Accidents Will Happen
By: Regina Gallette, RN
Emergency Department Manager
Boundary Community Hospital

September 2020 – Whether it is the terrible sound of a vehicle crash, the bloody injury of a chain saw accident, or the ominous sound of someone falling down the stairs, serious injuries cause fear and anxiety on many fronts. The Emergency Medical Team in Boundary County, which includes Boundary Community Hospital (bch), Boundary Ambulance and Life Flight Network, work together to move patients quickly to where they can receive the treatment they need, improve communications among those caring for patients in a traumatic situation, and ultimately decrease patient deaths and improve patient recovery. This unified coordination of care has resulted in the team’s renewal of their designation as an Idaho Time Sensitive Emergency (TSE) Level IV Trauma Center in 2020.

Worldwide there are 11 deaths every minute due to trauma – that’s 5.8 million fatalities a year, and over 1 million are the result of motor vehicle crashes. Wearing seatbelts, using helmets, not driving while under the influence of intoxicants, and not driving while distracted (texting, phone calls, etc.) 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.

In 2019, 70 TSE Trauma cases were handled through the BCH Emergency Department. Five seriously injured patients were treated and transported directly from BCH and four TSE Trauma patients were flown directly from the scene by a Life Flight Network medical transport helicopter. All of these cases have one thing in common: a team of dedicated individuals from various agencies working together to get their patients to the highest level of care as quickly as possible.

Hand in hand with the Idaho TSE designation system, BCH’s Process Improvement and Patient Safety (PIPS) Committee works to continuously improve patient outcomes. First, by carefully reviewing all TSE situations in the facility. Then by identifying areas that can be improved, whether it is an issue of equipment or a process that can be structured better, with the goal to ultimately improve the outcomes of each patient and improve the care provided to our community.

What can you do to help when an accident happens?
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. Control ongoing bleeding with direct pressure.

According to BCH Emergency Physician and Boundary Ambulance Service Medical 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 Network transporting a patient to a higher level of care facility such as a major trauma center.”

Boundary Community Hospital is proud to be an Idaho Time Sensitive Emergency Level IV Trauma Center since 2017. Our team will continue to strive to provide excellent care for our community. Together, we can save lives.

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The Time to Act is Now

By: Alana Temple, RN, BSN
Boundary Community Hospital

Heart disease is the leading cause of death for both men and women. Every year about 735,000 Americans have a heart attack. Boundary Community Hospital has made various efforts to improve cardiac care and outcomes for those presenting with heart-related problems.

Life Flight Network, Boundary Community Hospital and Boundary Ambulance work together in a Time Sensitive Emergency to get patients to the highest level of care as fast as possible.

On July 10, 2019, Boundary Community Hospital received designation from the Idaho Time Sensitive Emergency Registry as a Level II STEMI facility. This means that anyone seeking treatment due to cardiac issues from either Boundary Community Hospital (BCH) or Boundary Ambulance can expect to receive the best of care as defined by the Idaho State Registry guidelines. Two years of cardiac patient data were reviewed by state surveyors to ensure compliance with the designation.

When patients present to the hospital with chest pain, they must be quickly triaged. This begins with our Health Unit Coordinator, who is usually the first person on the hospital team that you will meet. When you state that you are having chest pain, they will quickly alert the Registered Nurse in the Emergency Department, and you will be taken into a room. Once your care begins, the guideline timer begins. Ultimately within the first 10 minutes of arrival into the treatment room, an EKG will be performed. This is the first diagnostic tool that is used for cardiac care. Blood will be drawn for laboratory testing, you will be placed on a cardiac monitor, and vital signs taken. You may be given baby aspirin to quickly chew.

A STEMI (ST elevation myocardial infarction) is the most life threatening cardiac event that can happen and quick intervention is the key. A STEMI is a very serious type of heart attack where a major artery to the heart has been blocked and it is detected on an EKG. Time is of the essence as oxygen and nutrient rich blood to the heart muscle is not able to circulate properly and causes damage. Once a STEMI is recognized, the goal of the TSE team is to have you on your way to a cardiac catheterization lab (the closest facility is Kootenai Health) within 90 minutes of the diagnosis. Cardiac catheterization may have the ability to re-open the blocked cardiac artery. In the course of the state survey, Boundary Community Hospital’s Emergency Team was found to meet and/or exceed all of these parameters.

Quick intervention is vital in any type of cardiac emergency. It is extremely important that care is initiated as soon as possible. Call 911, which will dispatch Boundary Ambulance with their life saving equipment and highly trained Paramedics. In addition, all Boundary County Sheriff’s Department patrol vehicles have been equipped with Automated External Defibrillators (AED). When a 911 chest pain is dispatched, the Hospital TSE Emergency Team is alerted so they can begin preparation.

Boundary Community Hospital is proud to have received the Idaho Time Sensitive Emergency Level II STEMI Center designation and will continue to strive to provide excellent care for our community. Together, we can save lives.

Hot Weather Safety

By Sunshine Bartlett, RN
Boundary Community Hospital Emergency Department

Summer is in full swing here in Boundary County. The temperature has been soaring. Heat-related emergencies are more common this time of year. Knowing how to prevent, spot, and treat these serious conditions is vital.

People at highest risk include those working or exercising outdoors. Also at risk are the very young, the very old, people who are drinking alcohol, and people with certain medical problems. Pets and animals are not immune to heat and can have similar heat-related reactions.

