Time Sensitive Emergencies – STEMI

By Stu Willis, MD
Emergency Department Medical Director
STEMI Center Medical Director
Boundary Community Hospital

Thump-Thump, Thump …

Pain in the chest, down the left arm, shortness of breath, nausea, pale and clammy –  these are sure signs of a heart attack, right? Not always.  If you are female, have diabetes, or are elderly you may not have the “classic” signs when you have a heart attack.

Boundary Community Hospital has always held an essential role in meeting the healthcare needs of Bonners Ferry and Boundary County.  With the development of the Idaho Time Sensitive Emergency System, the hospital is working towards meeting the stringent criteria for official designation as a TSE Level II STEMI (Heart Attack) Center. This designation will ensure an organized, coordinated system of care along the complete journey of the heart attack patient – from the EMS ambulance paramedics, to the Emergency Department staff, and then transport by air (or by ground if the weather doesn’t allow flying) to the heart specialists at a large cardiac center capable of giving definitive treatment. The goal of the TSE System is to prevent deaths and improve patient outcomes by providing the rapid movement of patients to appropriate centers for their required treatment – it’s all about getting the RIGHT patient to the RIGHT place at the RIGHT time.

There are two types of heart attacks:  ST elevation attack (STEMI) – blockage of a large, major vessel; and Non-ST elevation attack (Non-STEMI) – blockage of a small, minor vessel. It takes an electrocardiogram (ECG) to tell the difference. While small, minor heart attacks are still important and require prompt attention, the blockage in a large, major heart attack requires extremely urgent, “time-sensitive” treatment to avoid long-term consequences and complications. So, time is of great importance – TIME IS MUSCLE !

Heart disease is the leading cause of death in the U.S and Idaho. About 635,000 new heart attacks occur each year in the U.S. – one every 44 seconds; and there are another 300,000 repeat heart attacks annually. And very worrisome is that around one in five are fairly “silent” in that they don’t have significant pain and few of the more classic signs. Some heart attacks are sudden and intense – these are not hard to mistake. But most heart attacks start slowly and with only mild or moderate discomfort.

CHEST DISCOMFORT – Most heart attacks involve some form of discomfort in the middle of the chest that lasts more than a few minutes, or that comes and goes, and then stays. It can feel like uncomfortable pressure, squeezing, fullness, tightness, or actual pain.

OTHER AREAS OF DISCOMFORT – Signs can also include discomfort of pain in one or both shoulders or arms, or the upper back, neck, jaw, or stomach region.

SHORTNESS OF BREATH – The shortness of breath of a heart attack may occur with or without pain or discomfort in the chest or another region.

OTHER SIGNS – Often other signs occur during a heart attack, and can include breaking out in a sweat, nausea or lightheadedness, and appearing pale.

Similar to men, most common heart attack sign in women, diabetics, and the elderly is pain or discomfort in the chest. However, this group is also more likely to exhibit other symptoms, particularly shortness of breath, vomiting, and back or jaw pain.

WHAT SHOULD I DO IF I SUSPECT A HEART ATTACK? Even if you’re not sure it is a heart attack, immediately call 9-1-1 and chew four baby aspirin or one adult aspirin unless you have a true allergy to aspirin. The EMS paramedics can begin other early essential treatment with an ECG and medications while you are on the way to the hospital.

WHY DON’T PEOPLE ACT FAST ENOUGH? Many people having a heart attack wait more than two hours before getting help. Some people feel it would be embarrassing to have a “false alarm.” Others are so afraid of having a heart attack that they tell themselves they aren’t having one. These feelings are easy to understand, but they are also very dangerous.

HOW CAN I HELP AVOID A HEART ATTACK?

  • Don’t smoke, and avoid second-hand smoke
  • Treat high blood pressure if you have it
  • Eat foods low in saturated, trans fat, and sodium (salt)
  • Be physically active – exercise regularly
  • Reach and maintain a healthy weight
  • Take medicines as prescribed
  • Get regular medical check-ups
  • Control your blood sugar if you have diabetes

The Emergency Department staff of Boundary Community Hospital has coordinated with Boundary Ambulance, Life Flight Network, and the cardiology staff of Kootenai Health in developing a state-of-the-art process to quickly start the initial standardized treatment of heart attack victims and deliver them directly to the heart catherization lab to open the blockage…the faster, the better.

