news for ems teams at saint alphonsus … · also, the er grand opening ribbon cutting and blessing...

HEROES SAINTSNEWS FOR EMS TEAMS AT SAINT ALPHONSUS

ISSUE 10 | SEPTEMBER 2014

Eagle’s ED: Quickest in the Valley | ALS Ice Bucket Challenge | Texting While Driving

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SAINT ALPHONSUS | EMS NEWSLETTER

LETTER FROM THE EDITOR

Welcome to the 10th edition of Heroes

& Saints. Fall is around the corner which

means we’re just weeks away from the Ski

& Mountain Trauma Conference in Sun

Valley, ID which runs November 6-8. Sign

your team up before October 6 and take

advantage of our early bird special. Visit the

URL in the ad below for more information.

As we near the end of the Emergency

Department and Ambulance Bay construction,

we want to thank you for your patience

and support. Come celebrate with us at the

annual EMS BBQ on Friday, October 10 on

the helipad off Liberty Street from 12-4pm.

Also, the ER Grand Opening Ribbon Cutting

and Blessing Ceremony will be that morning

starting at 10am, followed by ER tours. We

look forward to seeing you and honoring our

EMS Heroes!

WELCOME HEROES

AIMEE STEINEmergency & Trauma Services Relationship

Manager & Editor

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).

ETYMOLOGY OF HEROES

“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.

Reflections from

SISTER BETH MULVANEY

SEPTEMBER 2014 3

SAINTALPHONSUS.ORG

Boise Mayor David Bieter and Tommy

Ahlquist of Gardner Co. challenged Boise

Fire Department Chief Dennis Doan, Boise

Police Department Chief Mike Masterson,

& Ada County Paramedics Director

Darby Weston, along with all public safety

employees to the ALS Ice Bucket Challenge.

HIGHLIGHTS

2 LETTER FROM THE EDITOR

3 HIGHLIGHTS

4 MEDICAL DIRECTOR GREETING

5 SARMC • ONTARIO

6 LOOKING AT US

8 CARDIAC CARE

9 EAGLE ER

10 LIFE FLIGHT NETWORK

STROKE CASE REVIEW Coughlin Conference Room 2 3rd Wed. of the month • 7-9am

TRAUMA ROUNDS Coughlin Conference Room 2 • 7-8am 10/8, 10/22, 10/29, 11/12 & 12/10

ER GRAND OPENINGRibbon Cutting & Blessing Ceremony October 10, 2014 • 10am

EMS BBQOctober 10, 2014 • 12-4pm

NAMPA CASE REVIEWSSaint Alphonsus Nampa 9/18 & 11/20 • 9-10:30am

SKI & MOUNTAIN TRAUMA CONFERENCESun Valley, ID • November 6-8, 2014

UPCOMING EVENTS

ABOUT THE COVER

SOCIAL MEDIA BUZZ Stay caught up with Saint Alphonsus

Emergency & Trauma News by liking

Heroes & Saints on Facebook. Sign up on

our email list to get newsletter delivered

directly to your inbox.

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HEROES SAINTS

EDITORIAL BOARDAIMEE STEIN Emergency & Trauma Services Relationship Manager & Editor

JOSH SCHLAICH Communications & 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

PAT BERGEY RN, BSN Trauma Coordinator

DR. KARI PETERSON IEP/Canyon County Medical Director

DR. ERIC ELLIOTT IEP/SARMC Medical Director

NICHOLE WHITENER MSN, CNRN, NE-BC Neuro/Stroke Director

JANA PERRY RN, MSN Trauma/ER General Surgery Director

DR. HEATHER HAMMERSTEDT IEP/Eagle ER Medical Director

DR. ANDREW NELSON IEP/Nampa ER Medical Director

BRAD HOAGLUN Communications & PR Director



The weather is beginning to mellow the

spirits of Idahoans seeking the last vestiges

of summer. Trauma season is starting

to wind down yet there still seems to be

plenty of people who refuse to wear their

protective devices or drink and drive to feed

the pipeline for the State’s Trauma facilities.

