Newsletter for REACT Staff and Friends

A quarterly newsletter for REACT staff and friends

NewsletterREACT

Summer 2019

REACT Night Out:

REACT hosted a free 2 hour CEU offering at Kishwaukee Community College on March 27. Attendees learned about emergency/complicated childbirth, as well as care of the infant. If you missed this offering, never fear. REACT will be offering another educational topic and opportunity as well as community events this summer. Follow us on Facebook (facebook.com/Mercyhealth.MPESC/.) for topics, dates and locations. If you are interested in having REACT present an educational topic to your department, please contact David Uly, Regional Business Development Manager ([email protected]) or Lois Hinton, RN ([email protected]).

Congratulations! Customer survey drawing

When REACT transports a patient, we are very interested in what you have to say about our service and how we can improve it. The avenue we use to get that information is our RSQ911 survey. Each quarter a submission is drawn for a prize. Thank you to everyone who provided feedback through our surveys. Your insight helps to improve our services to you.

We would like to congratulate our latest winner – Michelle Walker from Freeport Hospital. Congratulations!

Debra Webb, RN, CFRN, PHRN How do we protect our patients in the field? • It has been reported that transferring patients In 2014, the National Association of EMS Physicians with spinal cord injuries within the first 8 to 24 (NAEMSP) released new recommendations of full spinal hours to a spinal cord injury unit while providing immobilization. There is now increasing evidence that effective resuscitation has been associated with spinal immobilization is not only unnecessary, but may the most improved patient outcomes. be harmful. • Use of selective spinal immobilization: Spinal immobilization dates back to the early 1960s. It • Blunt trauma with altered level of was reported at that time that patients were suffering consciousness, spinal pain and\or paralysis due to improper prehospital handling and tenderness failure in detecting spinal injuries in trauma patients. • Patients unable to communicate. The theory then was that by extricating and moving • Neurological complaints such as patients onto spinal boards, EMS providers were numbness, tingling, hypersensitivity causing “secondary trauma”, so spinal protocols were • Drug or alcohol intoxication put into place as a preventive measure. • Distracting injury • Patients that would not require spinal By 2001, the use of spinal board management rose immobilization: dramatically. It was noted there were minimal studies • Normal level of consciousness, GCS 15 done to determine patient outcomes with the use • No tenderness or pain of spinal immobilization. Whereas there are several • No deformity studies on siting the risks involved with the use of • No distracting injuries spinal immobilization. One study showed an increase in • No neurological complaints patient disability after the use of spinal immobilization, • No intoxication especially in the penetrating trauma patient. The study • American College of Emergency also demonstrated that spinal immobilization increases Physicians (Prehospital Trauma Life transport times and interferes with resuscitative Support Committee) recommended no measures. spinal immobilization in patients with Other patient risks include: penetrating neck trauma • Increased pain to one or more sites, especially Spinal precautions can be maintained by application of a headaches, pain to occipital area and to the rigid cervical collar and securing the patient firmly to the lumbosacral area EMS stretcher: • Soft tissue injuries and pressure sores. • Increased exposure to radiation and increased • Patients found ambulatory at the scene cost due to additional testing done for evaluating • Patients being transported for a the areas with additional pain protracted time, interfacility transfers • Patients for whom a backboard is not Spinal immobilization has also been linked with indicated respiratory compromise due to constriction of the chest Although more studies need to be done, we can wall because the patient is lying flat. confidently use selective spinal immobilization protocols and limit future unnecessary patient complications.

