September 2013 - Saint Alphonsus

News For EMS Teams AT Saint Alphonsus
HEROES SAINTS
Issue 6 | September 2013
Time Sensitive Emergencies | Hero Call | Partnerships in Extrication
Saint Alphonsus | ems newsletter
LEtter FROM THE editor
Hello Heroes!
AIMEE STEIN
Emergency & Trauma
Services Relationship
Manager & Editor
Etymology
of Heroes
Coined in English 1387, during the time
of King Arthur’s round table, the word
hero comes from the Ancient Greek.
“Hero, warrior”, literally “protector” or
“defender”. It is also thought to be a
cognate of the Latin verb servo (original
meaning: to preserve whole) and of the
Avestan verb haurvaiti (to keep vigil over).
Welcome to the 6th issue of Heroes
& Saints. It has been a great summer full of
EMS activity. We are immensely grateful to
all agencies who are fighting against the fires
burning through our great state. Also, the
rescue that began as an Amber Alert involving
a young lady from San Diego hit national news.
Exceptional teamwork from local, state and
federal levels lead to her safe return. Inside
this issue, you will read more about life-saving
teamwork in the Partnerships in Extrication
article. You will also find the latest information
on Time Sensitive Emergencies in Idaho. Be
sure to attend the Annual EMS BBQ on Sept.
26th. I look forward to seeing you on the roof!
Reflections from sister beth Mulvaney
“Heroes.” “Saints.” They have a lot
in common.
When the Catholic Church names
someone a saint, it is official
recognition that during the person’s
lifetime, he or she was outstanding in
the way they responded to God’s love
and demonstrated it to others. Saints
respond to needs. Saints overcome
all kinds of obstacles to make good
things happen. Saints often put other
people’s hopes ahead of their own.
Yes, our present day emergency
medical responder “Heroes” and the
“Saints” as described above, have a
lot in common.
Larry Vanty
PA-C Trauma
November
7-9, 2013
Sun Valley
Idaho
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Highlights
Editorial Board
Aimee Stein
Emergency &
Trauma Services
Relationship
Manager & Editor
Jennifer
Krajnik
Communications
Manager & Editor
Dr. Billy
Morgan
Trauma Medical
Director & Medical
Staff President
Christine
Shirazi
MS, APPN, ACNS-BC
Cardiovascular
Clinical Program
Manager
Sister Beth
Mulvaney
Mission Education
Dr. Ben
Cornett
IEP/Ada County
Medical Director
Dr. Kari
Peterson
IEP/Canyon County
Medical Director
Pat Bergey
RN, BSN
Dr. Eric Elliott
Table of contents
2 Letter from
the Editor
3 highlights
IEP/Medical Director
Nichole
Whitener
MSN, CNRN,
NE-BC Neuro/Stroke
Director
Jana Perry
N, MSN Trauma/ER
R
General Surgery
Director
4Looking at us
4-7 time sensitive
emergencies
8-10partnerships
in extrication
11 life flight
network /
Eagle ER
12 Letter from
the ACP Medical
Director
13awards &
Recognition
Larry Vanty
PA-C Trauma
Dr. Heather
Hammerstedt
Eagle ER Medical
Director
Dr. Andrew
Nelson
Nampa ER Medical
Director
SOCIAL MEDIA BUZZ
When you log on to Facebook and RSVP for
the EMS Rooftop BBQ by September 23, you’ll be
entered to win a prize! See you all on the 26th!
facebook.com/HeroesandSaints
Upcoming events
Stroke Case Review
Coughlin Conference Room 2
3rd Wed. of the month • 7-9am
Trauma Rounds
Coughlin Conference Room 2 • 7-8am
9/11, 9/25, 10/9, 10/30, 11/13, & 12/11
ED Grand Rounds (CME Credit)
Saint Alphonsus Boise
McCleary Auditorium • 11am-1pm
10/24
Please welcome Larry
to the Trauma Team
Larry Vanty, PA-C, has worked as a paramedic for many years,
on the ground and in an air ambulance. Larry also worked as an
instructor and clinical evaluator in both EMT and Paramedic
education programs. In 2013, Larry joined Saint Alphonsus
Medical Group - Trauma and Acute General Surgery.