Speaking of Trauma Facilities – the

State’s Time Sensitive Emergency Council

(TSE Council) is up and functioning! We’ve

had several meetings and are almost finished

promulgating the rules and regulations

to present to the State Legislature in

November that will govern this new TSE

System for our state. As such, the next

step is to form the six regional committees

that will perform the crux of the work

in ensuring the TSE System provides the

quality of care necessary to each Idahoan

that enters the system.

The committees will be tasked with

oversight of the functioning of the medical

facilities and the EMS providers, the

education and preparation for designation

of the medical facilities and the EMS

providers, and conducting peer reviews

within the regions on a quarterly basis.

Over the next several weeks, the TSE

Council, a Governor appointed council

whose task it is to provide oversight for the

TSE System and the Regional Committees,

also known as RTACs, will begin polling

the medical facilities, the EMS agencies

and the lay public in each region to request

interested parties gather at an initial regional

meeting to discuss implementation and

election of membership in the RTACs. We

need your help with these meetings. They

are the key to the successful functioning

of the TSE System. If you are interested

in serving on an RTAC, please watch

for announcements regarding the initial

meetings and attend. The committees will

be elected from the interested individuals

who attend the start-up meetings, will have

a set number of members, and cannot be

appointed by the TSE Council.

As we move into another fall season,

we pray that the public stays safe and makes

traumatic injuries a thing of the past. Alas,

in 33 years of doing this, human nature

frequently overtakes sound judgment and

“Trauma Happens” with the resultant injury

and death that follows.

Thank you for all you do to provide the

absolute best care for your patients and the

injured. Keep up the good work.

IDAHO’S TIME SENSITIVE EMERGENCY COUNCIL

BILL MORGAN, MD

Trauma MD Executive MD SAMG Chief of Staff

“THANK YOU FOR ALL

YOU DO TO PROVIDE THE

ABSOLUTE BEST CARE

FOR YOUR PATIENTS AND

THE INJURED. KEEP UP

THE GOOD WORK.”

MEDICAL DIRECTOR GREETING

SEPTEMBER 2014 5

SAINTALPHONSUS.ORG

HIGH SCHOOL STUDENTS DEMONSRATE THE DEADLY EFFECTS OF TEXTING WHILE DRIVING

Adrian High School in Oregon

conducted a simulation on deadly texting

for one of their students’ senior project.

Similar to the “Every 15 Minutes” Program

the school has done in the past, they wanted

to film and showcase a scenario on how

dangerous texting while driving can be.

Saint Alphonsus Ontario Emergency

Department worked with Adrian High School

students, Treasure Valley Paramedics and the

Life Flight Network to create the scenario.

The Emergency Department received two

patients with one DOA on scene. Nurses,

Physicians, and Radiologists ran a mock

code with one patient expiring and the other

patient experiencing paralysis. The students’

video presentation will occur at an assembly at

Adrian High School in October.

Thanks for the great teamwork team

from Adrian High School, Life Flight

Network, Treasure Valley Paramedics and

Saint Alphonsus Ontario ED. We hope this

will be an eye opening experience for all

students at Adrian High School.

Kathleen Pimentel, Saint Alphonsus Ontario Emergency Department

SAINT ALPHONSUS • ONTARIO



LOOKING AT US

Approximately 5,600 people nationally

are diagnosed with ALS each year1. The

average life expectancy of ALS patients is

two to five years from diagnosis – however,

variants in the disease can allow for patients

to live longer2.

Saint Alphonsus Regional Medical

Center in Boise now offers a new

breakthrough technology in the treatment

of ALS respiratory symptoms. The NeuRx

Diaphragm Pacing System, a humanitarian

device used to improve the breathing

of patients suffering from Amyotrophic

Lateral Sclerosis (ALS), constitutes a major

step forward for treating the respiratory

symptoms of ALS in the region.

