SAINTS
ISSUE 12 | MARCH 2015
THE
EVOLUTION
OF
VITAL SIGNS
5th Century BC to Today
SAINT ALPHONSUS | EMS NEWSLETTER
LETTER FROM THE EDITOR
AIMEE STEIN
Emergency & Trauma
Services Relationship
Manager & Editor
EMS BBQ IS
MAY 20TH –
DON’T MISS THE
GIVEAWAYS!
ETYMOLOGY
OF HEROES
2
WELCOME HEROES
Welcome Heroes and Saints. Is
it spring yet? What a packed winter
it has been. Thanks to all of you for
your continued efforts in keeping our
community healthy and safe.
In this issue, Dr. Benjamin Cornett
illustrates the history, basics and
importance of vital signs and Christine
Shirazi looks at the chain of survival
modifications: early recognition and
response. Check out the new online
resource that’s available within her article.
We look forward to honoring each
and every one of you during National
EMS week in May. Don’t forget to “Like”
Heroes & Saints on Facebook as we will do
more online announcements and contests.
Make it a great SPRING!
Reflections from
SISTER BETH MULVANEY
Coined in English 1387, during the
“Heroes.” “Saints.” They have a
overcome all kinds of obstacles to
time of King Arthur’s round table, the
lot in common.
make good things happen. Saints
word hero comes from the Ancient
When the Catholic Church
often put other people’s hopes
Greek. “Hero, warrior”, literally
names someone a saint, it is official
ahead of their own.
“protector” or “defender”. It is also
recognition that during the person’s
Yes, our present day emergency
thought to be a cognate of the Latin
lifetime, he or she was outstanding
medical responder “Heroes” and
verb servo (original meaning: to
in the way they responded to God’s
the “Saints” as described above,
preserve whole) and of the Avestan
love and demonstrated it to others.
have a lot in common.
verb haurvaiti (to keep vigil over).
Saints respond to needs. Saints
Want to share your story? [email protected]
SAINTALPHONSUS.ORG
HIGHLIGHTS
SOCIAL MEDIA BUZZ
EDITORIAL BOARD
AIMEE STEIN
Emergency &
Trauma Services
Relationship
Manager & Editor
JOSH
SCHLAICH
Communications & Editor
DR. BILLY
MORGAN
Trauma Medical
Director & Medical
Staff President
DR. KARI
PETERSON
IEP/Canyon County
Medical Director
DR. ERIC ELLIOTT
IEP/SARMC Medical
Director
MSN, CNRN,
NE-BC Neuro/Stroke
Director
JANA PERRY
N, MSN Trauma/ER
R
General Surgery
Director
MS, APPN, ACNS-BC
Cardiovascular
Clinical Program
Manager
DR. HEATHER
HAMMERSTEDT
Mission Education
DR. BEN
CORNETT
IEP/Ada County
Medical Director
facebook.com/HeroesandSaints
NICHOLE
WHITENER
CHRISTINE
SHIRAZI
SISTER BETH
MULVANEY
HEROES SAINTS
Stay caught up with Saint Alphonsus
Emergency & Trauma News by liking
Heroes & Saints on Facebook. Sign up on
our email list to get newsletters delivered
directly to your inbox.
IEP/Eagle ER
Medical Director
DR. ANDREW
NELSON
IEP/Nampa ER
Medical Director
BRAD HOAGLUN
Communications &
PR Director
PAT BERGEY
RN, BSN Trauma Coordinator
New Boise Police Chief Bill Bones, Ada County Sheriff ’s Captain Steve Bartlett,
and Boise Fire and Battalion Chief Aaron Hummell attend the Trauma Intervention
Program (TIP) and thanked the volunteers for their hard work and dedication to helping
their community.