case reviews
Saint Alphonsus Nampa
1st Wed. every other month • 9-10:30am
10/2, 12/4
EMS Rooftop BBQ
September 26 • 4-7pm
Ski and Mountain
Trauma Conference
November 7-9, Sun Valley, ID
September 2013 3
Saint Alphonsus | ems newsletter
Looking at us
By Dr. Bill Morgan,
Jana Perry,
Nichole Whitener
and Chris Shirazi
Time Sensitive Emergencies
Frequently Asked Questions
BACKGROUND
“Time-sensitive
emergencies include
trauma, stroke,
and heart attack–
three of the top
five causes of
deaths in Idaho.”
4
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The Health Quality Planning
Commission asked the 2013 Legislature to
adopt a concurrent resolution, and during
the legislative session, House Concurrent
Resolution 10 was passed. It directed the
Department of Health and Welfare to
convene a working group to define the
elements of, funding mechanisms for, and
an implementation plan for a comprehensive
system of care for time-sensitive emergencies
in Idaho. The workgroup will also be
responsible for drafting legislative language
for the 2014 legislative session.
Time-sensitive emergencies include
trauma, stroke and heart attack – three of
the top five causes of deaths in Idaho in
2011. Idaho remains one of only a few states
without organized systems of care for trauma,
stroke and heart attack. Numerous studies
throughout the U.S. have demonstrated that
organized systems of care improve patient
outcomes, thus reducing the frequency
of preventable death and improving the
functional status of the patient.
A coordinated and comprehensive system
of evidence-based care addresses: public
education and prevention, 911 access, response
coordination, pre-hospital response, transport,
hospital emergency/acute care, rehabilitation
and quality improvement. By creating a
seamless transition between and among each
level of care and integrating existing community
and regional resources, an organized trauma
system will support achieving improved patient
outcomes and reduced costs.
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The workgroup is comprised of a
variety of stakeholders, including emergency
medical service providers, hospitals,
healthcare providers, public health, health
insurers, rehabilitation, legislators, community
members and others. They are moving
toward the development of a statewide,
evidence-based system of care in which all
Idahoans can expect standardized protocols
and consistent care within the limitations
and parameters of local available resources.
Consideration will be given to the needs
of all local hospitals, physician groups, and
emergency medical service providers and the
sensitivity of the financial implications.
A Communications Subcommittee has
been established to ensure that stakeholders
continue to be informed about the progress
of the workgroup and decisions that are
being made. A key communication piece
that will be continuously updated is a
Frequently Asked Questions document
that will be regularly shared by the Time
Sensitive Emergency Workgroup members.
Opportunities will also be provided for
comments and questions to be submitted
along the way.
1. What does a comprehensive, time
sensitive emergency system of care
look like?
Graphic 1 on the following page
represents the components of a time
sensitive emergency system of care. It
is a continuous process, cycling through
stages such as prevention of an emergency,
emergency response, medical care,
rehabilitation and quality improvement.
The TSE Workgroup is convening to
determine the best framework in which this
system can operate in Idaho. A Framework
Subcommittee was recently established to
propose a soulution to the TSE Workgroup
for consideration. Elements of the system
will likely include an administrative state
agency, such as the Idaho Department
of Health and Welfare; a system of care
advisory board appointed by the Governor
that consists of experts in trauma, stroke
and heart attack response directionsetting and policy; and regional advisory
committees comprised of local emergency
medical systems, hospitals and public
health representatives, and others that will
provide education, technical assistance and
coordination among other responsibilities.
2. H
ow will the system be governed
and where will it be housed? Who/
what will be the designating body
or authority?
Through the recently established
Framework Subcommittee, a comprehensive
system of care will be proposed back to
the TSE Workgroup for consideration.
Elements of the system will likely include
an administrative state agency, such as the
Idaho Department of Health and Welfare; a
system of care state board appointed by the
Governor that consists of experts in trauma,
stroke and heart attack response directionsetting and policy; and regional advisory
committees comprised of local emergency
medical system, hospital and public
health representatives, and others that will
provide education, technical assistance and
coordination, among other responsibilities.
The system may look something like graphic
2 on the following page. However, until the
system is thoroughly designed and vetted this
is only a representation.
