closer to the dream

GETTING TRAUMA CARE TO THE RURAL HEARTLAND

CLOSER TO THE DREAM By Amy Carpenter Aquino, ENA Connection

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NDIANAPOLIS — ‘‘Injury is the No.  1 killer of Hoosiers under age 45,’’ said Art Logsdon, JD, assistant commissioner of health and human services for the Indiana State Department of Health. Speaking to rural health care providers at the Aug. 8 plenary session, ‘‘A Statewide Trauma System: What It Would Mean for Indiana,’’ Logsdon shared that the development of a statewide trauma system would address the problem of timely treatment of traumatic injuries in a state where 36 percent of the hospitals are located in rural areas and 16 counties do not have Meredith Addison, MSN, RN, CEN, FAEN, speaks with fellow panelist Timothy Pohlman, MD, a hospital. before their session Aug. 8 at the Indiana Rural Health Association Annual Conference. ENA member Meredith Addison, MSN, RN, CEN, FAEN, had long interstate highway miles per land area adopted by the state EMS Commission envisioned a panel session on the — to join the 44 U.S. states that have in 2012, which says that emergency development of a statewide trauma statewide trauma systems. In 2010, medical service providers must transport system. That session became a reality Addison was named to the Indiana State the most seriously injured patients to a with the combined efforts of the Trauma Care committee by then-Gov. trauma center unless one is more than Indiana Rural Health Association and Mitch Daniels. Gov. Michael R. Pence 45 minutes away or the delay in care the ISDH, which coordinated the continued the committee in 2013, citing would endanger the life of the patient. session at the IRHA Annual Conference the fact that ‘‘more than 86,000 Hoosiers If these conditions exist, the patient is to in Indianapolis. In addition to Logsdon, are hospitalized each year due to be transported to the nearest hospital. panelists included Addison; Kayur Patel, traumatic injuries.’’ Addison is one of Despite the challenges of providing MD, MRO, FACP, FACPE, FACEP, two nurses on the state committee. trauma care in rural areas, ‘‘our secret medical director at Health Care Excel; ‘‘When we go to the Trauma Care weapon is our nine trauma centers,’’ Timothy Pohlman, MD, professor of committee meetings, we’re already Logsdon said. ‘‘When seriously injured surgery at Indiana University Healthtalking to the choir,’’ Addison said, people are taken to trauma centers, the Methodist; and facilitator Spencer ‘‘whereas at the Indiana Rural Health death rate drops.’’ Grover, MHA, FACHE, of the Indiana Association conference, we’re talking to The problem is that Indiana’s trauma Hospital Association. all 35 critical access hospitals and, in system is years, if not decades, behind Addison has been striving toward this case, an audience of 600 people, other states. Ohio, for example, has 40 the creation of a statewide trauma some of whom may be CEOs who can trauma centers, Logsdon said. system for more than 10 years. An ED bring this information back to their ‘‘Ohio has a bigger population, but it staff nurse at Terre Haute Regional departments.’’ illustrates how far other states are ahead Hospital in Terre Haute, Ind., she has Progress toward a statewide trauma of us,’’ he said. system has been made, Logsdon said, Indiana has the components for a long championed the need for Indiana citing the Triage and Transport rule statewide system, Logsdon added, — which ranks first in the nation for

