Doing whatever it takes to see you well. 2014 Trauma Annual Report Mercy Hospital and Trauma Center

Offering trauma patients the best possible outcome ... a second chance at life

Messages 1 Who we are 2 Our trauma team 3 Casualty Care Program 4 Trauma defined 5 Mercy trauma statistics: 2014 6-8 Life saving protocols 9 Simulation labs 10 Hospital-based services 11-12 Supporting the community 13-14 Trauma center messages

From the president referral center, RHS receives patients from an 11-county region for high-risk maternity, neonatal I am proud to present the Mercy Hospital and intensive care, pediatrics and pediatric critical care, Trauma Center 2014 Trauma Annual Report, adult critical care, and trauma. RHS is also a Level I highlighting our significant accomplishments over trauma center, and is equipped with a critical care the past year. It has been extraordinary, filled transport helicopter. I look forward to bringing the with advancements that made me very proud of Mercy and RHS trauma teams together to further our multi-disciplinary trauma team who dedicate enhance trauma care across the region. themselves to caring for the injured. See page 3 for a full listing of the many disciplines that The success of our MD-1 emergency response comprise our team. program in Rock County prompted us to roll out the program in Walworth County in 2014. Looking for - In October 2014, the remarkable care provided by ward, we will be adding two additional MD-1 vehicles our trauma staff, as well as all Mercy partners, was to serve the greater Rockford, Illinois region in 2015. recognized when Mercy was awarded Magnet ® Recognition by the American Nurses Credentialing I hope this report serves as a testimonial to the Center. This designation is considered the highest many accomplishments of Mercy’s trauma program honor in the country given to a health care organi - and our unwavering commitment to revolutionizing zation for nursing and patient care excellence. In critical care for residents throughout our region. fact, Mercy is one of only a few organizations in the Thank you for supporting us on our journey. country to achieve Magnet Recognition for an entire health care system. Wishing you good health, Javon R. Bea, president/CEO October brought other exciting changes Rockford Mercy Health System Health System (RHS) merged with Mercy Health System. As a State of Illinois-designated perinatal

From the trauma medical director patients. This care keeps patients close to home and family as they recover from life-changing The first step in any trauma event is preparation. events. At Mercy Health System, we are privileged to work with the most dedicated and talented emergency As highlighted in Janet Jasensky’s story on page 4, medical services (EMS) personnel in the region. EMS coordinated expedient care from the field to They allow our patients to receive coordinated care the hospital, where she required specialty care. before they reach the hospital. This exceptional This included emergent surgery for life-threatening coordination comes from continually updating EMS bleeding followed by specialized pelvic surgery protocols. At the Mercy Regional EMS Training provided by trauma/pelvic orthopedic specialists Center, which features a high-tech simulation lab, from Rockford Orthopedic Associates. She then we work with our EMS colleagues to assure our received months of rehabilitation, starting in Mercy patients are always receiving the best, most Manor Transition Center, and follow-up care after up-to-date care possible. discharge.

Our MD-1 trauma response program is an important It is only with the dedication and expertise of the part of our coordination between regional EMS and local EMS personnel, MD-1 providers, ED providers, Mercy Hospital and Trauma Center. Mercy physi - physician specialists, nurses, laboratory personnel, cians who staff the MD-1 vehicles meet local EMS respiratory therapists, physical/occupational thera - crews in the field, assist with invasive procedures, pists, speech pathologists, medical imaging staff, and talk to the hospital-based trauma surgeon from dietitians, social workers, case managers and the scene. This communication saves precious time, chaplains that stories like Janet’s are possible. allowing mobilization of hospital personnel to Our thanks go to all of those providers who work provide rapid and necessary care to patients when tirelessly every day to care for the injured. they arrive in the ED. Regards, As we grow as a regional trauma center, we make Robb Whinney, DO, medical director it our primary focus to provide the most up-to-date, Mercy Hospital and Trauma Center most specialized care to our critically injured