The framework that was discussed at
the July 9 TSE Workgroup meeting would
build off existing models for a trauma system
of care to address trauma first and later
incorporate stroke and heart attack.
+ T
he state agency, Idaho Department of
Health and Welfare, would provide oversight
of the state system of care for time sensitive
emergencies and the Department would
provide the process and standards for the
system, including the promulgation of rules.
+ T
he state board would be composed
of voting members appointed by the
Governor and equitably represent
stakeholders (geographic, rural, urban,
medical disciplines, etc). The board would
establish the various designation levels for
the time sensitive emergencies, standards,
procedures and duration of designation.
It would provide criteria for designation
and revocation. The state board would
establish quality improvement standards
as well as criteria for the operation of the
regional advisory committees.
+ T
he regional advisory committees would
be established based on health care
delivery patterns. The specific number
of regional advisory committees has not
been determined. A Region Definition
Subcommittee has been created to address
this issue. Each regional advisory committee
will have one representative that sits on the
state advisory board. The regional advisory
committees will be educational in nature
and provide technical support as needed.
The regional advisory committees could
potentially disburse and prioritize local
funding initiatives, conduct training, conduct
regional quality improvement initiatives, make
recommendations to facilities within their
respective regions, and advise the state board
about the overall system in an effort to meet
the criteria established by the state board.
3. What is the role of the existing
EMS regional advisory councils
in relation to the TSE regional
advisory committees?
It is the hope of the TSE Workgroup
that the existing regional advisory councils,
such as the Ada and Canyon County
Regional Interagency Committee for EMS
(RICE), will participate in, partner with,
or could even become the TSE regional
advisory committees in order to address
best practices and optimal patient outcomes.
September 2013 5
Saint Alphonsus | ems newsletter
Looking at us
1
4. What will criteria for designation
look like for the state of Idaho
and what about leveraging
national standards?
Whenever possible, national standards
are being considered for adoption to create
Idaho-specific best practices. Until the TSE
Workgroup and its various subcommittees
get further into their work, the full answer
to this question is unknown.
During the August 6 TSE Workgroup
meeting, there was further discussion about,
and support for, utilizing national standards
and best practices for trauma, stroke and
heart attack. This was further reinforced by
a presentation given by the State of Utah’s
manager of time sensitive emergencies
system of care and a CEO of a Utah critical
access hospital. Utah presented the group
with their guiding principles that articulate
the importance of national standards and
best practices as well as the designation and
verification criteria for the components of
time sensitive emergencies.
What are the Guiding Principles Idaho
is adopting for the TSE System of Care?
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The following guiding principles presented
by Utah were adopted with modification
by the Idaho TSE Workgroup during the
August 6 TSE Workgroup meeting. These
guiding principles will be used to help
support the 2014 legislation adoption as well
as the promulgation of Rules.
+ P
rovide
nationally accepted evidence
based practices to sensitive emergencies
+ Insure
that standards are adaptable to all
providers wishing to participate
+ I nsure
that designated facilities institute
a practiced, systematic approach to time
sensitive emergencies
+ R
educe
morbidity and mortality from
time sensitive emergencies
+ D
esign
inclusive systems for time
sensitive emergencies
+ P
articipation
is voluntary
+ D
ata
are collected and analyzed to
measure the effectiveness of the system
5. What data will be collected and
how will it be shared? How will
trust be created to share data?
Data to be collected is being discussed
during the development of the system. In
addition, a Registry & Data Subcommittee
has been formed to take deliberate action on
what data are needed for collection and how
that data will be collected.
Currently data are already collected
through the trauma registry. However, how
data will be collected for stroke and heart
attack is still to be determined. There will be
a delicate balance to ensure participation and
collection of adequate information to ensure
performance measures are effectively being
evaluated so that Idaho can be compared
to the national efforts. As of the August 6
TSE Workgroup meeting, it was determined
that the collection and analysis of data to
measure the effectiveness of the system is
imperative and is a guiding principle of the
group. However, the TSE Workgroup is very
cognizant of the potential burden of data
collection and reporting and will continue to
keep this in mind moving forward.
6. H
ow are the interests of
ALL stakeholders identified
and addressed?
