Organization Newsletter

July 2013

In this issue...

  1. President's Message
  2. University of Washington Medical Students Participate in Rural and Underserved Opportunities Program (RUOP) in Washington State
  3. Healthcare Hiring Off The Beaten Path: Insights and Strategies for Recruiting Executives in Small and Rural Hospitals
  4. Rural Anesthesia Provider Network
  5. Community Health Worker Training Available
  6. Lake Chelan Community Hospital Emergency Medical Services (EMS), with other Chelan and South Douglas County EMS Teams, Top State in CPR Saves
  7.  Northwest MedStar New Helicopter in the Air
  8. Stroke Survivor Improves with Help from St. Luke's Rehabilitation Institute
  9. Washington State Public Health Association Training Events and Resources
  10. Exceptional Skills and Fast Thinking Save a Young Woman's Life
  11. Two of Life Flight Network's New AW119Kx "Koala" Helicopters: Already Serving Washington State Communities
  12. Cambia Health Foundation Awards Grant to Intergrate Primary Care and Behavioral Health Services in Rural Washington
  13. Urgent Pediatric Fracture Clinic

Welcome

The Washington Rural Health Association e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.
WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.


President's Message

submitted by: John Hanson, WRHA President

[email protected]

I just returned from a regional meeting of the National Organization of State Offices of Rural Health. The meeting was held in Denver, CO. These regional meetings are a great way for each State Office of Rural Health to share ideas of what works and what doesn’t as we continually try to protect and enhance the quality of health care available to our rural residents. Our region is Region E and is comprised of the states: Alaska, Washington, Oregon, Idaho, Utah, Wyoming, Colorado, Montana, North Dakota and South Dakota.The meeting contained ample opportunity to share ideas and listen to national and local experts talk about the coming changes in health care under the Affordable Care Act and how to prepare for them. Two of the most important pieces of the Act that we know will impact Washington are the expansion of Medicaid and the implementation of the Health Benefits Exchange.The expansion of Medicaid is important because now there are so many people who don’t qualify for Medicaid. What typically happens for these people is that if they have an illness, or non-serious injury, they will tend to not seek medical help until their condition escalates and becomes more serious. Then they will seek help from their local hospital’s emergency room. They will get treatment there, but there are two problems with this. The first, is that these patients have no way to pay for their care so the hospital writes off the cost. This creates an enormous pressure on rural hospitals because they typically write off millions of dollars per year and many are already struggling financially. Second, by the time the patient seeks medical care their condition is much worse then it would have been had they had the resources to visit their doctor. This may lead to serious complications that could have been avoided if they had been covered by Medicaid. When the expansion begins on January 1, 2014 we should see its positive effects on both health and finances fairly quickly. For more detailed information please see the Health Care Authority’s web site (www.hca.wa.gov).The other important development is the Health Benefits Exchange, which will provide those who do not qualify for Medicaid and do not have health insurance with a way to find a plan that fits them and their wallets. The state is working hard to engage insurance plans to participate and is contracting with organization to train people to help navigate those looking for health coverage through the often hard to understand medical insurance options. More information on this program is available on the Washington Healthplanfinder web site (www.wahealthplanfinder.org).

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University of Washington Medical Students Participate in Rural and Underserved Opportunities Program (RUOP) in Washington State



Image: Medical Student, Kelli Geiger with her preceptor, Dr. Troy Witherrite, White Salmon, WA

submitted by: Toby Keys
[email protected]

This summer 120 University of Washington medical students elected to participate in the Rural and Underserved Opportunities Program (RUOP). The purpose of the program is to provide students with an early exposure to the challenges and rewards of practicing primary care medicine in a rural or urban underserved setting.

With the help of the Eastern and Western Washington Area Health Education Centers, the RUOP program placed 44 students with primary care physicians in Washington State. Western Washington Area Health Education Center (WWAHEC) Director, Jodi Perlmutter notes, “WWHEC has been an integral partner in the RUOP program since its onset over 24 years ago. WWAHEC Staff recruit exemplary western Washington physician preceptors in rural and underserved areas, match the students to the community and locate the housing. There are now many practicing physicians in rural areas that were RUOP students and they now host a new generation of students! The rural communities are so generous in the support of this program, they house and include students in community events.”