To introduce the community to the Idaho Time Sensitive Emergency Initiative, Dr. Willis is speaking with community and church groups about “What You Need to Know About Heart Attack, Stroke and Trauma.”  If you would like to have Dr. Willis speak with your group, call 267-6912 to get on the calendar.

Time Sensitive Emergency – Trauma

WaaahYah! WaaahYah! WaaaYah!…

By Dr. Stu Willis, Emergency Department Director

The sudden sound of a vehicle crash…the sight of a bloody leg from a chain saw encounter…the thump, thump, thump of granny pivoting down the stairs…these all produce instant fear, anxiety, and worry for an episode of serious injury.

As the first Pacific Northwest hospital to be awarded the Critical Access Hospital designation by the federal government, Boundary Community Hospital has always had an essential role in meeting the healthcare needs of Bonners Ferry and the surrounding county.  With the advent of the Idaho Time Sensitive Emergency System, the hospital is working towards official TSE Designations by meeting the stringent criteria as a Level IV Trauma, Level III Stroke, and Level II STEMI (Heart Attack) Center.

The 2014 Idaho Legislature approved and funded a plan to develop a statewide Time Sensitive Emergency System of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack.  Studies show that organized systems of care improve patient outcomes, reduce the frequency of preventable death, and improve the quality of life of the patient.  The goals of the TSE system are to decrease mortality and improve patient recovery by providing the rapid movement of patients to an appropriate center for definitive treatment.

Worldwide there are eleven deaths every minute due to trauma – that’s 5.8 million fatalities a year, and over one million are the result of motor vehicle crashes. Wearing seatbelts, not driving after drinking, and not driving while distracted (texting, etcetera) are major preventive efforts that have already shown to have a dramatic positive impact.

Trauma is the fourth leading cause of death in Idaho, and the third leading cause in Boundary County. It is estimated that by 2020, one out of every ten persons will die from an injury.

But short of death, other major disabilities result from trauma. For example, various degrees of brain injury, whether a concussion or a massive bleeding injury, occur in the U.S. some 1.7 million times per year. These injuries result in nearly 300,000 hospitalizations, over 52,000 deaths, and about 90,000 cases of severe disability each year. Protective headgear, such as helmets, help some, but preventing the injury in the first place is even more important.

Each year 10 million children visit U.S. emergency departments due to an injury – that’s one visit for every six children…and 10,000 are fatal. “Childproofing” the home and other areas children visit, and simple careful supervision are paramount to ensuring child safety.

For the lay person encountering an injury case, remember the A-B-Cs – Airway, Breathing and Circulation. Ensure the airway is open, but don’t move the neck around as there could be a major neck fracture. Assist with breathing, if necessary, and control ongoing bleeding with direct pressure.

According to Emergency Department Director, Stu Willis, MD, “As a rural community hospital, we have an obligation to provide services that improve survivability. However, we need the community to be aware of the signs and symptoms of time-sensitive emergencies so they can get help as fast as possible, whether it’s the paramedics with advanced life support training, the hospital emergency department staff, or Life Flight transporting a patient to a higher level of care facility such as a major trauma center. In addition, prevention education is a key and vital component of this, especially in regards to injuries and major trauma.”

“At Boundary Community Hospital, our goal is to provide the community with timely healthcare services that are second to none, whether it’s emergency services or long-term care, inpatient or outpatient,” says Hospital CEO Craig Johnson.

To introduce the community to the Idaho Time Sensitive Emergency Initiative, Dr. Willis is speaking with community and church groups about “What You Need to Know About Trauma, Stroke, and Heart Attack.”  If you would like to have Dr. Willis speak with your group, call 267-6912 to get on the calendar.

The TSE System could potentially save 244 lives annually in Idaho according to the Idaho Department of Health & Welfare.

Time Sensitive Emergencies in Boundary County

Time Sensitive Emergencies in Boundary County

Recent news events have highlighted the statewide Time Sensitive Emergency (TSE) initiative in Boundary County.  A tree falling on someone working in their yard has the Boundary Ambulance Service paramedics working with Boundary Community Hospital Emergency Department physicians to call in Life Flight Network to transport the patient directly by air to the nearest Trauma Center.  Then a heart attack on a rainy day is rapidly treated in the Emergency Department and transported swiftly by ambulance directly to the Cardiac Catheterization Lab at Kootenai Health. These are but two prime examples of coordinated care when TIME is critical.