Every effort has been made to ensure
that a diversity of stakeholders are involved
in the creation of the framework, legislation,
and process. However, the TSE Workgroup
members are conscientious about ensuring
that a variety of opportunities for input must
be provided. Currently, Workgroup members
utilize a SharePoint site to distribute and
comment on materials. The Communication
Subcommittee is creating talking points for
Workgroup members to be able to share
with their constituents. A website will be
established to display information about the
Workgroup’s progress and to post documents
for public comment. TSE Workgroup
members are also sharing the products of their
work with their colleagues, constituents and
members to ensure they are being provided
ample opportunities to be involved. New TSE
Workgroup members continue to be identified
and recruited to ensure representation.
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Looking at us
A survey the Idaho Hospital
Association recently routed to its member
hospitals was an opportunity to provide
input. The survey, still underway, informed
the hospitals of the TSE Workgroup
activities as well as solicited their input on
specific topics around protocols, capacity
and capabilities, barriers, and coverage.
There were multiple open-ended questions
to allow for additional feedback.
7. How do we ensure adequate
coverage, training and education
in rural areas?
This activity will be conducted through
the regional advisory committees.
8. H
ow will this system be funded
and how will funding be sustained?
This is a fundamental question for
the system of care development and
deployment. The funding source needs
to provide for both immediate and longterm solutions. To this end, a Funding
Subcommittee was established to determine
not only how much the system would cost,
but also identify potential funding sources.
This subcommittee will begin work after
the Framework Subcommittee presents
their recommendations back to the TSE
Workgroup for consideration. It is important
to know what the system design will be in
order to estimate the cost of the system.
8. What are the potential
implementation costs for
rural facilities?
Until the system design is complete,
it is unclear what the costs to rural
facilities may be. As both the Funding and
Framework Subcommittees proceed in their
work, more information will be known. The
goal would be to have the state board cover
the majority of any costs to facilities.
9. Will facilities be able to participate
in one or more component of the
system but not all, i.e. stroke and
trauma? If so, how will the system
address non-participating facilities?
Participation in the system of care is
voluntary but the goal is for every facility to
want to participate up to their abilities and
resources. It is not necessarily to participate
at the highest designation level.
10. What is the process for developing
the TSE system of care authorizing
legislation, as well as rulemaking?
The TSE Workgroup has many
decisions to make about the framework for
the system of care, the budget, the creation
of regions within the system, etc before
the enabling legislation or draft rules can
be created. The legislation will be created
based on the work of the TSE Workgroup
and will likely be complete in October. It
will describe what the system will look like.
Rules, that describe how the system will
work (the nuts and bolts), will be created
tangentially to the legislation, particularly
the trauma component, so they can be
possibly presented to the 2014 legislature
as emergency rules based on the passage of
the enabling legislation. Once the legislation
passes, it will be effective July first or at sine
die (last day of the legislative session).
11. I understand the concept of a
trauma system but am unclear
what a heart attack system of care
looks like. Where can I get more
information?
The American Heart Association
created Mission: Lifeline to help promote
STEMI systems of care. STEMI stands for
ST-Segment Elevation Myocardial Infarction,
a type of heart attack that is particularly
life-threatening and in need of more urgent
treatment. The goal of Mission: Lifeline is
to provide guidance for developing systems
between EMS, referring and receiving
hospitals, allowing for seamless and effective
treatment to all STEMI patients.
More information can be found at:
http://www.heart.org/HEARTORG/
HealthcareResearch/MissionLifeline
HomePage/LearnAboutMissionLifeline/
STEMI-Systems-of-Care_UCM_439065_
SubHomePage.jsp
Resources for a trauma system development through the
American College of Surgeons can be found at: http://
www.facs.org/trauma/tsepc/pdfs/regionaltraumasystems.pdf
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Saint Alphonsus | ems newsletter
LOOKING AT US
Ada County Paramedics, Eagle Fire Department and Life Flight Network
Partnerships In Extrication
By Brandon Erickson, Eagle Firefighter & Paramedic
At 10 am, the units pulled up to the front of Pick-A-Part Jalopy Jungle
in Boise. It was 90 degrees and quickly approaching the 100-degree
BRANDON
ERICKSON
Eagle Firefighter & Paramedic
mark for the day. There were no clouds to offer cover from the
beating sun. In attendance were Life Flight Network’s ground
ambulance, Ada County Paramedics, and Eagle Fire Department’s
Rescue 41. With introductions completed, Captain Rob Shoplock
“Engraved on
the tool it said,
In Memory of
Shauna Hill.