RUOP has traditionally been one of the highest rated programs in the medical school. Medical student Kelli Geiger enthusiastically describes her recent rotation: “My RUOP experience in White Salmon, WA gave me glimpse into the day-to-day life of rural family medicine doctors. It was amazing and inspiring to see the depth of relationship that the physicians had with not only their patients, but their patients’ families. I loved talking to patients and hearing about how much they valued the kind of relationship they had with their doctor. There was something really beautiful about the trust and communication that had been developed over so many years.” Kelli goes on to say, “It was also surprising to see how frequently I saw patients around town–at the library, the grocery store, or just walking down the street! There certainly isn’t any anonymity like you find in an urban area, and I found myself feeling more a part of the community in just a month, than I have in many of the places I’ve lived.”

Ms. Geiger and 23 other RUOP students receive their stipend funding from the Washington Academy of Family Physicians. These essential contributions often make it possible for students to afford taking time over the summer to participate in the RUOP program.

In November, the RUOP program will host an annual poster session in Seattle, WA to showcase the 2013 student projects from around the region. Questions about the RUOP program or the upcoming poster session should be directed to RUOP Education Specialist, Toby Keys, [email protected]

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Healthcare Hiring Off the Beaten Path: Insights and Strategies for Recruiting Executives in Small and Rural Hospitals


submitted by: Jeff Souza, BSN
Chief Executive Officer, Leaders For Today

Marie Vienneau chuckles as she describes the setting of Maine’s Millinocket Regional Hospital, the 25-bed Critical Access facility over which she presides as CEO: “We’re a small town in a cold climate, 40 miles from the nearest Walmart. The North MaineWoods begins just north of us…we’re literally at the end of the road.”

For Vienneau, and thousands of other small and rural hospital CEOs, directors and board members like her across the country, isolation determines the way in which both hospital staff recruitment and retention are accomplished. And yet with 20% of the US population living in areas defined as rural by the 2000 US Census (now totaling over 60 million Americans), the need for effective staffing in out-of-the-way locations is as great as ever.

When it comes to recruitment in small and rural hospitals, and despite popular perceptions, the good news is that it’s not all bad news (not by a long shot). Many of the most successful small and rural hospitals, in fact, use their unique surroundings and remote locations to their advantage in bringing aboard qualified medical staff at all levels. One key, it seems, is in knowing how to leverage a small or rural hospital’s unique assets.

Play to Your Strengths, But Don’t Oversell

Stressing the benefits of life in a beautiful, natural setting, far from the congestion, crime and high cost of living more typical of urban areas, was a recommendation made by nearly all of the people interviewed for this article. Tana Casper, for example, Chief Nursing Officer of Grand Itasca Clinic & Hospital in Grand Rapids, Minnesota remarked, “Because of our location and the characteristics of the region, our appeal is the outdoors and an outdoor lifestyle. It’s an important part of any recruitment,” she says, “and we include a heavy emphasis on the region and what it has to offer in our recruiting materials, our Web site, and our discussions with potential hires.”

For those who appreciate rural life, the opportunity to enjoy fishing, camping, hiking and other outdoor activities year round, and just minutes from where they live and work, is a treat and a benefit to relocation. That said, successful candidate placement comes not from convincing people to relocate to small and rural areas, but rather from finding people who will be a good fit because of the interests they already have.

As Joseph Woodin, President and CEO of Gifford Medical Center in Randolph, Vermont, explains, “If somebody doesn’t want to be here, you can’t pay them enough to be here. An extra $50,000 to be in a place you don’t want to live doesn’t work.”

Instead, says Woodin, the key is to have frank conversations with candidates about what life is like, and to not overstate the benefits of small town living. Woodin’s discussions with candidates include providing information regarding distances to nearby cities, quality of schools, recreational activities, and of course, weather – all in an effort to put all the cards on the table. Woodin has these discussions early in the interview process and continues probing to find out why a candidate might want to live in rural Vermont. Drilling down with candidates regarding their interest in the region allows him to differentiate between the person who will fit in well and thrive in a rural setting, and the person who is simply attracted to a fictional fantasy of small town America.