To continue raising support and

awareness for ALS, Boise Mayor David

Bieter and Tommy Ahlquist of Gardner Co.

challenged Boise Fire Department Chief

Dennis Doan, Boise Police Department

Chief Mike Masterson, & Ada County

Paramedics Director Darby Weston, along

with all public safety employees to the

ALS Ice Bucket Challenge. Each agency

accepted the challenge! Fire Chief Dennis

Doan issued the next challenge to Eagle

Fire Chief Mike Winkle and the Eagle

Fire Department & Meridian Fire Chief

Mark Niemeyer and the Meridian

Fire Department.

1 http://www.alsa.org/about-als/facts-you-should-know.html, 20122 www.alsa.org/als-care/resources/publications-videos/factsheets/

breathing-difficulties.html, 2009

Saint Alphonsus Regional Medical Center

BOISE CITY AND ADA COUNTY EMS JOIN THE ICE BUCKET CHALLENGE

SEPTEMBER 2014 7

SAINTALPHONSUS.ORG

LOOKING AT US



CARDIAC CARE IS CENTRAL AT NAMPA I84/GARRITY The Cardiac Catheterization Lab at Saint

Alphonsus Nampa I-84/Garrity opened its

doors on January 15, 2014. This new lab is

a state of the art Cardiac Cath Lab, offering

24/7 diagnostic and emergency cardiac care to

the residents of Canyon County and beyond.

The site at the I-84 Garrity Boulevard exit is

a central stop for patients being transferred

for cardiac care from Southwest Idaho and

Northeast Oregon.

The lab is currently staffed with seven

team members – covering two cardiac

Cath Labs, one at I-84/Garrity and one at

the 12th Ave location, and one Interventional

Radiology lab at the 12th Ave location. Since

opening at I84/Garrity, the team has performed

approximately 170 diagnostic and interventional

cardiac catheterization procedures, including 22

emergent ST-Elevation Myocardial Infarctions,

or STEMIs.

The metric for measuring process times

for STEMI patients is known as Door to

Balloon (D2B). Our process clock starts the

moment a patient enters the building and stops

the moment the blocked artery is opened and

blood flow is reestablished to the heart muscle.

The goal is to get the vessel open as quickly

as possible to minimize irreversible damage

to the heart muscle. Data suggests that every

ten-minute delay in treatment can result in a

one percent higher chance of an individual

dying from a heart attack. Currently, the D2B

time average by the Nampa heart team is 60.7

minutes, well below the CMS guideline of 90

minutes. Here is one example of our many

STEMI patient experiences.

On this particular case, D2B was 51 minutes.

This patient did very well afterwards, with

complete resolution of his chest pain. He

was discharged to home after two days.

John Doe is a very typical emergency

patient, and the Nampa Heart Team is

proud to be able to offer this type of

24/7 emergency care to our community.

The team works very closely together to

ensure the best possible outcomes for our

patients and values our role in the life-

saving care provided at Saint Alphonsus

Nampa I-84/Garrity.

Pictured from left to right: (Top) Mark Rushing, Ruth Grant, Don Tulloch, Keith Baker, (Bottom) Diane Bjoralt, Suzanne Larsen, Tara Bewley

CARDIAC CARE

T I M E DETAILS

19:00 On April 10 John Doe noticed some chest pain while sitting on his couch.

19 :20

After about 20 minutes of this pain, he called EMS. EMS arrived on scene and a 12-lead ECG was performed and transmitted to the Emergency Department at Saint Alphonsus Nampa I84/Garrity. The ER MD confirmed that the patient was indeed experiencing a STEMI.

20:05The Cardiac Cath Lab team was notified via a page. The paramedics began their transport to the hospital and the CCL team rushed in from home.

2 0 : 1 1 John Doe arrived at the emergency room.

20:20The team arrived and began preparing the lab for the patient. The ED staff transported the patient to the Cath Lab and the cardiologist arrived.

20:27

The patient arrived at the Cath Lab doors. The patient was then transferred to the procedure table and prepped and draped for his angiogram. Arterial access was difficult to obtain for John Doe, but this was ultimately achieved using the femoral artery. Pictures were taken and the blockage was identified.