This was why
we were there...
No matter what
the incident, there is
always something
to learn.”
8
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gave a safety briefing of the extrication training for the day.
This was going to be a chance for
each of the participants to cut apart a car.
As the Eagle crews were walking everyone
through some of the extrication equipment,
there was a pause on a new Hurst Cutter.
Engraved on the tool it said, “In Memory
of Shauna Hill”. This was why we were
there, why we were putting on turnout
gear in extreme heat and doing it with
enthusiasm. This one engraved tool showed
the cyclical impact one call can have and the
need for this partnership in extrication.
Eagle Fire Department responded to
an auto accident on December 10, 2012
involving a young girl named Shauna Hill.
Hill was extricated from her vehicle and
transported to Saint Alphonsus Trauma
Center by Ada County Paramedics. She
spent some time in Saint Alphonsus before
she eventually passed away from her injuries.
At the conclusion of this and every
other incidents we ask the question, “What
could we have done better?” No matter
what the incident, there is always something
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LOOKING AT US
to learn. We not only review incidents we
have responded to, we also communicate
with our neighboring departments to share
lessons learned and challenging calls. From
these reviews; we develop training; taking the
challenges to the drill ground.
We have an amazing opportunity in
our partnership with Pick-A-Part Jalopy
Jungle on State Street in Boise. They have
generously allowed us access to practice
extrication on cars which allows us to hone
our skills and reach maximum efficiency.
They are even assisting us with recreating
these challenging calls.
In this session, they provided a T-bone
accident, a vehicle on its side, a car with its roof
crushed on its wheels, and a vehicle upside
down with its roof crushed. Each of those
set-ups represented recent challenges one of
the departments had faced. It is one thing to
practice extricating on an undamaged vehicle
that is sitting on its wheels - that is how we
learn the concepts and usage of our tools - but
that is not what we are facing on 911 calls.
We have to dissect and work around the
damage that was created during the incident.
We also have to work around the impact the
vehicle intrusion is having on the patient.
Is the intrusion just preventing access and
removal of the patient, or is it crushing or
entrapping the patient or an extremity? We
also have to look at how extrication will
impact the stability of the vehicle.
It’s a pretty easy concept to understand.
If the roof supports are cut on a car that is
upside down, the car will fall like crushing a
pop can. With that understanding, the upside
down vehicle first has to be stabilized and
lifted up off its roof, which is supporting the
weight of the car. In the scenario with the
vehicle upside down and the roof crushed, it
not only needs to be lifted, it must be lifted
high enough to provide responders access to
remove patients from the vehicle.
All these techniques would be extremely
difficult to effectively practice on an
undamaged car sitting on its wheels. Even if
the car is just tipped over on its top, we do not
get to practice extrication with the additional
challenge of having the roof crushed. We
continuously search to find and practice new
scenarios. We are always trying to get better,
and, through our partnerships, we can.
Ada County Paramedics transported
Shauna Hill after the extrication had been
complete. The relationship we have with
transport medics is crucial to improving
patient outcomes. They have to trust that
we are taking the fastest, safest route to
extricating the patient. In addition we need
prove our proficiency in our patient care. We
need to have completed a good triage of the
patients, recognizing exactly how much time
we have to remove critical patients.
Life Flight is also a huge partner in
extrication. We use them on a regular basis
for auto accidents on Highway 55 and
Highway 16. Where we are further away from
Saint Alphonsus, their rapid transport can
make the difference in that critical patient’s
outcome. That is not where the impact or the
relationship with Saint Alphonsus ends.
Rich Trump, PA-C Trauma, has been
a big part in providing feedback to first
responders on patient outcomes and findings.
September 2013 9
Saint Alphonsus | ems newsletter
LOOKING AT US
Thanks to Rich taking his time to come back
to responders, we are able to see the patient
progress as they moved though their hospital
care. We can see all the injuries faced and get
feedback on the interventions provided in
the field.