Hire the Person First, the Skill Set Second

In many ways, of course, staff at small and rural hospitals face the same challenges as their counterparts at larger institutions. They perform surgery, take care of broken bones, deliver babies, etc. A critical difference between the two, however, is that the breadth of responsibility in a small or rural setting is typically much wider than its counterpart in an urban setting.

Says Woodin, “When you work in a rural location, you need to be much more of a jack-of-all-trades. There are not as many specialized functions, and an orthopedic surgeon, for example, may need to cover lots of modalities.” Woodin emphasizes the importance of screening for a willingness to perform a wide range of tasks and work as part of a close-knit team. “There’s no right or wrong,” he says, “but again, we want to make sure that people realize how we operate, and that we bring in people who will appreciate that.”

Vienneau of Millinocket Regional agrees, and suggests that in a small hospital, hiring for personal fit may be as important as professional skills. Skills can be taught, she explains, whereas the “chemistry” needed to integrate well with the existing staff is often more a matter of personal makeup and character. “We have primarily one culture and one personality and one community, and for you to be happy here you need to like it. In a large hospital, if you want a different culture, you switch departments.”

Hire Families, Not Just Individuals

When a new hire relocates, it’s often with a family in tow. Even if this person thrives in her new position, if her spouse and children are miserable, the match probably won’t last.

To manage this, many small and rural hospitals deliberately and extensively involve the spouse in the match-making process from the start. This can involve arranging meetings with real estate agents to help the family find the right house; with school officials to make sure the children are comfortable; and with others who will have an impact on the life of the family. In addition, if the spouse works outside of the home, many hospitals will take an active role in helping him or her find suitable employment.

Once on board, Grand Itasca’s Casper recommends taking it a step further by using a “welcome wagon” approach to make sure everyone gets happily settled in; a lesson she learned the hard way while with a previous hospital. “We lost a physician because his spouse was very unhappy” she says. “We just didn’t do as good a job as we could have in helping them make the transition as a family.”

Start Early and Work Your Relationships

Relationships are the backbone of any small community, and for many hospitals, this personal approach extends to the recruitment process. Working through her extensive local network, for example, lifelong local resident Vienneau will often attempt to recruit back into the area people who’ve moved away, sometimes even paying for their education as part of the arrangement.

Woodin does the same, in addition to taking a long range view by keeping tabs on which members of the community are attending medical school. “We start relationships and stay with them for years,” he says.

In addition, both Vinneau and Woodin work to continually stay visible, make connections in the community, and communicate with their respective staff members regarding available positions and hospital needs. Taken together, it all adds up to a strong, word-of-mouth recruiting effort, one which pays off handsomely over time.

Keep ‘Em If You’ve Got ‘Em

All the hospitals we spoke with boasted of “better than average retention,” an outcome that’s not surprising given the tight-knit communities so typical of small and rural locations. The hospitals that are most successful in maintaining the staffing levels they need, play this to their advantage.

Says Linda Minsinger, Chief Nursing Officer of Gifford Medical Center, “We know each other well and spend a lot of time together. The CEO makes rounds and we never want staff to feel that we’re not listening or that we’re mandating things they don’t want. We’re simple people – not a lot of politics, not a lot of ego, and all on
the same team.”

This is not to say that small and rural hospitals don’t bring in outside expertise when they need it – particularly for specialized skills and experiences that may not be found internally. Still, the benefits to the hospital staff and the patients they serve of seeing the same people year after year are great, and the most successful of these institutions work hard to keep turnover low.

Get Help When You Need It

In general, the use of external recruiters – for either permanent placements or interims – is seen as an important part of the mix. In a small institution, the loss of a key player can have a devastating impact, since there are typically fewer people available to back-fill (particularly for positions that require specialized or mission critical skills). As Woodin makes clear, “You could lose a key specialist and that could cost you millions of dollars in revenue until that position is filled.”

In particular, the use of interims is on the rise, as small and rural hospitals have slowly come to appreciate the benefits this tactic provides. One such benefit is that of “taking the pressure off,” while the search for an appropriate permanent candidate can be conducted. Without such a person in place, the temptation is great to simply fill the hole, a situation which can ultimately prove frustrating for all involved.

Interims also seem particularly well-suited to jumping into the cohesive team environment of most small institutions. As Casper observes, “They tend to be people who are go-getters. They hit the ground running and are usually very outgoing in nature.”