The 2014 Idaho Legislature approved and funded a plan to develop a statewide Time Sensitive Emergency system of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack. To introduce our community to TSE, Dr. Stu Willis, Emergency Department Director at Boundary Community Hospital and representatives from Boundary Ambulance will be speaking to the community about “What You Need to Know About Heart Attack, Stroke and Trauma” on Tuesday, November 29th at 5:30 pm at the University of Idaho Extension Office.

Boundary Community Hospital Emergency Department staff work closely with the Boundary Ambulance EMTs and paramedics and Life Flight Network personnel to design system-wide processes and procedures for expedited care based on the state and regional guidelines. This initiative has put strategies in place so the RIGHT PATIENT gets the RIGHT CARE at the RIGHT TIME, helping to ensure an optimal outcome, especially when TIME is a life-threatening factor.

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BoCo Backpacks Christmas Giving Tree

Christmas Giving Tree

boco-backpacks-giving-tree-120616

This year Boundary Community Hospital is sponsoring a Christmas Giving Tree in the Outpatient Services Lobby for the benefit of Boundary County children through the BoCo Backpacks program. Special limited edition, hand-crafted ornaments created by Naples, Mt. Hall and Valley View elementary school students will be available for a $10 suggested donation.

 

The Giving Tree will be on display in the Outpatient Services Lobby during normal business hours at Boundary Community Hospital November 30th through December 30th. In addition, ornaments will be available at the BoCo Backpacks booth at the American Legion Craft Fair on December 2nd and 3rd.

 

100% of the donations will be used to provide healthy food for children in Boundary County through the BoCo Backpack program and Boundary Community Hospital will make matching contributions based on the number of ornaments distributed.

 

For more information about the BoCo Backpack program, please contact Shirley Anderson, 267-3068

Fall Semester CNA Graduation

CNA Graduation

Boundary Community Hospital and North Idaho College announced the graduation of the fall semester Certified Nursing Assistant (CNA) class.  Pictured Left to right: Instructor, Tracey Maas, RN; Rebecca Maas;  Maureen Dammarell; Emma Hovis; Shelley Woodward; and in front: Bayleigh Nielsen.

fall_2016_graduates-lores

Next semester starts on January 10th and scholarships are available.  Scholarships include paid tuition and employment in the Boundary Community Hospital Extended Care Facility.  Application deadline is December 9th. For more information about the Certified Nursing Assistants Program at Boundary Community Hospital please contact Tracey Maas, RN at tracey.m@bcch.org or call (208) 267-3141 ext 4312

Healthy Holiday Meal Planning

Healthy Holiday Meal Planning
By Edna Eby MS RD LD
Dietician, Diabetes Outreach
Boundary Community Hospital

It’s November and you are planning the annual holiday family dinner. Everyone loves Grandma’s famous southern sweet potato casserole and Aunt Louise’s Pumpkin Pie with plenty of whipped cream. But Uncle Bill and Cousin Ann are coming to dinner too. Bill has diabetes and Ann has heart disease. Your daughter Emily is trying to get everyone to eat healthier. What to do? A little planning goes a long way to make your family dinner a success.

Here are some tips to make the holidays healthier:

  • First set a definite time to serve the meal. A diabetic can plan ahead and adjust meal and medication times according to when the meal is to be served. A two-hour delay can cause problems; normal or routine meal times are the best choice.
  • Plan a variety of healthy choices. A fresh veggie tray is a good choice with a ranch, salsa or hummus dip. Ordinary foods without adding dressings or sauces are best.
  • Herbs and spices are a must! Get creative and remember, salt is a personal choice – less is better. Most recipes can be modified to lower the carbohydrate level. Cranberry gelatin salad can be made with sugar free gelatin, have guests add their own whip topping and bet how many will guess this salad is not only delicious but healthy as well! Prepare candied yams with a brown sugar substitute or serve two types of potatoes: candied yams and mashed potatoes. The amount of sugar can be reduced in most recipes, then add herbs and spices for a great taste.
  • Have a variety of beverage choices including ice water, sugar free punch or soda and coffee. Although not recommended for diabetics, alcohol is a personal choice. If a diabetic does elect to drink, make sure that food is available to prevent hyperglycemia or hypoglycemia.
  • Desserts – Yikes!! Always a temptation. A diabetic diet controls all carbohydrates. Carbohydrates found in gooey desserts can raise blood sugars very fast and high. Offer low sugar desserts. A single crust pie or a custard without the crust are better choices than double crust pies. If the diabetic offers to bring something for the meal, have them bring the dessert.