1 Improving pre-hospital care for cardiac patients Empowering teachers to handle MCIs Mercy Foundation donated seven LUCAS Chest Compression In November, Mercy emergency medicine Systems to the Walworth County EMS system in addition to physicians, along with Janesville police and those donated in 2014 to Rock County. LUCAS is used by EMTs firefighters, trained teachers at Craig High in the field to deliver hands-free chest compressions, allowing School and Parker High School to handle mass EMTs to give cardiac arrest patients other lifesaving therapies, casualty incidents (MCIs) using Casualty Care such as ventilation, medication and defibrillation, and to think Classroom Kits. Teachers remarked that it was ahead in planning the patient’s care. empowering and powerful. More information about the program can be found on p. 4. LUCAS allows safer patient transport in both out-of-hospital and in-hospital situations, and makes CPR more effective from the field to the hospital. In addition, LUCAS reduces the impact of extenuating circumstances that can interrupt or affect the quality of chest com - pressions, such as transport conditions, rescuer fatigue and rescuer experience level.

14 Supporting the community

A well-earned honor On October 21, Mercy Health System was granted Learning from experience Magnet ® Recognition by the American Nurses Credentialing Center. The recognition is considered the highest honor given to a health care facility for nursing excellence. In fact, Mercy Health System is one of a few organizations in the country to achieve Magnet as an entire health care system, including all components of the organization (3 hospitals, clinics, home health and hospice, and an insurance company) across the two states of Wisconsin and Illinois. Other hospitals have received Magnet Recognition, but never before has an entire health system such as Mercy, achieved such an honor.

The Magnet Recognition Program ® honors health care organizations that provide the very best in nursing care and professionalism in nursing practice. Magnet serves as the gold standard for nursing excellence and provides consumers with the ultimate benchmark for On October 18, 60 participants attended Guy Caspi’s measuring quality of care. fascinating presentation about his lessons learned from mass casualty incidents in Israel. Guy is a paramedic, chief multi-casualty incident instructor and director of HAZMAT exercises and operational training for Magen David Adom (MDA), Israel’s ambulance, disaster relief and blood services organization. MDA is the world’s most experienced paramedic organization and has pioneered protocols used worldwide.

Celebrating National EMS Week Local EMS providers enjoyed a tasty Texas-style BBQ luncheon on Mercy in appreciation and gratitude of their lifesaving and life-changing work. Many stopped in to enjoy their lunch at the newly relocated Mercy Regional EMS Training Center at 580 N. Washington St., Janesville.

13 Who we are

At Mercy Hospital and Trauma Center, we offer Our mission critically injured patients immediate, life-saving To reduce regional trauma-related death and care close to home, 24 hours a day, seven days a disability by providing seamless care resulting week, 365 days a year, and continue to care for in healing in the broadest sense. most injured patients through their entire course of hospital care and rehabilitation. Our vision We are committed to provide: Our trauma services go well beyond the emergency • Regional trauma leadership department. Mercy’s multi-disciplinary trauma and • Community injury prevention education critical care team is ready at a moment’s notice to • Education to those who care for the injured care for the most severely injured patients. We ensure • The highest quality care through continuous everything is in place when the patient arrives: doctors, performance improvement surgeons, nurses, imaging equipment, operating rooms and support staff.

Mercy Hospital and Trauma Center is the only Level II Trauma Center in south-central Wisconsin as verified by the American College of Surgeons Committee on Trauma. We treat more than 800 trauma patients annually.