References: 1. White CC, Domeier RM, Millin MG. EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18(2):306-314. 2. Geisler WO, Wynne-Jones M, Jousse AT. Early management of patients with trauma to the spinal cord. Med Serv J Can. 1966;22(7):512–523. 3. Farrington JD. Death in a ditch. Bulletin of the American College of Surgeons. 1967;52(3):121-130. 4. Farrington JD. Extrication of victims- surgical principles. J Trauma. 1968;8(4):493-512. 5. Riggins RS, Kraus JF. The risk of neurologic damage with fractures of the vertebrae. J Trauma. 1977;17(2):126-133. 6. Soderstrom CA, Brumback RJ. Early care of the patient with cervical spine injury. Orthop Clin North Am. 1986;17(1):3-13. 7. McHugh TP, Taylor JP. Unnecessary out-of-hospital use of full spinal immobilization. Acad Emerg Med. 1998;5(3):278-280. 8. Kwan I, Bunn F, Roberts I. Spinal immobilisation for trauma patients. Cochrane Database Syst Rev. 2001;(2):CD002803. 9. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31(6):531-540. 10. Conrad BP, Rechtine G, Weight M, Clarke J, Horodyski M. Motion in the unstable cervical spine during hospital bed transfers. J Trauma. 2010;69,432-436. 11. Horodyski M, DiPaola CP, Conrad BP, Rechtine GR. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41(5):513-519. 12. Hughes SJ. How effective is the Newport/Aspen collar? A prospective radiographic evaluation in healthy adult volunteers. J Trauma. 1998;45(2):374-378. 13. Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phil Pa 1976). 1999;24(17):1839-1844. 14. Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS. Cervical spine motion during extrication. J Emerg Med. 2013;44(1):122-127. 15. Dixon M, O’Halloran J, Cummins NM. Biomechanical analysis of spinal immobilization during prehospital extrication—a proof of concept study. Emerg Med J. 2014;31(9):745-749. 16. Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998;5(3):214-219. 17. Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010;68(1):115-120. Predesignated Landing Zones

Anthony (Tony) Rehberg, BSN, CFRN, EMT-P a landing area. These sites provide a quickly controllable area to be utilized for helicopter EMS operations. As you respond to the scene you know the intersection well—limited access with long transport time to an The FAA publishes an Advisory Circular, AC No:150/5390-2b appropriate hospital. Multiple accidents in the past allow Heliport Design. This publication outlines the requirements you to predict that there are bound to be severe injuries for helipad construction. This would be the reference for to any involved victims. Nearly all providers can name the those considering a permanent landing spot. locations this scenario is bound to play out. There are many Most of the time predesignated landing sites can following resources available through mutual aid, including additional the recommended landing zone selection process that is ambulances, MD-1 or REACT. Each will present different presented in our helicopter safety course. Pick an area that options for incident command when utilized. is easily accessible for responding vehicles. Select a level Once on scene incident command has many responsibilities, surface of at least 100'x100'. Ideally a prepared surface is not the least of which is the safety of all responders involved. best, but groomed grass works well too. The area around Coordination of responding resources is complex requiring should be free of obstructions such as light poles, wires, management of police, EMS, extrication and fire services signs and posts. Any antennas within a half mile should be and the ever-present public. When you add to that the noted. Remember that antennas less than 200 feet tall do needed manpower and space need for helicopter EMS not require lights and will be a hazard at night. The location operations, there will be times that use of a predesignated can be plotted by road intersection or GPS coordinates. This landing zone makes perfect sense. information should be readily available in the requesting Developing a plan for a designated landing area is a simple agency’s preplan file for relay to our dispatch when REACT is option that is often overlooked. Several communities that requested to respond to this landing zone. REACT serves have taken the step to create a sufficient Most agencies can easily preplan a couple landing zones landing area to relieve the impact of the helicopter landing in a few hours. Once established a periodic review should at a scene. These landing areas can take several forms. be planned to assure the surrounding area remains clear of Pecatonica and Stillman Valley have, at the site of their fire obstructions and hazards. Anyone wishing assistance with stations, a designated, lighted helipad that appears on FAA planning or review of a potential landing area can contact Aviation maps. Other towns have designated the community REACT at (815) 971-4110. baseball/football field, park, church or business parking lot as

References 1. Doc. No. AC No:150/5390-2b Heliport Design. 2. Physician’s Guide To Helicopter EMS Use in Virginia [PPT]. (n.d.). Virginia Office of Emergency Medical Services. 3. When Ground Meets Air. (2007, May 1). Retrieved from https://www.fireengineering.com/articles/2007/05/when-ground-meets-air.html Mercyhealth REACT Now Utilizing Ultrasound Technology Jonathon Hartmann, FP-C, NRP