UPCOMING EVENTS
STROKE CASE REVIEW
Coughlin Conference
3rd Wed. of the month • 7-9am
TRAUMA ROUNDS
Coughlin Conference Room 2 • 7-8am
3/25, 4/8, 4/22, 4/29, 5/6, 5/13, 5/27,
6/10, 6/24, 7/8, 7/22, 7/29, 8/12, 8/26,
9/2, 9/9, 9/23, 9/30, 10/14, 10/28, 11/11,
12/9
NAMPA CASE REVIEWS
Saint Alphonsus Nampa
12th Main, Winter Room
Thur. Mar. 19th • 9-10:30am
Thur. May 21st • 9-10:30am
NATIONAL EMS WEEK
May 17-23, 2015
EMS BBQ
TABLE OF CONTENTS
2LETTER FROM
THE EDITOR
3HIGHLIGHTS
4CARDIAC CARE
5NEURO STROKE
6FROM THE
ACP MEDICAL
DIRECTOR
8 L
IFE FLIGHT
NETWORK
11AWARDS AND
RECOGNITION
Saint Alphonsus Garrity
May 20th • 11am-2pm
MARCH 2015 3
SAINT ALPHONSUS | EMS NEWSLETTER
CARDIAC CARE
CHRISTINE
SHIRAZI, MS
Cardiovascular Clinical
Program Manager
EARLY HEART ATTACK AND
CARE PROGRAM
Many of you are familiar with the chain
of survival that was first introduced in the
late 1980’s. During my career in healthcare
the chain has been modified multiple
times. It now includes early access, CPR,
defibrillation, and advanced care. The Society
of Cardiovascular Patient Care (SCPC)
would like to add an additional link to the
chain: early recognition and response.
Dr. Raymond Bahr, the founder of the
SCPC, has developed the Early Heart Attack
Care program (EHAC) to educate the public
in the signs and symptoms of a heart attack.
Dr. Bahr believes warning signs for a heart
attack can begin days or even weeks before
the event. Early recognition and response
assists patients in preventing or decreasing
the damage that occurs to their heart. The
EHAC program is designed to educate the
public with early recognition of signs and
symptoms, thus directing them to earlier
response by calling 911.
The EHAC course is available online at
www.deputyheartattack.org/intro along with
brochures and printable education materials,
which are provided free of charge in both
English and Spanish. The program is available
for individual use and also provides a syllabus
for use by volunteer groups. When logging into
the course you are asked to provide your name
and address to participate. The demographic
information allows the SCPC to record the
number of people who participate along with
their locations. To date, the SCPC has had over
360,000 individuals participate.
Please introduce the EHAC program in
your communities to increase awareness of
early recognition and response when signs of
a heart attack present.
INTRODUCE
THE EHAC
PROGRAM
IN YOUR
COMMUNITIES
TODAY
4
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SAINTALPHONSUS.ORG
NEURO/STROKE
NICHOLE
WHITENER, MSN,
CSRN, NE-BC
Neuro/Stroke Director
“ONE CONTRIBUTING
FACTOR TO OUR
SUCCESS IS OUR
RELATIONSHIP
WITH PRE-HOSPITAL
TRANSPORT.”
LOWERING THROMBOLYTICS IS A
TEAM APPROACH
Did you know that the average adult
cerebral cortex has 22 billion neurons?
According to Saver (2006), when a stroke
happens neurons begin to die due to lack
of oxygen and fuel (glucose) that is usually
delivered by blood flow.
Each minute, the brain loses:
• 1.9 million neurons
• 14 billion synapses
• 7.5 miles of myelinated fiber
• 3.1 weeks of memory
This is why Saint Alphonsus has such an
intense focus on how long it takes to deliver
thrombolytics (door to drug). The sooner a
patient receives a clotbuster drug, the sooner
blood flow can be restored to the brain and
the better the outcome.
The American Stroke Association
promotes a goal of door to drug in 60
minutes. A year ago, Saint Alphonsus’ door
to drug average time was 62 minutes. Good,
but not good enough. Our stroke team is
continually improving our processes and
our current (October through January) door
to drug has been reduced to 49 minutes!
One contributing factor to this success is
our relationship with pre-hospital transport.
The accuracy of the handoffs as well as the
depth of information about the patient’s
health history all contribute to the team’s
capability to rapidly diagnosing and treating
for optimal outcomes.
Each month, Saint Alphonsus Neuroscience Institute hosts a Stroke Case Review. We
encourage anyone with
interest in stroke care to
attend and learn more about
what happens to the patients that you bring to us.
Join us:
The 3rd Wednesday of each
month from 7 - 9 am in
Coughlin Conference room #1.
Even if you can’t stay for
the entire 2 hours, you are
welcome to attend. If you
have any questions about
Stroke Case Review, contact
Nichole Whitener at 367-2233
or [email protected].