2 Our trauma team Our full hospital trauma team includes:

Trauma Peer Review Committee • Emergency doctors and nurses Robb Whinney, DO, trauma surgery • Trauma surgeons and nurses Edward Snyder, MD, trauma surgery • Neurosurgeons Derek Wall, MD, trauma surgery Patricia Garner, MD, general surgery • Cardiothoracic surgeons Glenn Milos, DO, emergency medicine • Orthopaedic surgeons James MacNeal, DO, emergency medicine services, • Vascular surgeons emergency medicine • Ear, nose and throat surgeons Christopher Wistrom, DO, emergency medicine services, emergency medicine • Plastic and reconstructive surgeons Jonathan Ehrhardt, MD, radiology • Ophthalmologists Andrea Lapusca, MD, anesthesiology • Anesthesiologists Douglas Palmer, MD, orthopaedic surgery Merle Rust, MD, neurosurgery • Radiologists/interventional radiologists Sue Ripsch, CNO, chief nursing officer • Critical care specialists Alissa DeVos, PA-C, trauma surgery • Hospitalists Krista Kimball, PA-C, trauma surgery Lori McKibben, RN, BSN, MBA, trauma • Chaplains • Laboratory and blood bank technicians Trauma Operational Process • Diagnostic imaging technicians Performance Committee • Inpatient nursing staff Vicky Berget Lori McKibben • Respiratory therapists Kristin Clemons, MD Glenn Milos, DO • Social services staff Kathryn Cramer Beth Natter Alissa DeVos, PA-C Douglas Palmer, MD • Dietitians Jonathan Ehrhardt, MD Kristine Phillips • Palliative care specialists Shelby Farberg Jeannine Potts Patricia Garner, MD Anne Quaerna • Inpatient and outpatient rehabilitation staff Cynthia Hanson Sue Rispsch, CNO • Trauma clinic follow-up care staff Barb Hermening Merle Rust, MD Don Janczak, PharmD Cindy Smith Jere Johnson Sue Sunby Michelle Keller Barbara Turner Pat Kendall Deanna Vanderhei Krista Kimball, PA-C Robb Whinney, DO Andreea Lapusca, MD Christopher Wistrom, DO Rachel Luety David Zemke Brooke Lewis James MacNeal, DO

3 Accredited Chest Pain Center

Heart care at its best Laura Kingsbury, RN, BSN, TNS, chest pain program coordinator

Chest Pain Center — As an accredited Code STEMI — STEMI is an abbreviation for ST-elevation chest pain center , Mercy Hospital and myocardial infarction. It’s a severe heart attack caused Trauma Center has resources in place by a prolonged period of blocked blood supply to a large to reduce the time from the onset of area of the heart. Mercy’s Code STEMI team assesses, a person’s heart attack symptoms to treats and supports these patients as fast as possible diagnosis and treatment. We treat because crucial minutes are at stake. The national patients faster during the critical standard for STEMI treatment is 90 minutes. In 2014, window of time when the heart muscle Mercy’s average was 48 minutes. When time is muscle, can be preserved. it is important to open the obstructed cardiac vessel as soon as possible. Through the use of 12-lead, pre-hospital EKGs, our heart catheterization lab times are better than the For recovery from a heart attack or heart surgery, national average. Our state-of-the-art monitoring our cardiopulmonary rehabilitation programs help watches patients when it is not certain they are patients return to a healthier quality of life. having a heart attack; this means they are not sent home too quickly and we are sure they receive the best treatment for their condition.

Our cardiac resources • Telemedicine in place with cardiology for EMS 12-lead EKGs • Immediate notification of cardiology for STEMI • 24/7 cardiac catheterization lab • Cardiothoracic surgery • Therapeutic hypothermia, which greatly improves both ROSC and neurologic outcomes of cardiac arrest patients • Rapid bedside laboratory response to STEMI patients • Bedside digital x-ray for STEMI patients • Emergency pacemaker placement

12 Certified Primary Stroke Center

Primary Stroke Center improves outcomes Nichelle Jensen, BSN, RN, CCRN, stroke program coordinator

Mercy Hospital and Trauma Center has advanced certification as a Primary Stroke Center by the Joint Commission . Mercy is the first and only hospital in the area to receive this level of certification.