Furthermore, Casper recommends that when using interims, it’s important to set clear expectations with staff. “When I introduce them, I frame it as ‘we are not on hold; we’re moving ahead.’ I want it to be clear they are in charge – not just here to sign time cards and hand out checks.”

In Summary

Hiring in small and rural hospitals is clearly not for the faint of heart. Still, neither is it the impossible task it’s so often described to be. Honest communication, a commitment to the whole person and family, and patience go a long way towards staffing success.

As Tana Casper observes, “Transparency is ultimately the best thing you can do. Be clear about the job, the situation, the region, the town…all of those things from lifestyle to professional. Otherwise you’re just wasting everyone’s time and money.”

Many of the most successful small and rural hospitals, in fact, use their unique surroundings and remote locations to their advantage in bringing aboard qualified medical staff at all levels.

About Leaders For Today
Leaders For Today is a leader in healthcare interim & permanent executive management. The Company works with top hospitals and healthcare institutions across the country to find, place, and support healthcare executives and directors. These organizations hire interim & permanent executives from Leaders For Today to provide leadership during times of transition, help improve current operations, deliver superior expertise, and mentor junior staff.

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Rural Anesthesia Provider Network


submitted by: Rick Brown
[email protected]

Alright….how many of you anesthesia providers out there working in rural settings and critical access hospitals have been charged with developing a new department policy or updating an existing policy and said to yourself “Where do I start”? Or something like….”Surely someone out there in a similar position has had to tackle this very same issue”.

Unlike in larger hospitals and academic centers, nurse anesthetists and anesthesiologists practicing in rural settings are often called upon to provide care and services to patients in situations where resources are limited and collegial support and expertise may not be readily available. Practice isolation and stagnation can often occur despite our best efforts.

One constructive way to address these scenarios is the development of the opportunity to network and share useful information and knowledge with other anesthesia providers in similar rural settings. Such a network could be effective in helping each other with policy development and updates, dealing with communication issues with co-workers, understanding the impact of new regulations, reviewing equipment, and providing easily accessible answers and resources to common practice related problems. And…don’t forget the importance of sharing with others our success stories as well.

If you would be interested in forming a network specifically for anesthesia providers in rural settings in WA, let’s make it happen! Hospital administrators please pass this invitation along to your respective anesthesia personnel. Contact me with your ideas, interest and energy.

Rick Brown, CRNA
Willapa Harbor Hospital
Dept. of Anesthesia
800 Alder Street
South Bend, WA 98586
(360) 601-6991 – Cell
[email protected]

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Community Health Worker Training Available



submitted by: Donna Oliver
[email protected]

FREE Community Health Worker Training coming to your area soon!

Community Health Workers play a vital role in our health care system by linking people with health care services and sharing health knowledge that improves people’s ability to be self-reliant. The Department of Health is offering a free on-line Community Health Worker Training that is part of the Healthy Communities Washington initiative to increase access to quality preventative health care services. The Community Health Worker Training will strengthen current health worker skills, knowledge and abilities so our state is better prepared for success in this new health reform environment.

We are working with the department’s Breast, Cervical and Colon Health Program’s Prime Contractor System and the Tacoma Pierce County Health Department’s Community Transformation Project to facilitate quarterly trainings in seven regional areas around the state. Each area has a co-trainer trained in the curriculum. The co-trainer co-facilitates the in-person trainings and is the ‘face’ of the community health worker in their area. As the Community Health Worker representative in their region, they reach out to agencies and programs that have staff or volunteers who might benefit from attending the training.

The Community Health Worker Training is eight weeks long and uses a combination of 2 in-person training days wrapped around six weeks of online learning. Graduates receive a certificate of completion and are eligible to continue their education by enrolling in one-week online disease specific modules.

Since the Department of Health rolled out the Community Health Worker Training program in fall 2012, 239 Community Health Workers have completed the core competency course and twenty-six graduates have completed a one week disease specific module of their choice.

In an effort to increase participation from the hard to reach areas of our state, the next Community Health Worker Training locations are in rural areas including Sequim, Omak, and Prosser. For more information about the Community Health Worker training, visit our website at www.doh.wa.gov/chwts. Videos, contact information, flyers, regional map, and training schedule are available online.