November is Diabetes Awareness Month. As of 2012 approximately 21.1 million Americans (9%) had diabetes and today, 1 in 3 people are undiagnosed.

Some diabetes signs or symptoms are:

  • Extreme thirst;
  • Frequent urination; and
  • Fatigue.

Diabetes does not discriminate; it can affect any age, sex or racial group. It can cause many complications or morbid conditions.
Remember that holiday meals are a time for family and traditions. Offer choices; it is up to the diabetic to make the right decision. If they want to eat a small piece of dessert, it is their choice. Just be sure that healthy options are available.
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The Boundary County Diabetes Education Support Group meets the second Wednesday of each month at 1:00 pm at the Panhandle Health Building Meeting Room in Bonners Ferry. Call Edna Eby RD, LD (208) 267-3141 ext 4235 for more information.

Behind the Scenes: Quality Care

Quality Healthcare Close to Home

By: Tari Yourzek, RN, BSN Chief Nursing Officer

Sitting in a meeting of my peers recently, I was struck by how much time we spend talking about quality and what it means in healthcare and specifically to Boundary Community Hospital. As a hospital we have chosen to be accredited by DNV-GL along with the other five hospitals in North Idaho. Within healthcare, DNV-GL helps hospitals achieve excellence by improving quality and patient safety through hospital accreditation, managing infection risk, management system certification and training. DNV-GL’s accreditation program is the only one to integrate the ISO 9001 Quality Management System with the Medicare Conditions of Participation (COP). By earning accreditation, Boundary Community Hospital has demonstrated it meets or exceeds patient safety standards (COP) set forth by the U.S. Centers for Medicare and Medicaid Services. The DNV-GL program is consistent with our long-term commitment to quality and patient safety. The ability to integrate ISO 9001 quality standards with our clinical and financial processes is a major step forward.

DNV-GL’s accreditation program, called NIAHO® (National Integrated Accreditation of Healthcare Organizations), involves annual hospital surveys and encourages hospitals to openly share information across departments and to discover improvements in clinical workflows and safety protocols. A few months ago, it was our Extended Care Facility’s turn for the annual survey. The Survey Team was extremely thorough, checking through all of the records and talking with our staff. The results were a 100% deficiency free survey – very rare for a nursing home.

good-catcher-meme

This experience brought home the realization that we have an outstanding staff at Boundary Community Hospital. The entire staff, both medical and non-medical, is committed to quality patient care and caring about the people of Boundary County, continuously making a conscious effort to improve our services. Their attitude toward a culture of quality is reflected in their efforts to stay ahead of standards of care, setting an example for other small rural hospitals.

How do you define quality healthcare? It’s been my experience that quality healthcare can be defined as providing best practice care with the most up-to-date resources by empathetic
and caring staff. That’s what we have and why Boundary Community Hospital has been recognized by the American Hospital Association as a high performing hospital for clinical quality.

Quality healthcare, close to home. It’s important.

Boundary Community Hospital salutes our staff for providing quality patient care and for their excellent service, attention to detail, thoroughness, and the compassionate care that they provide to the community.

Break the Chain of Infection

By: Connie Sue Clum, RN, MSN
Infection Prevention Nurse
Boundary Community Hospital

With the seasons changing, it is an excellent time to remind everyone that each of you play an important role in infection prevention.  Despite the variety of viruses and bacteria, germs spread from person to person through a common series of events.  Therefore, to prevent germs from infecting more people, we must break the chain of infection.