Around 1,500 people in the U.S. die each year from a heat-related condition. Prevention is key. Properly hydrate with water or diluted sports drinks. Dark urine or a decreased urination is a sign you may not be drinking enough. Take breaks in the shade. If possible, wait to do strenuous activities until a cooler part of the day. Never leave children or pets unattended in a car. Leave your pets where there is adequate water and shade. Fill the birdbath for our winged friends.

There are three main types of heat-related illness; heat cramps, heat exhaustion, and heat stroke.

Heat cramps are painful muscle spasms of the legs, arms, or abdomen. If these occur, stop activity and rest in a cool, shaded area. Drink water or other cool beverages. Gently massage or stretch the affected muscles. Seek medical help if these measures do not relieve your symptoms.

Heat exhaustion occurs if early signs of heat-related illness are not treated. Signs of this include sweating, headache, dizziness, nausea, weakness, and a rapid heartbeat. These signs are more serious and should not be ignored. Stop activity. Sit or lie down in a cool area. Drink cool water or other liquids. Sponge yourself with water. If symptoms do not improve seek medical assistance.

Heat stroke is the most serious of these emergencies. Symptoms of this can include confusion, fainting, or even seizures. The person’s skin is hot and may be moist or dry. The person will have an excessively high body temperature. If you find someone you suspect may be having a heat stroke, call 911. Remain with the person. Sponge them with cool water. Fan the person’s skin. Apply cold packs to armpits, wrists, and groin if available. Loosen any tight clothing. If they experience a seizure, protect them from harm but do not force anything into their mouth.

If you believe an animal may be experiencing a heat-related emergency, similar cooling measures will also help them. Move the animal to a cool, shaded area if possible. Offer water if they are conscious. Wet them with cool water. Do not submerge the animal in ice water. Seek veterinary help.

Boundary Community Hospital and the Idaho Time Sensitive Emergencies program are committed to aiding in the prevention and timely treatment of these and other emergencies. Stay cool out there!

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August 2017

By: Sunshine Bartlett, RN
Boundary Community Hospital Emergency Department

The man sitting beside you in church slumps forward. When you speak with him his words are slurred. He seems unable to lift one of his arms.

You are at a family dinner. Your aunt mentions to you she has been having chest pain for the last 30 minutes. She doesn’t want to cause a fuss. She wants to know what you think she should do.

You are driving down the road. You come upon a truck which ran off the road and struck a tree.

What do these three situations have in common?

They are all considered Time Sensitive Emergencies.

Time sensitive emergencies are medical conditions where rapid treatment can make a big difference in the eventual outcome for a person.

The state of Idaho has recognized Stroke, Heart Attack and Trauma as circumstances where timely care can prevent and lessen disability and even death. Many of the Emergency Medical Systems (EMS) and hospitals throughout the state are adopting new systems to reduce delays for these people. These measures include calling ahead an alert to make these patients a priority, developing protocols to assure the highest level of care and expediting transfers to the most appropriate facility.

You are the most crucial piece in the chain. Without people in the community alerting medical personnel the process cannot begin.

What can you do if you recognize the signs of these critical situations?

Stroke:

Slurring of speech, facial droop and/or weakness on one side of the body.

Heart attack:

Chest pain or pressure which can move into the neck or arm, sweating, nausea and/or pale skin.

Trauma:

Any concerning trauma or injury.

First, remain calm and Call 911.  EMS in Boundary County have been trained to respond and treat these emergencies. They will notify the Hospital of the type of emergency so other preparations can be made.

Next, stay with the person. Dispatch may have questions for you which can help EMS locate and treat the person who is sick or injured.

In each of these cases, the quicker the person can get to medical care, the better the chance they will go on to lead a healthy and productive life. Your ability to recognize these critical situations and act may really make a difference in someone’s life.

Boundary Community Hospital in Boundary County and Bonner General Health in Bonner County have been designated as Level IV Trauma Centers by the State of Idaho for Time Sensitive Emergencies.

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**** BREAKING NEWS ****

Hospital Designated Level IV Trauma Center

February 17, 2017

Bonners Ferry, ID – Boundary Community Hospital has been designated as a Level IV Trauma Center by the State of Idaho.  The designation for the Hospital is part of the Idaho Time Sensitive Emergency System (TSE) and is reserved for Hospitals that meet the stringent criteria established by the State as part of the statewide TSE system of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack.  Emergency Department Director, Dr. Stu Willis with Gina Gallette, RN have been spearheading the effort at Boundary Community Hospital.

According to Emergency Department Director, Stu Willis, MD, “As a rural community, we have an obligation to provide services that improve survivability. It is important for our Emergency Department staff to work together with local EMS at Boundary Ambulance and Life Flight Network in an organized process to be sure patients are treated or when required, transported to another Hospital for the appropriate level of care. In addition, prevention education is a key component of this, especially in regards to injuries and major trauma.”

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.  In 2012, 49.1% of preventable deaths in Idahoans under age 75 were the result of trauma, stroke, or heart attack. The TSE initiative is putting processes in place so the RIGHT PATIENT gets the RIGHT CARE at the RIGHT TIME, helping to ensure an optimal outcome, especially when TIME is critical.

The hospital is investing in the community through the fully-staffed Emergency Department with physicians and nurses experienced in emergency medicine, and certified in advanced trauma, cardiac, and pediatric care.  The Clinical Medical Laboratory and Diagnostic Imaging technologists are also available 24/7 so that tests can be performed when time is critical for patient treatment in a Time Sensitive Emergency.