In years past, responders never had this
unprecedented access to understanding the
full injuries and treatments provided to the
patient. Ultimately this feedback gives us the
tools needed to continuously improve the
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patient care we provide in the field.
With the sun beating down and crews
dressed up in PPE, each of the partners
participated in extrication training. The Ada
County Paramedics and Life Flight crews
were given the tools and steps to complete the
extrication. Sweat rolled in everyone’s eyes, and
yet there were still smiles and enthusiasm in
exchanging information. Even Aimee Stein and
Jennifer Krajnik got in on the training and were
able to feel the full weight and sheer power of
the tools cutting through metal like hot butter.
When the training was done and
Shauna Hill’s cutter was being put away, this
partnership in extrication came to a close. In
lieu of sending flowers to honor Shauna’s
passing, the Hill family asked that donations
be made to the Eagle Fire Department in
her name. Donations came from all over the
country and overseas to purchase the new
cutter that was used in the training conducted
with our partners in extrication.
sarmc.org
Life Flight Network/eagle ER
EricK Borland
Marketing Director
Life Flight Network
Life Flight Network’s New AW119Kx “Koala” Helicopters
Now Providing Lifesaving Service from Bases in Boise, Idaho and Ontario, Oregon
Highlights of Life Flight Network’s
New Koala helicopters and critical
care teams:
+ A
bility to transport a two-person
critical care team and two patients
with full-body access
+ A
state-of-the art Garmin G1000H
avionics package with synthetic
vision, enhancing safety and
situational awareness
+ A
ppareo video and data cockpit
recording system
+ N
ight vision goggles, satellite weather
and tracking, and Helicopter Terrain
Avoidance Warning System (HTAWS)
+ 1 5 bases throughout Idaho, Oregon,
and Washington, all dispatched from
LFN’s Communications Center in
Boise, Idaho
+ A
fully-equipped emergency medical
cabin, including a LTV 1200 ventilator,
blood products, Zoll Propaq MD
cardiac monitor and a C-MAC PM
video laryngoscope
+ C
ritical care Flight Nurses with a
minimum of five years of ICU, ED,
and Trauma experience and Flight
Paramedics with a minimum of five
years of experience
+ Speeds up to 175 miles per hour
+ L
FN’s highly-skilled critical care
teams have the ability and resources
to provide a multitude of essential
medical functions during transport of
pediatric and adult patients
And… AIR CONDITIONING
Eagle Never stops improving
HEather
Hammerstedt, MD
MD MPH FACEP Director
“A higher level
of patient care,
close to home”
Saint Alphonsus’ Eagle Emergency
Department continues to provide the
Eagle community with quality, efficient
emergency care. The Eagle ED staff prides
itself on its patient satisfaction (95%
average over the last several years), short
wait times (average wait to be seen of 5
minutes), and high quality care (Certified
Emergency Nurses and the same Board
Certified Emergency Physicians as the
Boise campus). Eagle now has 24-hour
CT techs in house and are accepting
ALL patients by EMS per community
protocols. We now also have Life Flight
Paramedics stationed here for urgent/
emergent transport for inpatient admission,
decreasing Ada County re-dispatching.
Recently, a stroke patient brought in by
Ada County EMS to Eagle received IVtPa
within the door-to-drip 60-minute window,
was transported emergently by Life Flight,
and was the recipient of intra-arterial tPAs
and resulted in a terrific outcome. Given the
onset of symptoms, if the patient had been
transported to another ED, it is likely that
the patient would have missed the window
of opportunity for intervention. This is
an example of providing a higher level of
emergency care, close to home. We look
forward to seeing you soon!
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Saint Alphonsus | ems newsletter
LETTER FROM THE ACP MEDICAL DIRECTOR
Avoid Stagnation:
Challenge yourself
Benjamin
Cornet, MD
Ada County
Medical Director
“The caliber of
patient care in the
Treasure Valley
EMS system is far
and away a higher
level than I have
seen in my travels.”
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The nature of the EMS provider is to
be the ultimate problem solver, dealing with
complex medical or trauma situations in
challenging environmental circumstances.