No matter the germ, there are six points at which the chain can be broken and a germ can be stopped from infecting another person.  The six links include:

  • The infectious agent is the pathogen (germ) that causes the disease.
  • The reservoir is the place in the environment where the pathogen lives. This includes people, animals and insects, medical equipment, your countertop or any object in your home, soil and water.
  • The portal of exit is the way the infectious agent leaves the reservoir. This could be through open wounds, aerosols, and the splatter of body fluids including coughing, sneezing, and saliva.
  • The means of transmission is the way the infectious agent can be passed on. This could be through direct contact like touching, ingestion into the stomach, or inhalation into the nasal cavity or lungs.
  • The portal of entry is the way the infectious agent can enter a new host. In contrast to the means of transmission (which is the movement of the germ from the object to you or another person), the portal of entry is the actual entering of the body.  This can be through broken skin, the respiratory tract (nose or lungs), mucous membranes (including the urine), and catheters and tubes.
  • Lastly, the susceptible host can be any person. The most vulnerable are those receiving healthcare, are immunocompromised, or have invasive medical devices including lines, devices, and airways.

Imagine all of these links in a circle.  A germ can travel around this circle very quickly.  The way to stop germs from spreading is by interrupting this chain (or circle) at any spot.  There are many ways to do this.

bch-chain-of-infection-graphicHere are some common sense tips to interrupt the chain and reduce your chances of spreading germs:

  • The most important is cleaning your hands You can use hand sanitizer but the best way to clean your hands is soap and water.
  • Getting your flu shot If you are over 65, you can get the Prevnar 13 (recommended to get first) or the Pneumovax vaccines to help prevent pneumonia.
  • Covering coughs and sneezes and staying home when sick are other important ways of stopping the spread of germs. Did you know coughing or sneezing into your elbow or shoulder is one of the best ways to cover your cough?
  • At home, cleaning and disinfecting high touch surfaces is important. High touch surfaces are items like countertops, sink and toilet seat handles, computer keyboards or any other surfaces that you touch frequently with your hands.

Be honest: Have you ever used your scarf or gloves to wipe your nose or cover a sneeze/cough when a tissue wasn’t available? Oh, my! And then with your runny nose-contaminated glove, you touch a steering wheel, doorknob, or seat—all the time spreading the germs to others. Remember to wash your gloves and scarves on a regular basis, preferably once per week or when soiled. Most germs will survive for two or three days on inanimate objects—some longer. They don’t have to look soiled or smell bad to be loaded with germs either!

Stopping the spread of germs is key to staying healthy.  Interrupting the chain at some point on the link, will keep you healthier this year.  Now you are an Infection Preventionist too!

Is Doing Chores Your Workout?

By: Petra Timmermans, PT
Boundary Community Hospital Rehabilitation Services Manager

apples-pictureFall is a busy season for Boundary County residents preparing for winter. Lots of snow is predicted and time is ticking – we need to get things in order! The physical therapists in the Rehabilitation Department at Boundary Community Hospital routinely treat injuries that are related to activities around the house this time of year:

  • Cutting, splitting and stacking wood: People can easily hurt their backs; wood is heavy and is usually on the ground. Avoid twisting when lifting and stacking wood – turn with a straight body using your legs. Use a good chopping technique to avoid back or shoulder injuries and consider alternatives – rolling, tipping wood on its high side and ….. be careful with chainsaws.
  • Pulling up the garden: weed/plant pulling is hard on your back and knees. Divide this chore over several days. Sit on your knees or use a chair for some of the pulling.
  • Outside painting: Limit overhead painting to avoid neck and shoulder strain: adjust the ladder, use a scaffold and try to paint at eye level or lower.
  • Picking and gathering fruit: Over-reaching when picking fruit can hurt your shoulder or back. Move your ladder often, making sure it has stable footing before you climb, and always have the ladder or a branch to hold on to. Never stand on the top step.
  • Cleaning gutters: To avoid losing your balance and grabbing for the gutter or falling off the ladder, use a tall, stable ladder that doesn’t need to be moved often to reach the gutter.
  • Raking leaves: To prevent back and buttock strain from twisting and rotating repetitively in the same direction, switch sides and use the rake in the other hand. Better yet, use a leave blower.
  • Pruning: Pruning overhead with force puts the rotator cuff muscles in the shoulder at high risk for injury. Use a good quality pruner that can telescope. Hand pruners/clippers strain wrists and hands. Take breaks to stretch your wrists and fingers.