21 :02 The vessel was reopened and critical blood flow was re-established to the heart muscle.

SEPTEMBER 2014 9

SAINTALPHONSUS.ORG

EAGLE ER

EAGLE’S ED: QUICKEST IN THE VALLEY

“OUR DOOR TO NURSE

TIME IS LESS THAN

5 MINUTES, OUR

DOOR TO DOCTOR

TIME IS CONSISTENTLY

AROUND 15 MINUTES,

AND OUR PATIENT

SATISFACTION RATES

ARE CONSISTENTLY

THE HIGHEST.”

Saint Alphonsus Eagle Health Plaza

emergency department is Eagle’s only

24-hour emergency department, staffed

by emergency medicine board certified

physicians. Our door to nurse time is less

than 5 minutes, our door to doctor time is

consistently around 15 minutes, and our

patient satisfaction rates are consistently

the highest. We care for all emergencies

and urgencies, and encourage all EMS

traffic according to regular standing

community protocols.

Recently, we’ve been doing simulation

projects at Eagle Health Plaza for Eagle and

Boise physician and nursing staff. Here are

some updates:

1) STEMI

Some STEMIs “walk in” and when they do,

we are ready! After completing simulation

exercises to work on process, patient care,

and flow, one walk in STEMI patient had

an “Door in Door Out” time of 20 minutes

and easily met “Door to Device” criteria

at 61 minutes. This means that we got the

patient appropriately identified and treated

at Eagle Health Plaza and transferred to

the Boise cath lab within the standard time

expected within the same hospital. Great job

to the EMS team whose time in to time out

at Eagle Health Plaza was only 5 minutes!

2) NEONATAL RESUSCITATION AND PRECIPITOUS DELIVERY

Saint Alphonsus Regional Medical Center’s

Neonatal and OB staff came together with

Boise and Eagle Emergency Department’s

nurse and physician staff at Eagle Health

Plaza two weeks ago for a simulation on

neonatal resuscitation and precipitous

delivery. We always want to be prepared for

every situation – especially scary things that

don’t happen often. Things went great and

we’re ready!

Thank you EMS for continuing to

be great community partners with Saint

Alphonsus Eagle Emergency Department

and the Eagle community.

HEATHER HAMMERSTEDT, MD

IEP/Eagle ER Medical Director



CASCADE EMT SIMULATION

The key to a successful training exercise

is to simulate reality as closely as possible.

Our imaginations are uniquely adapted to

prepare us for actual situations, but hands-

on experience has been shown to be one

of the most effective means of teaching in

the healthcare setting. Knowledge becomes

meaningful when nestled in relevant context,

and memory of this knowledge becomes

cemented when we combine visual, verbal,

and kinesthetic stimuli. In other words, the

more realistic a training scenario is the more

effective a teaching tool it becomes. On the

morning of Friday, May 6th, in downtown

Cascade, Idaho, we were reminded of this

when a second EMT, who was traveling

through the area, stopped by our simulation

drill on Highway 55 to ask if we needed

help. Clearly, we had succeeded in creating a

realistic scenario.

Life Flight Network, Saint Alphonsus

Regional Medical Center, and Idaho State

University collaborated to create a successful

simulation training event for the benefit of

staff and volunteers who work for Cascade

Medical Center and Cascade Ambulance.

What began as an educational opportunity

for the staff of Cascade Medical Center

quickly grew into an all-day experience for

pre-hospital and in-hospital care providers

alike, thanks to the suggestion of a local

physician’s assistant and former Ada County

paramedic, Nikki Rota. Nikki worked with

Life Flight Network to produce a training

event that would encompass the entire

patient care continuum from the time of

9-1-1 activation, until the patient received

definitive care in the hospital.