This comes with certain pros and cons. I
should know. I started at the bottom of the
totem pole and steadily worked my way up
the ladder through the pre-hospital ranks
in the National and Professional Ski Patrol
systems and then through organized urban
EMS systems across the country.
In that time, I realized that care providers
come in very different types and have different
motivations in their careers. After 11 years
and five states of traveling from one EMS
system to another, my family and I landed in
Boise, Idaho. The caliber of patient care in the
Treasure Valley EMS system is far and away
a higher level than I have seen in my travels,
which is what motivated me to stay.
However, even in what I would
consider a top-tier system, those varying
degrees of dedication, motivation, and
compassion are still present. We are in
a unique environment here with stable
departments and employers who focus
on employee satisfaction and retention.
This creates a risk of stagnation for EMS
providers. Stagnation is the seed for apathy
and results in errors in attitude or practice
that lead to early dismissal or burnout.
Daily, we make conscious choices
in our personal and professional lives to
either promote or prevent stagnation. As an
emergency physician, I make it a point to read
at least one journal a month to keep abreast of
current issues or changes in practice. There are
those in the EMS world who choose this path
and those who spend their time at the station
watching re-runs of Judge Judy or planning
their next hunting trip.
I encourage all EMS providers to take
inventory of their personal and professional
lives and determine what will give satisfaction in
both areas. Also, with changes in practice such
as the new selective use of long spine boards, it
is essential for providers to be educated on the
logic and research surrounding these practices
and become active in their application.
Certain practices in medicine carried
over from generations past have never been
substantiated with research. Evidence-based
practice is now the standard. As we question
these previous practices, change can be
uncomfortable, but is necessary to ensure we
are providing the best care for our patients.
As the ultimate problem solvers, EMS
providers are the ones that are taking the words
of articles in journals, protocols, or standing
written orders and applying them to the real
emergency scenario. This is where the art of
pre-hospital care is completely unique and
requires a special skill set of medical knowledge,
common sense, and problem solving.
I would encourage you to take the time
to invest in your career. Keep an open mind
as new research emerges and affects how
you practice. Share ideas or concerns with
your administrators or medical directors to
affect change yourself. This can increase
your career interest and satisfaction as well
as avoid stagnation.
Challenge yourself with continuing
education that is not a reiteration of the
landing zone preparation you have gone
through for the last 10 years. Try attending a
physician or nursing conference that offers
challenging material that may stimulate your
interest in an aspect of your career you have
not preciously considered.
Thank you for your continued dedication
to our communities.
sarmc.org
Awards & Recognition
Picture provided courtesy of Ada County Paramedics
Shout out
to Ada County Paramedics and Boise Fire Department
pat Bergey
RN, BSN
Trauma Coordinator
“Great job
Ada County
Paramedics
and Boise Fire
Department!”
On July 27, 2013, an older gentleman
was working with a wood chipper outside of
his shop at his home. Ada County Paramedics
and Boise Fire Department were called to
the scene where the patient was found on the
ground with a large laceration to the top of
his scalp. There was confusion by bystanders,
since the accident was unwitnessed, of what
kind of accident had occurred since there was
a metal ladder on the ground and a large metal
piece from the side of the wood chipper lying
on the ground near the ladder.
The patient had an obvious decrease in
his level of consciousness and was attempting
to stand. Boise Fire Department and Ada
County Paramedics personnel promptly
assessed the situation and rapidly placed
a C-spine collar on the patient. A physical
assessment was performed and the patient was
transported to the Emergency Department as
a Level 1 trauma activation.
The report received when the
activation was called to the Access Center
relayed the patient had an “obvious open
skull fracture”. The patient was met and
assessed by the Emergency Department
Physician and the Trauma Surgeon. He
was emergently transported to CT where it
was discovered the patient did indeed have
an open depressed skull fracture with a
small epidural, subarachnoid, and bilateral
punctate hemorrhages.
The neurosurgeon took the patient
urgently to the Operating Room for bifrontal
craniotomy for elevation of the depressed
skull fracture. The attending trauma surgeon
noted at the Trauma Rounds review that the
EMS agencies handled this patient with what
was felt to be exceptional care. He noted
the report called in to the Access Center
appropriately labeled the injury as an open
skull fracture based on the physical exam and
assessment performed by the EMS agencies.