Sonar has been used since the early 20th century on naval ships to guide them and avoid objects in the sea (www.jems.com, 2019). These days ultrasound has evolved into tablet size, portable devices that allow us to gain images of internal structures that are otherwise invisible in the prehospital setting. The cost of these devices has been the biggest barrier cited by medical directors when asked about implementation of ultrasound in the prehospital setting. Today portable ultrasound units have decreased in size and cost making implementation more feasible (www.jems.com, 2019). Ultrasound is a form of imaging that is portable, non- invasive, painless, and does not expose the patient to harmful ionizing radiation. It is used at the point of care to obtain immediate anatomical, diagnostic, and useful information about critically ill or injured patients. improve outcomes for patients with life-threating conditions appear to be endless at this point. Prehospital The extended Focused Assessment with Sonography ultrasound has the possibility of changing treatment and for Trauma (eFAST) scan is a point-of-care ultrasound guiding patient care in the prehospital scene, directing exam performed at the time of presentation of trauma. transport to the most appropriate receiving facility, and This procedure can be quickly and accurately be guiding the receiving hospital’s management of the performed by a clinician with formal training and critically ill or injured patient (www.jems.com, 2019). exposure to the process and device. Some studies It’s not the shiny new tool that enhances the value, it’s have shown no significant difference in diagnostic the elevation to the clinical provider’s medical decision- accuracy between radiologists and non-radiologists making that provides the ability to obtain otherwise (radiopaedia.org, 2019). Published research examining invisible physiologic and anatomic information about the pros and cons of the eFAST exam has shown a high critical patients in the prehospital scene that can’t be sensitivity and specificity for identifying intraperitoneal understated. free fluid (radiopaedia.org, 2019). The idea of this exam being performed at point-of-care in the field is There are many applications for the use of prehospital to provide immediate transfer to the operating room emergency ultrasound that can potentially reduce or CT in the most critical cases, reducing the time to patient morbidity and mortality from life-threatening repair internal hemorrhage. The study also evaluates emergency conditions. The diagnosis of ischemic stroke the thoracic cavity where it has shown to have better in the prehospital setting via early ultrasound is one area diagnostic capabilities than chest X-ray in the diagnosis of future research which has the potential to improve of pneumothorax. time to thrombolysis and even radiographic intervention (www.jems.com, 2019). This research could translate Prehospital ultrasound has been widely adopted across into better neurologic outcomes of stroke affected the US and world with a growing list of diagnostic patients. applications (www.ems1.com, 2019). Patients presenting with time critical emergency conditions The Mercyhealth REACT flight crew recently completed can be rapidly assessed by clinicians in the prehospital extensive ultrasound training and will now utilize the setting who can obtain the diagnostic answers to portable iViz ultrasound unit by Sonosite to enhance focused clinical questions with this technology. our ability to assess and manage critically ill and injured patients during transport. The clinical applications of prehospital ultrasound that have the potential to reduce morbidity and potentially

Arshad, Faizan H. “Point-of-Care Ultrasound in the Prehospital Setting.” Journal of Emergency Medical Services, 1 Feb. 2018, www.jems.com/articles/print/volume-43/is- sue-2/features/point-of-care-ultrasound-in-the-prehospital-setting.html. Bickle, Ian. “Focused Assessment with Sonography for Trauma (FAST) Scan | Radiology Reference Article.” Radiopaedia Blog RSS, 2019, radiopaedia.org/articles/fo- cussed-assessment-with-sonography-for-trauma-fast-scan. Meenach, Dean. “Prehospital Ultrasound: Emerging Technology for EMS.” EMS1, 18 Mar. 2016, www.ems1.com/ems-products/technology/articles/72040048-Prehospital-Ul- trasound-Emerging-technology-for-EMS/.