Saver J.L. (2006) Time is Brain Quantified. Stroke. 37:
263-266
MARCH 2015 5
SAINT ALPHONSUS | EMS NEWSLETTER
FROM THE ACP MEDICAL DIRECTOR
BENJAMIN
CORNETT, MD
IEP/Ada County
Medical Director
Barring the sixth vital sign of pain that
is a new patient assessment tool, vital signs
have been assessed since Before Christ (BC)
with basic observations of the body. They
have been a foundation of medicine for
centuries and the omission or neglect of the
basic measurements of human physiology
are potential pitfalls to today’s healthcare
providers. We will review the basics of vital
sign history and their importance.
Since 2600 BC, the Chinese assessed
and recorded the pulse of several “patients”
and described their potential implications in
very rudimentary terms. Over the ensuing
centuries, the investigations of multiple
renowned scientists made observations
on the potential implications of the pulse
character and variability. I recall in medical
school sitting for hours with cardiologists,
listening to the heart tones and peripheral
6
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EVOLUTION OF VITAL SIGNS:
5TH CENTURY BC TO TODAY
pulses to define potential disease processes
simply by the auscultation. We used terms
such as “pistol shot pulses” in diagnosing
aortic insufficiency and teased apart an
S2 murmur to determine if it was more
indicative of pulmonary hypertension
or an atrial septal defect. Today, our
reliance on EKG’s, echocardiograms and
other technology to characterize cardiac
physiology has overshadowed the careful
attention to this skill.
Temperature was historically noted
since the time BC, but the second century
AD brought about the first rudimentary
thermometer. To this day there are devices
being developed to measure temperature by
various means. We realize that temperature
has a host of implications for patients and
can indicate serious disease on either end
of the spectrum, particularly when coupled
with the chief complaint. Although there are
arguments about the accuracy and precision
of certain products on the market and how a
temperature is measured, an abnormal value
is not to be overlooked.
Respiratory rate and quality have been
described since 5th century BC. Hippocrates
himself described a patient with temperature
and infrequent deep and rapid respirations
several days before they culminated in
the patient’s death. Since then (and the
development of the stethoscope in 1816),
we now have terms to describe what sounds
the lungs can produce and what they may
imply for the underlying disease process.
The characteristics of respirations may be
the only sign of a patient in DKA (Diabetic
Ketoacidosis) or a non-respiratory emergency.
Measurement of blood pressure has
come a long way since the first described
SAINTALPHONSUS.ORG
FROM THE ACP MEDICAL DIRECTOR
“THE HISTORY AND
PHYSICAL EXAM ARE
STILL THE STARTING
POINT OF EMERGENCY
MEDICAL CARE.
PERFORMING THE
BASICS OF THE PHYSICAL
EXAM, INCLUDING VITAL
SIGNS, ACCURATELY AND
PRECISELY WILL NOT
ONLY HELP IDENTIFY
POTENTIAL UNDERLYING
ILLNESS, BUT ALSO
WILL HELP PROTECT
AGAINST UNNECESSARY
LEGAL PITFALLS.”
5th CENTURY BC
Respiratory rate and quality
have been described since
5th century BC.
measurement by Hales in 1733 in which
he placed a brass pipe in the carotid artery
of a horse and described the height of the
column of blood that resulted. It was in the
late 1800’s that the precursor of the modernday sphygmomanometer was born. Blood
pressure along with palpated pulse and heart
rate, again, are critical to the assessment
of a patient, and along with the other vital
signs, provide invaluable insight into not only
the underlying illness but also the potential
severity of the illness. Multiple variables are
at play in assessing a blood pressure ranging
from patient body type to choice of cuff size
and technique for obtaining a blood pressure.
Oxygen saturations are perhaps the
newest of the vital signs to be considered
as standard after the development of the
first sensor probe in 1935. Since that time,
the application of the “pulse oximeter”
has essentially revolutionized the field of
anesthesiology, provided early detection for
impending respiratory emergencies, and
helped develop early detection of other
disease processes.
The purpose of this review is to remind
all of us as health care providers of the
importance of obtaining a complete set of
accurate vital signs, which have been the
historical backbone of the physical exam.
Technology provides us a convenience in
medicine with electric monitors and automated
blood pressure cuffs, however as Bernard
Baruch eloquently said, “During my eightyseven years I have witnessed a whole succession
of technological revolutions. But none of them
2600 BC
Chinese assessed and recorded the pulse of
several “patients” and described their potential
implications in very rudimentary terms.