We have a full team of experts dedicated to caring for people who are having or have had a stroke. Our initial Code Stroke services include fast diagnosis and treatment. Our gold standard of treatment is administering a clot-busting drug— for those who qualify—within 60 minutes of arrival. The national rate of thrombolytic therapy for ischemic stroke patients is 6%. In 2014, Mercy’s thrombolytic therapy rate was 10%. This shows Mercy’s commitment to aggressive stroke therapy.

We also offer complete inpatient and outpatient rehabilita - tion services, plus a stroke survivors’ support group. Mercy Hospital and Trauma Center has a de clared and established commitment for acute stroke care.

Our Stroke Center resources The major areas that Mercy Hospital and Trauma Center is required to have as a certified Primary Stroke Center:

• A 24-hour acute stroke team, including neurology, ED, and critical care physicians and nurses • 24-hour access to a neurosurgical surgeon and neurosurgical services • CT or MRI available 24/7 • Rapid assessment of priority labs and CT/MRI scans for acute stroke patients • Designated stroke units with specially trained staff • Written tPA protocol in the ED and inpatient units • Written acute stroke clinical pathways (detailed, evidence-based care plans) • Regular stroke education sessions for all stroke staff • Long-term follow-up for stroke treatment outcomes and quality improvement

11 Mercy Casualty Care Program

Preparing employees for active shooter incidents The FBI’s 2013 report on active shooters shows that incidences of school and workplace violence are increasing annually. Studies show that hemorrhage represents the largest percentage of preventable deaths in penetrating trauma, such as shootings.

Even in the best of circumstances, EMS providers may not be in a position to immediately render aid to the wounded. Because of this, it is up to individuals at the scene to help victims and stop the bleeding. empowerment to save lives in the event of a shooting or other traumatic event in a school or business. To Mercy Health System and the Janesville police de - date, over 4,800 casualty care kits have been distrib - partment, fire department and public school district uted throughout six states. collaborated to create a way to help these individuals. While we hope none of this training is ever used, we After extensive research, development and testing, ask our communities to join us in refusing to say, “It the Casualty Care Program was created. This program could never happen here.” gives participants the knowledge, skills, tools and MercyCasualtyCareKits.com

Janet’s story remember any of it, but my family told me Mercy’s ICU The February roads were sheer ice when the accident doctors and nurses were fabulous … the care was happened. The driver lost control and slid into an oncom - wonderful,” said Janet. ing car, getting hit hard on the passenger side. The pas - senger, Janet Jasensky, bore the brunt of the impact. Janet only remembers her last four days in the ICU before doctors moved her to Mercy Manor Transition Janet was brought to Mercy Hospital and Trauma Center, Center to regain strength. Later she was transferred where she was diagnosed with internal bleeding from a to Edgerton Hospital so she could continue her rehabili - laceration to her liver, a small bleed in her brain and 16 tation closer to her home. At the end of March, Janet bone fractures. Dr. Robb Whinney, board certified trauma was finally able to go home and continues her outpatient surgeon, repaired her internal organ and tissue damage rehabilitation therapy. during multiple operations. Dr. David Pittenger, board certified orthopaedic surgeon, repaired the majority of Janet still follows up with Dr. Pittenger and Dr. Whinney. her bone fractures. Orthopaedic traumatologists from She regrets not meeting her Rockford surgeons. “I would Rockford Orthopedic Associates reassembled her pelvic have loved to thank them,” she said. bones. The neurosurgery team monitored her closely and she was thankful surgery was not needed. The critical “Even though I’m still sore, I feel pretty good. My family, care intensivists managed all of her medical needs during especially my husband, all deserve a warm pat on the and after her surgeries in the ICU. back for going through everything with me.”

Because her body was so traumatized, Janet was kept She continues to regain her emotional strength as well. in an induced coma for several weeks in the ICU. “I don’t “My outlook on life is much better. I am happy for whom I have and what I have. And best of all, I’m walking!”