Many injuries can be prevented with preparation and attention. Here are some additional tips:

  • Take some deep breaths before beginning to oxygenate the blood and help focus on the task.
  • Stretch. Stretching out your muscles and doing a quick warm-up will loosen up muscles in preparation for your chores.
  • Be prepared: have your tools close by and at the right height, have stable footing and/or a steady ladder; be positioned so you aren’t reaching too high or too low.
  • Remember to lift with your legs not your back.
  • Carry items close to your body at waist height.
  • Don’t twist while lifting or carrying, turn your whole body by moving your feet.
  • Don’t overload your arms, shovel, wheelbarrow or whatever you carry. It may take more trips but your back with thank you.
  • Rotate activities. Rake leaves for a while, carry wood for a while, etc.
  • Use the right tools for the right job: don’t prune big branches with a small clipper, or small branches with a heavy pruner.
  • Don’t throw or swing anything heavy: logs, hay.

Pain-free movement is crucial to your quality of daily life, ability to earn a living, the pursuit of leisure activities, and much more; so please be careful when you begin your winter chores.
Physical Therapists can improve mobility and motion as well as long term pain management. Talk with your physician about all the ways a physical therapist can help.

TSE Childhood Injury Prevention Month

September – National Childhood Injury Prevention Month

 

By – Stu Willis, MD & Gina Gallette, RN

Boundary Community Hospital Emergency Department

 

Your three-year-old child falls from the ladder as he mimics his dad changing a light bulb a few minutes ago…he’s unconscious and has a softball-size swelling on his forehead!  Your six-year-old daughter slips and slices into her tummy while “playing mommy” cutting a zucchini…there’s a lot of blood and she’s barely breathing! What panic just the thought of these cause parents. What fret for friends and relatives. And then, “Where did I put the cell so I can call 9-1-1?”

According to the Centers for Disease Control and Prevention, 10 million children visit U.S. emergency departments each year due to an injury – that’s one visit for every six children…and tragically, over 10,000 are fatal. Injury is the leading cause of death and disability for U.S. children.

In the past 11 months, the Emergency Department of Boundary Community Hospital treated 287 persons under the age of 18 for injuries. Over 130 were fractures, dislocations, and sprains. Over 60 were injuries to the head and neck, more than 50 were deep cuts, along with a scattering of burns, bites, stings, and a few potential poison ingestions.  The majority of these injuries were related to motor vehicle accidents, organized sports, or playground-type activities.

In 2012 the Center for Disease Control (CDC) launched the National Action Plan (NAP) for Child Injury Prevention. The goals of this NAP are first to raise awareness of childhood injuries; second, highlight preventive solutions; and finally, implement those solutions to decrease childhood injuries through community education and training.

Looking back over the last few decades, various child safety initiatives have made a difference…“child-proofing the home,” use of child safety seats and bike helmets, concussion guidelines for sports injuries, installing smoke alarms and pool fencing, to name a few.  While childhood injuries have decreased, the NAP goal is for continuous improvement.

The staff of Boundary Community Hospital is dedicated to providing more than just treatment of injuries – we play an active and key role in community education in injury prevention.

 A Few “Be Safe” Reminders:

  • Motor vehicles: Inside of vehicles, use appropriately sized and fitted restraints and safety seats; watch for distracted drivers; and set an example – no texting or using the cell phone while driving. Outside of vehicles, teach and model safe pedestrian habits.
  • Water safety: Use life jackets…they float, you don’t. Also, install and maintain safety fencing around pools
  • Poisoning: Keep all medications and cleaning products secured and out of the reach of children. Also, post the Poison Control Center phone number, 1-800-222-1222
  • Fire safety: Prevent burns with safe cooking practices and review basic fire safety with your children. Also, use smoke alarms and carbon monoxide detectors, and review safe exits from your home in the event of a fire
  • Falls and sports: Always wear the proper helmet for the activity. Also, be aware of safety factors and potential hazards in your child’s play area

And parents, keep in mind your children are much more likely to follow safety measures if you model them. As the old saying goes, “More is caught than taught” – your example is powerful.

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