2nd CENTURY AD
The first rudimentary thermometer
was brought about.
has done away with the need for character in
the individual or the ability to think.”
Employing gadgets and advanced
procedures does not supersede the basics
of prioritizing assessment of a pulse being
present, absent, thready or otherwise
abnormal on the initial assessment of a
patient along with a careful observation
of the mental status, respiratory status and
counting respirations. Moreover, the first
blood pressure of a patient should be a
manual blood pressure with an appropriately
sized cuff and further automated blood
pressures should be validated with the manual
if inconsistent. Abnormalities in vital signs
need to be addressed in the treatment record
and if interventions were taken, the response
documented as well.
High risk patients such as refusal of care
need to have a complete set of vital signs
that are within normal limits (or near-normal)
and a normal physical exam to ensure their
safety and ours. Any abnormalities need to
be reconciled in the medical record. Similarly,
for these patients in particular, perform
a thorough physical exam and document
the exam and vital signs accordingly in the
medical record.
The history and physical exam are still
the starting point of emergency medical care.
Performing the basics of the physical exam,
including vital signs, accurately and precisely
will not only help identify potential underlying
illness, but also will help protect against
unnecessary legal pitfalls.
1935
Development of the first
sensor probe to determine
oxygen saturations.
1733
Measurement of blood pressure
first described by Hales.
MARCH 2015 7
SAINT ALPHONSUS | EMS NEWSLETTER
LIFE FLIGHT NETWORK
Pictured from left to right: Jathan Nalls, Jim Kranz, and Brian Scalf
POLLI
BUZZINI
Life Flight Network
8
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SAWTOOTH WILDERNESS EMERGENCY
POLLI BUZZINI
On a sunny Sunday afternoon
in August Jim Kranz and six riding
companions set off on horseback into the
Sawtooth Wilderness area near Grandjean.
Kranz, a very experienced horseman who
has been riding and hunting in the area since
the mid-1980s, was headed with his hunting
group to camp when he was bucked off his
horse at approximately 12:45 p.m. Kranz,
a chiropractor, immediately knew he had
severely injured his pelvis. A member of
the hunting group had a satellite phone, but
was separated from the rest of the group at
the time of the accident. They decided their
best course of action would be to get Kranz
back on his horse and move to less rugged
terrain where they could call for help.
Kranz struggled to stay on his horse
for approximately five miles through very
rugged, steep terrain until he could no
longer handle the pain and stay conscious.
EMTs from Lowman Ambulance, Mike
Harkins and Gretchen Sherlin, along
with drivers, Duffy Zieber and Dale
Andreason, were dispatched to the scene
and arrived near the Grandjean trailhead at
SAINTALPHONSUS.ORG
LIFE FLIGHT NETWORK
approximately 4:30 p.m. Since Kranz was still over a mile into the
On arrival, Kranz remembered his cell phone in his front shirt
backcountry, campground hosts Darwin and Gretta Rich let Harkins
pocket, which one of the nurses used to call his wife, Jeannie, and
and Boise County Sheriff Deputy Mike Baker use their ATV to
let her know he was okay. His wife knew there must be something
access Kranz. Upon accessing Kranz, Harkins evaluated him before
wrong because he always checks in and she had not heard from
placing him on a scoop stretcher and securing it to the ATV.
him all day. She said the nurse that called her was very calm and
Life Flight Network had been activated and was en route to the
reassuring, explaining that her husband had been injured, but was
scene, along with additional personnel from Boise County, including
awake and stable. Mrs. Kranz immediately came to the hospital, and
Deputy Jim Kaczmarek and U.S. Forest Law Enforcement Officer
the first thing Jim said to her was, “Is our Life Flight membership
Dean Hickman. The Life Flight Network helicopter arrived at the
up to date?” They both panicked for a moment, wondering who
designated landing zone around 7:00 p.m. Andreason shuttled the
renewed their membership last. The next day Mrs. Kranz called
flight paramedic Jathan Nalls and flight nurse Karol Stafford to the
the membership office and was assured that their membership was
trailhead for ATV transport to Kranz. To expedite the transport,
indeed up to date. In fact, they have been members since 1984.