4 Trauma defined

According to the American Trauma Society, trauma is a Level II trauma care severe blunt or penetrating injury primarily caused by These facilities have resources available 24/7 to care an automobile crash, gunshot wound, knife wound, fall, for the majority of injured patients. Key elements bat tery or burn. The Centers for Disease Control’s (CDC) include 24-hour coverage by general surgeons and field trauma triage guidelines recommend trauma cen - prompt availability of care in varying specialties such ters for these types of patients because of improved as orthopaedic surgery, neurosurgery, plastic surgery, outcomes. The CDC rates injury as the leading cause anesthesiology, emergency medicine, radiology, internal of death for American children and adults ages one medicine, oral and maxillofacial surgery, otolaryngology to 44. and critical care, which are needed to adequately respond and care for various forms of trauma that Minor injuries can also be treated at a trauma center, a patient may suffer. and will typically be handled by an emergency medicine physician with backup from other medical specialists. Level II facilities accept patients transferred from Level III and Level IV facilities. In addition, Level II Level I trauma care facilities take part in community injury prevention Patients who require certain sub-specialties may and outreach education initiatives, and are involved be transferred to a Level I trauma center, including with local and state government issues related to University of Wisconsin Hospital and Clinics in Madison trauma care and prevention. and Froedtert Hospital in Milwaukee. These facilities are equipped to accept: Level III trauma care • Critical burn patients who meet These facilities, often community hospitals, generally burn center criteria have resources available to treat and stabilize the • Critical pediatric (younger than 15) patients majority of injured patients, however, these resources who require intensive care monitoring may not be available 24/7. • Complex pelvic fracture patients who require trauma-trained orthopaedic surgeons • Amputations with the possibility of Level IV trauma care re-implantation This is available at settings such as urgent care centers and physician clinics. Minimal resources are available, In addition to Level II criteria, Level I trauma centers but they have procedures in place to immediately also provide emergency and surgical residency transfer injured patients to a higher level of care. programs and participate in trauma-related research activities.

5 Simulation lab

Simulation lab offers real-world training Mobile simulation laboratory Paramedic students and health care professionals This retrofitted ambulance contains all the necessary enjoy real-world training simulations at the Mercy equipment for paramedic and EMT training, including Regional EMS Training Center’s simulation lab. By the METIman. The mobile sim lab is used at outlying using the METIVision ® digital audio/video health fire departments for on-going training and refresher care simulation environment, instructors develop sessions. Paramedic crews provide emergency care a variety of patient care scenarios, complete with to METIman in the environment they actually work in. sounds and realistic backgrounds projected onto the walls. The program offers a complete objective record for student debriefing, assessment and evaluation. Instructors play back the simulated cases so students can review and critique their own performance as part of their training process.

Within these scenarios, students practice skills on the METIman ®, a human patient simulator. The METIman’s unsurpassed level of believability and life-like accuracy allows health care learners to intervene instinctively, quickly, consistently and competently with clinical measures that can save a human life. Mercy offers male, female and child patient simulators. EMS.MercyHealthSystem.org

10 Focusing on lifesaving protocols

Lori McKibben, RN, BSN, MBA, use of prothrombin complex concentrates (PCC). This trauma program coordinator product can be described as the antidote to blood thinners. It helps to rapidly reverse the effect of blood Verification as a Level II Trauma Center thinners, thereby allowing the blood to form clots requires adherence to strict guidelines again. This product, whether used by itself or in con - designed to ensure the highest quality junction with our massive transfusion protocol, can of care for injured patients. These guide - significantly decrease the amount of blood loss our lines must be continuously monitored, evaluated and patients experience. reported with the program. Issues that prevent adher - ence to these guidelines must be addressed and Even though these new processes can significantly changes made to system processes and/or patient improve the outcome for some patients, others may care. I would like to highlight a few of the changes we be too badly injured to survive their injuries. In these have made through this process. tragic instances, our care does not stop there.