This allowed the appropriate medical staff to
be present in the trauma bay and the patient
to be cared for in an appropriate and rapid
manner. The patient was also rapidly and
appropriately placed in a C-collar. An MRI
of the patient’s C-spine on day 2 post injury
revealed the patient had a very extensive
ligamental C-spine injury that also required
surgical repair.
Great job Ada County Paramedics and
Boise Fire Department!
September 2013 13
Saint Alphonsus | ems newsletter
Awards & Recognition
HERO CALL
Hero: Lilly Knudsen (12-year-old)
Hero: Travis Stroman (Boise Fire)
Hero: Mark Austin (Boise Fire)
Top: Brandon
Knuteson &
John Blake
Bottom:
Mike Nugent
Hero: Geoffrey Chally (Boise Fire)
Medics: Brandon Knuteson,
John Blake, Mike Nugent
Call Type: Patient under
respiratory arrest
The patient was at home with her daughter,
Lilly on March 28, 2013. Lilly noticed there
was something not quite right with her mother
as she sat in the living room and saw her lips
turn blue. The patient’s husband initially called
911. When 911 called back, Lilly answered and
responded to questions dispatch asked about
her mother. Lilly knew that the paramedics
would be arriving, so she thought to put their
pets away to allow the medics easier access into
their home. Lilly then went out into their culde-sac and waited for the ambulance, because
she knew that her house was sometimes hard
for people to find. Lilly’s mother says her
12-year-old daughter likely saved her life. For
these reasons Lilly is being honored as a hero
today. Her mother accepts Lily’s award on her
behalf while Lilly is at camp.
Hero: Delaney Barker
(Mother/patient)
Hero: J
anet Mulhern
(911 Call Operator)
Hero: Brad Devroude (Eagle Fire)
Hero: Jason Allen (Eagle Fire)
Hero: Kelsey Backen (Eagle Fire)
Hero: Brian Olson (Eagle Fire)
Top: Stacy
Beaumont
Bottom:
Jeremiah
Wickham
Medics: Jeremiah Wickham,
Stacey Beaumont
Patient: Mother and Newborn
Call Type: Home delivery, CPR given
to newly delivered baby
Patient, mother–to-be went into labor at her
home on November 4, 2012 at just 38 weeks.
Patient called 911 about a minute prior to actually
delivering her baby. 911 dispatch operator Janet
Mulhern answered the call and walked the patient
14
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through her delivery. Upon delivery, her brand
new baby girl was not breathing and appeared
blue in color. Janet provided the patient with
instructions on how to give her baby CPR until
the paramedic team arrived. Her administration
of CPR, paired with Janet’s instruction likely
helped save her baby as she awaited the EMS
crew’s arrival. Today, Janet is being recognized
as a hero, and the new mother is being
recognized as a hero, as well as a great mom!
sarmc.org
Awards & Recognition
Hero: Tim Grett (Gave CPR)
L to R: Jeremy Schabot,
Tim Goslin and John Blake
Hero: Tracey McCombs (911 Operator)
Hero: Stacy Stuart (Called 911)
Hero: Greg Womack (Boise Fire)
Hero: Randy Majors (Boise Fire)
Hero: Rob Pettinger (Boise Fire)
Medics: Jeremy Schabott,
Tim Goslin, John Blake
Patient: Randy Berry
Call Type: Cardiac arrest
Football coach and patient, Randy Berry,
was kicking balls to his players on September
27, 2012. Suddenly, he fell to the ground
on the football field. Bystander, Stacy
Stuart immediately called 911 while another
bystander, Tim Grett, began giving the
patient compression-only CPR as 911
dispatch operator, Tracey McCombs advised
the correct method. The three, in tandem,
helped save his life—and all three are being
honored as heroes today.
Congratulations
to Dr. Rob Hilvers
and his team on the
groundbreaking
ceremony of the
upcoming Emergency
Responders
Health Center.
Ada County
Paramedics
Excellence
awarded to
Community
Paramedic Mark
Babson
What a nice day to honor EMS week at the Nampa
Health Plaza BBQ. Ada Boi, Life Flight Network and
Canyon County Paramedics had VIP parking!
September 2013 15
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