Hickman used a chainsaw to cut up fallen trees and logs, creating a
Dr. Todd Zeigler, Saint Alphonsus Orthopedic Surgeon stated,
clearer path. The flight
“Jim’s pelvis injuries were
crew arrived at Kranz’s
very severe and could even
side at approximately
have been life-threatening.
7:45 p.m. After
The fact that he came to our
receiving a report from
trauma center in a timely
Lowman Ambulance,
fashion after the excellent
“WE ARE EXCITED AT SAINT
establishing an IV, and
care from Life Flight and
administering pain
the Lowman EMTs made
ALPHONSUS TO SERVE OUR
medication, the flight
our job much easier. After
REGION
AS
ITS
TRAUMA
CENTER
team began the arduous
arrival at Saint Alphonsus
trek out of the forest.
that night, Mr. Kranz was
AND TO BE ABLE TO PROVIDE
Nalls stated, “The
stabilized by the trauma
THIS TYPE OF COMPLEX
trail was made for foot
team and then promptly
traffic only and was
taken to surgery the next
ORTHOPEDIC TRAUMA CARE.
extremely rugged. After
day to repair his pelvis.”
making sure the patient
“We are excited
was secured onto the
at Saint Alphonsus to
ATV, we began to move
serve our region as its
down the trail toward
trauma center and to be
the trailhead.” Due
able to provide this type
to the ruggedness of the terrain, Hickman had to use a chainsaw
of complex orthopedic trauma care. Jim has made a remarkable
to help clear the path so the ATV could get though. At times the
recovery since his injury, consistently staying ahead of his doctor’s
trail was too narrow and they would reposition the stretcher on the
expectations. Just a few months after this injury, Jim was able to return
ATV or remove Kranz and have multiple persons carry him over
to his practice as a Chiropractor,” Dr. Zeigler continued.
trees and rocks. The trek back to the trailhead took approximately 90
Kranz is very thankful for the incredible amount of people that
minutes. Once at the trailhead, Kranz was transported in Lowman’s
helped him that day.
ambulance to the awaiting helicopter and arrived at Saint Alphonsus
Idaho is a great place to live; the outdoor activities are
Trauma Center a short time later.
wonderful and endless. But what is truly amazing about Idaho is the
Kranz stated, “The flight was great.” He further explained that the
dedicated professionals that live here who are willing to step in at a
flight crew made him very comfortable, and his only complaint was
moment’s notice and help someone in need. Without the tremendous
he was not able to sit up and enjoy the scenery as the helicopter
coordination and teamwork of these agencies Kranz’s outcome
made its way to Saint Alphonsus Trauma Center.
could have been drastically different. Thank you to Lowman
continued on page 10 „
MARCH 2015 9
SAINT ALPHONSUS | EMS NEWSLETTER
LIFE FLIGHT NETWORK
from page 9 „
Ambulance, Boise County Sheriff deputies,
U.S. Forest Service personnel, Life Flight
Network, Saint Alphonsus Trauma Center.
The many volunteers that stepped in to help
is nothing less than incredible; they are the
true Heroes and Saints.
Emergencies happen every day
without warning. That’s where Life Flight
10
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Network comes in. Life Flight Network
offers memberships for $60 per month.
A membership covers you, your spouse
and unmarried dependents claimed on
your income tax return. Members will not
incur out-of-pocket expenses for medically
necessary emergent flights if flown by Life
Flight Network or our medical transport
partners. To request more information about
the membership program, please contact the
LFN membership office at 800-982-9299.
SAINTALPHONSUS.ORG
AWARDS AND RECOGNITION
KAREN PORTH, MD
Neurology
PLEASE WELCOME DR. PORTH TO THE NEUROLOGY TEAM
Saint Alphonsus Neuroscience Institute and the Stroke Center are
pleased to announce the addition of Dr. Karen Porth to our neurology
team. Dr. Porth joins Saint Alphonsus as our full time inpatient stroke
neurologist. She brings extensive neuro critical care and vascular
neurology experience to the Treasure Valley. In fact, she is the only
neurologist with this specific skillset in Boise. Having Dr. Porth on
our stroke team at Saint Alphonsus means that stroke patients now
have access to a level of care that can usually be found only at large
academic medical centers.
PARAMEDICS AND
PLASTIC BAGS
Ada County Paramedics are
helping the area’s homeless
by donating basic supplies
through their new program,
“Paramedics and Plastic
Bags.” Way to give back to
the community, ACP!
MARCH 2015 11
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