If you have a topic you would like to see discussed, please email our Outreach Coordinator at [email protected]. Keeping summer safe TRAUMA SEASON STATS & TIPS

INJURIES SWIMMING ATV/MOTORBIKE/ From 2005-2014, there were an average of 3,536 fatal unintentional drownings (non-boating related) annually in the US — about 10 MOTORCYCLE INJURIES deaths per day. An additional 332 people died each year from drowning in boating-related incidents. More than 14,000 ATV-related fatalities occurred between 1982 and 2015, with 22% About one in five people who die from drowning are children 14 and being children under 16 years old. younger. For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries. In 2015 alone, there was an estimated 97,000 ATV-related ER-treated injuries in the U.S. According to the Directorate for Epidemiology, the annual numbers of fatalities and injuries are expected to increase. INJURIES According to the National Highway Traffic BICYCLE Safety Administration, between Did you know in 2015, bicycles were associated with more injuries 1966 and 2008, an estimated over all age groups than skateboards, trampolines, swimming pools 148,000 people have died and playground equipment combined? That year, 488,123 people were in motorcycle accidents. treated in emergency rooms for bicycle-related injuries and about 1,100 deaths resulted from cyclists colliding with motor vehicles.

IN THE BACKYARD

More recreational sports Depending on your location, you may mow mean more joint pains and your lawn 30 times or more this year, and knee injuries. What’s the most Trampolines cause thousands of injuries each time you’re operating a potentially “dangerous” summer sport? It’s each year, with the majority occurring when dangerous piece of equipment. In 2011, basketball, which results in one multiple children are jumping at one time according to the Consumer Product Safety million youth injuries a year. on home trampolines. In addition, small Commission, more than 83,000 children are 14 times more likely to get hurt people were treated in U.S. than older children. ERs for lawn mower injuries.

Bare feet beware: going barefoot is one of the many simple pleasures of summertime. But bare feet mean higher incidents of A recent study found young children are at the greatest risk for dog puncture wounds, bee stings and bites in the summer and are especially vulnerable to severe bites in warm-weather rashes such as poison ivy. the head and neck areas. Family pets were responsible for 27 percent of dog bite injuries. 1

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ACROSS such as knives and 3 shock due to poor 13 bruising behind the ears bullets, that pierce the distribution of blood due indicating possible basal 6 The energy of a moving surface of the body and to vasodilation skull fracture object.Crossword Puzzledamage internal tissues 4 an open chest wound 14 Resistance that slows a 8 The slowing of an object. and organs. that draws air during projectile, such as air. Across Down 10 Any object propelled by 22 bleeding beneath the inhalation 15 Animpact on the body by force, 6. The such energy as a ofbullet a moving by object. dura mater and above 51. Abbreviation Late shock, duringfor Motor which the body objects is no that longer cause able injury to weapon. 8. The slowing of an object. the brain Vehiclecompensate Collision and blood pressure without begins penetratingto fall. soft 12 head 10. Anyinjury object resulting propelled in by 23force, scraping such asinjury a bullet to the by 72. a Bone function of the of incidentupper arm. tissues or internal organs temporaryweapon. alteration of surface of the skin. 3. command Shock due that to poormonitors distribution of and blood cavities. due to brain 12. Headfunction injury resulting in temporary alteration of brain thevasodilation. safety of operations. 18 both sides 16 lateral bone of the DOWN This person can 19 bones of the spinal function. 4. An open chest wound that draws air during inhalation. forearm independently halt an column. 17 referred 16. Lateral pain bone in the of the forearm. 1 late shock, during which 5. operation Abbreviation if it isfor deemed motor vehicle collision. shoulder 17. Referred due to pain possible in the shoulder the due body to ispossible no longer 7. unsafe A function of incident command that monitors the abdominalabdominal organ organ injur injury. able to compensate and 9 Thesafety product of operations.This of force person can independently 20 a 20.fracture A fracture where where the skin the skin is blood broken. pressure begins to timeshalt an distance. operation if it is deemed unsafe. is 21.broken Injury caused by objects, such fall as knives and bullets, 119. when The product a person of isforce trapped times distance. 21 Injury caused by objects, 2 bone of the upper arm in a confined space that pierce the surface of the body and damage 11. When a person is trapped in a confined space. internal tissues and organs. 13. Bruising behind the ears indicating possible basal 22. Bleeding beneath the dura mater and above the skull fracture. brain. 14. Resistance that slows a projectile, such as air. 23. Scraping injury to the surface of the skin. 15. Animpact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities. 18. Both sides. 19. Bones of the spinal column.