Tuesday, July 16, 2019
St. Lukes Improves Trauma Care
Emergency room Doctor Brock Bemis and Emergency Room Nurse Sheridan Jones show off the Ranger Pressure Infuser, which can transfuse a liter of blood in two minutes.
Thursday, March 28, 2019


It started with a directive from the Idaho legislature. And it’s translated into better care for trauma patients rushed to St. Luke’s Wood River Hospital.

The Sun Valley-area hospital was approved as a Level IV Trauma Center by the Idaho Time Sensitive Emergency Center this month. The designation demonstrates the hospital’s ability to provide advanced trauma life support and seamless transfer of patients to higher-level trauma centers in Boise or Twin Falls when specialized care is needed.

About 29 percent of St. Luke’s Wood River’s 9,000 annual Emergency Department cases involve trauma.

Shelly Warmack fingers the protocol standards each care provider is expected to wear.

Achieving Level IV designation didn’t involve simply shuffling a bunch of paperwork, although Shelly Warmack, the emergency department nursing manager, can point to a 200-plus page application involving policies and procedures. Meeting requirements involved some very real changes that ensure patients not only survive their accident but have fewer lifelong problems as a result.

“We’re the only hospital in Region 4 with the designation—Jerome, Cassia, Minidoka and others in our region don’t have it, said Warmack, who led the year-long effort, along with Dr. Malie Kopplin. “Whatever’s best, latest greatest out there we’ll do—our goal is to reduce morbidity and mortality with trauma. We don’t have as much trauma as a big city. But when we do, we want to make sure we apply all the best procedures.”

The road to being designated a Level IV Trauma Center started in 2014 when legislators voted to create standardized care for trauma, stroke and heart attack—three of the top five causes of death in Idaho. They asked hospitals to use evidence-based procedures that reduce the frequency of preventable deaths and improve patients’ quality of life.

One of the ways St. Luke’s has improved care is by collaborating with local ambulance services.

Dr. Brock Bemis uses an ultrasound purchased by St. Luke’s Wood River Foundation last year. The ultrasound can tell is there’s bleeding in the abdomen, among other things.

Ambulance personnel no longer call just to say they have an incoming patient. They specify the problems the patient is dealing with so that all the doctors needed to deal with those problems from a surgeon to a respiratory therapist are in the emergency room when the patient arrives.

A list of procedures has been put in place to follow. If the patient has blunt trauma to the chest, emergency personnel follow certain protocol. If it’s internal bleeding, they follow different protocol.

Personnel even wear tags in the emergency room outlining their duties. The team leader, for instance, is supposed to brief the team and clarify roles, receive the EMS report and direct transfer to stretcher, perform the primary survey, treat life threatening symptoms and immediately let staff know if transfer is necessary.The leader also performs secondary surveys as appropriate and orders meds and diagnostic studies.

The primary nurse is responsible for room temperature setting out anticipated supplies and removing unnecessary supplies, documenting the event, conducting assessments and reassessments and accompanying the patient to diagnostic studies.

Nurse Sheridan Jones and Emergency Room Tech Marcus Smith check out some of the emergency room equipment.

The secondary nurse sets up IV and lab supplies and a rapid infuser or warmer as needed and provides IV access, Foley, lab draw and splints among other things.

“When I went into the army 30 years ago, I remember watching a resuscitation in Texas. And I remember thinking: If it had been silent, it would have been like watching a ballet as everyone moved around the patient doing their role,” Warmack said. “That’s what we strive for--and we practice following the procedures.”

In addition to better taking care of the patient up front, the Level IV procedures provide an electronic trauma flow chart that’s easy for physicians to fill out. Physicians who assume the patient’s care later can look at the chart and immediately tell what the patient went through from the moment they arrived at the hospital.

“That means they don’t have to wonder about the patient’s neurological status when he first got to the hospital. That means they can immediately see how many ccs of something the patient got,” Warmack said.

Shelly Warmack keeps not one but two copies of the Time Sensitive Emergency Trauma Triage guidelines on her walls.

Warmack regularly reviews cases looking for trends and complications and ways staff can make care even safer and more effective.

“If I notice a patient didn’t get a certain medication that could have improved their case, we sit down and discuss it,” she said. “We have four certified emergency care physicians in this hospital, which is amazing for a town this size. In most small towns the emergency physician is also seeing patients in an office. We’re one of the handful of rural emergency departments in the country that has physicians  board-certified in emergency medicine on a 24/7 basis.”

St. Luke’s Magic Valley was recently designated a Level III trauma center. Idaho has three Level II trauma centers: Saint Alphonsus in Boise, Kootenai Health in Coeur d’Alene and Eastern Idaho Regional Medical Center in Idaho Falls.

Level I designations are awarded to hospitals that are associated with a medical school and ongoing research. Those facilities can offer access to clinical studies.

St. Luke’s Wood River has not applied for a Level IV designation regarding stroke or heart attack because it doesn’t have a cardiothoracic surgeon who can cut open a chest nor does it have a neurosurgeon to deal with things like bleeding in the brain.

“We’re particularly good at orthopedic injuries—the mountains around here send significant number of patients who injure themselves skiing in winter and biking in summer,” said Warmack. “But we’re very good at stabilizing patients before sending them on to a higher level of care.”

St. Luke’s Wood River has plenty of the tPA clot buster drug to inject into appropriate stroke victims within 60 minutes of their arrival as protocol calls for. It then transfers patients for additional neurological care in many cases.

Those suffering heart attacks are transferred 100 percent of the time to a cardiac catheterization lab where a qualified cardiac surgeon can put in a stent or open a valve via balloon.

The goal is to get the patient to Twin Falls or Boise within 90 to 120 minutes. The quicker the vessel is opened, the quicker the patient is able to normalize—some are able to return home within 24 hours whereas heart patients used to spend days in the ICU.

St. Luke’s staff is regularly able to do this, thanks to EMS personnel alerting the hospital to get a helicopter in the air before the patient hits the door of the hospital. It takes between 28 and 35 minutes to fly to Twin Falls and 35 to 40 minutes to get to Boise due to the prevalent headwind.

Emergency Room Dr. Brock Bemis said the standardization of protocols has improved care tremendously.

“We have all the same gear you would find in a trauma center,” he added. “We can do all you would do elsewhere on a small scale.”


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