As our program has expanded, we have seen an in - We are committed to offering our patients and their crease in more critically injured patients. Many of loved ones the opportunity to save another life these patients suffer injuries that lead to major blood through organ donation. There are currently more loss and require rapid resuscitation in the emergency than 120,000 patients waiting for an organ transplant. department, operating room or intensive care unit. In Twenty-two of these patients will die every day and an effort to improve our response to these patients just one organ donor could potentially save up to and to prevent significant blood loss from occurring, eight of those lives. we have developed new protocols that start with our emergency medical services partners prior to arriving Mercy Hospital and Trauma Center’s donation resource at the hospital. Tranexamic acid (TXA) is a medication team was developed to expertly and compassionately given to help stabilize the clotting process, helping to guide our family members through this process. In decrease bleeding from significant wounds. Initiating 2014, we assisted 10 patients and families to “give the this medication in the field can potentially decrease gift of life.” Thirty-four patients benefitted from these the amount of blood the patient loses and therefore gifts with a total of 45 organs being transplanted. We the need for significant resuscitation and potential celebrate these tremendous gifts with a Donate Life surgery. flag-raising ceremony for the donor families.

Another trend is the number of patients we see who I am very thankful to have the opportunity to work are on anti-coagulation (blood thinner) medications. with so many dedicated and caring health care profes - Even minor injuries can be exacerbated by these sionals who go above and beyond every day to ensure medications. To address this, we have instituted the our patients receive the highest quality care possible.

9

Mercy Hospital and Trauma Center statistics: 20 14

Trauma Patients Discharged from ED

ED response: 8% 100% No activation: 40% 79% 80%

60% 47%

40% Modified: 42%

20% 4% Full: 10% 0%

Full Modified ED

Full Potential life-threatening injuries; may require immediate surgical intervention Modified Significant mechanism of injury, stable injuries; may require surgical consult ED response Minor mechanism of injury, minor injuries; usually does not require surgical consult

Mechanism of Injury

Injury Severity Score (ISS) Other: 11% Pedestrian: 1%

>41: 1% 25-40: 3% 0: 6% 16-24: 4% Firearm: 2% Fall: 37% Stabbing: 1%

Motorcycle: 3%

9-15: 27%

1-8: 58%

Motor vehicle: 45%

ISS is an established medical s core to asses s trauma/injury

severity. It correlates with mortality, morbidity and hospital length of stay. The higher the ISS, the more severely injured

the patient, with a score of 15 o r greater defining a major trauma patient.

6

Mercy Hospital and Trauma Center statistics: 2014

Annual Trauma Patient Volume Mode of Arrival

Helicopter: 1% 800 Per own vehicle: 19% 647 Ground basic life 611 support: 25% 600 551

400

200

0

2012 2013 2014

EMS Agency Ground advanced life support:56%

5% Beloit 3% Town of Beloit Other 12% 2% Brodhead 4% Clinton Whitewater 2% 4% Edgerton

Paratech 5%

Patient Disposition 3% Evansville Orfordville 3% 3% Footville Transfer out: 5%

Other: 1% Milton 8% Deaths: 2%

Discharged from ED: 26%

Janesville 46%

We see our EMS partners as an invaluable extension of

the exceptional trauma care our patients receive in the

hospital. Improved outcom es for trauma patients are closely linked to adequate early resuscitation and timely transfer of appropriate patients to trauma centers (WI State Trauma Triage and Transfer Guideline). Studies show that the sooner a trauma patient can get to Admits: 65% definitive care, the better their outcome.

7

Age Gender

<15 yrs: 6% >55 yrs: 41%

56% 44%

15-55 yrs: 52%

Injuries by Body System Average Length of Stay

6

Head: 14% 5

Extremity 18% 4 days 4 days 4

3 Chest: 7%

Pelvis: 2% 2

1

Spine: 5% Abdomen: 13% 0 ICU Hospital

8