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October 2013

EMINENCE Project Inspired By Fellow’s Passion When it came time for Academy of Emergency Nursing fellow Meredith Addison, MSN, RN, CEN, FAEN, to take on an EMINENCE project, the direction was clear. She told her mentor, fellow Thelma Kuska, BSN, RN, CEN, FAEN, that she wanted to focus on trauma system development. Kuska was an enthusiastic supporter, driving from Chicago to Indianapolis to hear Addison present as part of a panel session on the topic. The EMINENCE program is designed to facilitate mentoring relationships between a limited number of current ENA members and AEN fellows. During a From left: Yonna Heath, BSN, RN, CEN, president of the Indiana ENA State Council, structured mentorship of up to Larry Addison, RN, treasurer of the Indiana ENA State Council, Meredith Addison and one year (beginning at Annual Thelma Kuska at the Indiana Rural Health Association Annual Conference in Conference and concluding the Indianapolis, where Meredith Addison spoke as part of her AEN EMINENCE project. following Sept.  30), ENA • Injury prevention (SBIRT procedure) members looking for professional • Professional presentations growth opportunities are matched with fellows who have • Program development similar interests and appropriate experiences. Typical • Research projects include, but are not limited to, the following areas: • Writing for publication • Advanced practice role development For more information about the EMINENCE program, • Educational conference planning e-mail [email protected]. • Grant writing Amy Carpenter Aquino • Health policy including emergency medical services, its trauma centers, a trauma registry and rehabilitative services. The key is to add more trauma centers where they are needed most, shortening the distance between rural residents and the nearest available trauma center to a 45-minute ambulance ride, shortening the transport time. Only 58 percent of the population lives within 45-minute access. Treating the other 42 percent of the population is where Addison steps in. ‘‘Which doors are open 24/7?’’ she said. ‘‘It’s the ERs.’’ ‘‘Lives are actually saved at our local

facility on a day-to-day basis,’’ said Patel, who worked in Terre Haute with Addison. ‘‘How to get the patients to the hands of a trauma surgeon is the key question, along with what resources are we giving to nurses and physicians in local ERs.’’ Hospitals that inappropriately transport patients to other facilities run the risk of EMTALA violations, so they need to ensure they can care for traumatic-injury patients. For emergency nurses in Addison’s 14-bed ED, ENA’s Trauma Nursing Core Course and Emergency Nursing

Official Magazine of the Emergency Nurses Association

Pediatric Course are crucial resources. ‘‘TNCC and ENPC are the courses that we have taken statewide for the last 15 years to give nurses who are caring for their own communities,’’ she said after the conference. ‘‘It doesn’t matter if you’re military or civilian — it’s basic, standardized care for how to do a treatment and assessment on a trauma patient. It’s still not mandatory in our state, but we will go anywhere and provide the courses to anyone who asks.’’

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Indiana Statewide Trauma

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problems in all of surgery. I think it’s

she asked the IRHA session attendees.

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unconscionable that people suffer

‘‘Then it’s real important to have a

serious injury just because they choose

statewide trauma system.

Pohlman spoke to the urgency of having trauma centers within reach of critically injured patients, using a ‘‘rural triangle of death’’ slide to illustrate how far many Indiana residents live from a trauma center. ‘‘If you’re that distance away from a trauma center, you are in a world of hurt,’’ he said. ‘‘The idea of a trauma system solves one problem: disproportionate death in rural counties.’’ Later, Pohlman clarified a point made by another panelist. ‘‘There is no such thing as a ‘golden hour,’ ’’ he said. ‘‘The clock starts ticking at the time of injury. The faster you get the patient stabilized, the better the care. Trauma systems are not for the inner city — they’re for you here in rural Indiana. The American College of Surgeons recognizes why it is a problem. I’ve come here today because I think this is one of the most serious

to live in a rural area.’’ Grover shared the story of how his

‘‘The dots are out there. We just need to connect them.”

mother drove his brother — honking her horn the entire way — to the hospital after he lost his leg in a grain elevator accident.

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‘‘We need to create a better system for all of Indiana,’’ he said. He questioned whether teletrauma medicine could benefit rural residents. ‘‘For him to speak up and talk about his personal experience with trauma, that ties right in with what I’ve been saying all along,’’ Addison said later. ‘‘You’ve got to make it personal. Trauma is personal — it’s not about the bricks and mortars, it’s about blood and guts, it’s about your family and your loved ones. And once you get it to that level, there’s no argument that we’re going to do this.’’ ‘‘What if it’s your 2-year-old who

2014 ENA Election Candidates Coming this fall, watch for ENA’s call for candidates seeking election in 2014 to serve on the ENA Board of Directors and on the Nominations Committee. Application information will be available at www.ena.org. If you have questions, please contact Executive Services at 800-900-9659, ext. 4095, or e-mail [email protected].

falls off a quarter horse onto bedrock?’’

October 2013