The scenario was initiated with an

emergency call to Cascade Ambulance

describing a semi-conscious male on the

sidewalk in the downtown area who was

complaining of chest pain. When EMTs

arrived, they found our simulation team on-

site with a highly sophisticated mannequin

lying on the sidewalk. The EMTs worked

LIFE FLIGHT NETWORK

“IF WE HAVE AN

ENVIRONMENT IN

WHICH WE CAN

TRAIN AS A TEAM,

GET DIRECT FEEDBACK

FROM THE “PATIENT,”

AND LEARN FROM

A FORMAL REVIEW

PROCESS, WE CAN

HOPEFULLY REDUCE

MEDICAL ERRORS

AND IMPROVE THE

OVERALL DELIVERY

OF PATIENT CARE.”

Tim Rawlings, RN, LF74 Base Manager

SEPTEMBER 2014 11

SAINTALPHONSUS.ORG

LIFE FLIGHT NETWORK

together to assess the mannequin as if it

were a real patient. The mannequin had

breath sounds, a palpable pulse, and an

electrical cardiac rhythm once he was

placed on an ECG monitor. The patient

was bradycardic with a heart rate in the low

40s. Once the patient had been assessed

and packaged for transport, a radio call was

made to the Cascade Medical Center alerting

them that this patient would soon arrive at

their emergency department. The patient

was loaded into the ambulance and driven

the short distance to the hospital. Once

inside the ED, the EMS crew gave a patient

report to Nikki Rota, PA-C. The patient

then suddenly went into cardiopulmonary

arrest, prompting all staff to dive into their

Advanced Cardiac Life Support protocols,

beginning with CPR.

Just as the entire group was fully

consumed with their cardiac patient, they

were notified a pregnant female patient had

just arrived and was preparing for imminent

delivery. Nikki and her team juggled this

added scenario like the well-trained clinicians

they are, providing appropriate care for both

patients despite being over-tasked and at the

limits of their facility’s capability. Everyone

learned how taxing two critical patients can

be for a small, rural medical center that has

just a few staff on duty.

After both patients had been

appropriately cared for, a debrief session

was provided as an opportunity for

everyone involved. We disused elements

where the team performed well, and

identified areas were we might benefit from

additional practice. In a non-threatening

environment such as this, communication

is unfiltered and unintimidating. This

allows more effective learning for everyone

involved and provides people a chance to

share thoughts and feelings about how

things had gone and offer suggestions for

improvement. The staff from Life Flight

Network and Saint Alphonsus Regional

Medical Center offered feedback

and advice based on their experiences

with the group.

Once the debriefing was complete, the

same scenario was repeated, this time with a

different group of staff. Although the event

proceeded similarly, differences in training

and personalities added a new element to

the simulation. Both groups of practitioners

were very successful in working as a team

and providing appropriate care for their

mannequin “patients.”

Simulated clinical training leads to a

marked improvement in skills and learning

to deal with stressful situations in close-to-

real stressful environments. If we have an

environment in which we can train as a team,

get direct feedback from the “patient,” and

learn from a formal review process, we can

hopefully reduce medical errors and improve

the overall delivery of patient care.

BOISE 1055 N. Curtis Rd. 208.367.2121

EMERGENCY DEPTS.

BAKER CITY 3325 Pocahontas Rd. 541.523.6461

EAGLE 323 E. Riverside Dr. 208.367.5300

NAMPA 1512 12th Ave. Rd. 208.463.5000

NAMPA I-84/GARRITY 4400 E. Flamingo Ave. 208.288.4600

ONTARIO 351 SW 9th St. 541.881.7000

Saint Alphonsus Regional Medical Center 1055 N. CurtisBoise, ID 83706

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WE CAN’T THANK YOU ENOUGH.(But we’re going to try.)

Saint Alphonsus Regional Medical CenterER Grand Reopening & EMS BBQ

YOU’RE INVITED

FRIDAY | OCTOBER 10 | 12 – 4 PMBack Helipad off Liberty St.

RSVP BY PHONE 208.367.7791 EMAIL [email protected]

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news for ems teams at saint alphonsus … · also, the er grand opening ribbon cutting and blessing...

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