If you have experience as a peer counselor, outreach worker, Promotora de Salud, patient navigator or just want to learn more about the role of the community health worker, register for this training today at http://hcwcommunityhealthworker.org/. Our goal is to train 500 Community Health Workers each year.

Contact: Debbie Spink @ 360-236-3717 or [email protected] 0, 31.3, 14.8

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Lake Chelan Community Hospital Emergency Medical Services (EMS), with other Chelan and South Douglas County EMS Teams, Top in State in CPR Saves



submitted by: Celeste Thomas
[email protected]

Lake Chelan Community Hospital’s (LCCH) EMS, with other Chelan and south Douglas county EMS teams, was recently recognized as first in Washington state for the highest percentage of cardiac saves in 2012, knocking King County from the top of the list.

This major accomplishment comes after LCCH paramedic and EMS operations manager Ray Eickmeyer brought a new high-performance CPR protocol back to the region after completing a resuscitation training in 2010. The new program was implemented county wide in 2011, and the percentage of cardiac saves increased significantly as a result. Eickmeyer is pictured second from the right in photo.

For EMS crews, high-performance CPR means a team approach that dictates tight coordination and communication. Using a “pit crew” approach, providers deliver excellent chest compressions with minimal interruptions.

For example, they gain critical seconds by continuing compressions while the AED is powering up. Compressions are stopped only to allow for the analysis and shock—no more than 3 seconds. Responders return to compressions immediately after the patient is shocked. Interventions such as intubating, placing an IV and administering drugs are also completed without interrupting chest compressions.

The LCCH EMS team is also an active partner in building a healthy community. As part of EMS week in May, they participated in a disaster drill involving more than 30 youth from the Chelan High School’s Medclub and taught children about ambulance and emergency medicine during a teddy bear clinic. In June, they offered a bike rodeo at Chelan’s elementary school and a SafeSitter two-day workshop, as well as their regular bi-monthly First aid, CPR and AED class. For more information, call 682-6120, visit lakechelanhospital.com or email [email protected]

Lake Chelan Community Hospital EMS has carried on the work of the Lake Chelan Valley Ambulance Association since 1987 by providing prompt, quality medical care and transportation. They are a community-supported public service that provides paramedic-level advanced life support to residents and visitors. Working in conjunction with the community’s fire departments, law enforcement, US Forest Service and the National Parks Service, LCCH EMS responds to over 1,000 requests for aid each year.

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Northwest MedStar New Helicopter In the Air



submitted by: Jerrie Heyamoto
[email protected]

Join Us at Our Hangar Celebrations!

Northwest MedStar Tri-Cities Base – 1909 Airport Way, Richland, WA
September 12, 4 – 6 p.m.

Northwest MedStar Palouse Base – Moscow/Pullman Airport
September 19, 4-7 p.m.

Northwest MedStar New Helicopter In the Air
Northwest MedStar, has enhanced its regional service, purchasing an additional helicopter and adding a weekend day base in north central Washington. These additions increase Northwest MedStar’s presence and provide greater access to communities in eastern Washington, northern Idaho, western Montana and northeastern Oregon.

“The purchase of an additional helicopter shows our commitment to the region and ongoing investment in the expert staff, operations and equipment,” said Nancy Vorhees, chief operating officer for Inland Northwest Health Services (INHS), the parent organization of Northwest MedStar. Northwest MedStar purchased a Eurocopter EC-135 helicopter that includes the next generation of avionics and enhanced situational awareness for pilots. It can be spotted by its updated paint design. It began operation in mid-June. Northwest MedStar now has five helicopters serving the region in addition to fixed wing and ground ambulances.

Beginning June 15, 2013, Northwest MedStar has had a helicopter weekend day base in the north central region of Washington, improving access and availability to critical care transport in the Okanogan, Chelan and Douglas counties during the busy summer months. During weekdays, the helicopter is being used at other bases throughout the service region.

“We are excited about the opportunities this new base brings to the communities, local hospitals and EMS personnel throughout north central Washington” said Eveline Bisson, program director for Northwest MedStar.

Northwest MedStar, a Commission on Accreditation of Medical Transport Systems (CAMTS) accredited critical care transport program. Named 2012 Program of the Year, Northwest MedStar provides high-quality care and transport to over 3,700 patients each year from its bases in Spokane, Tri-Cities, Moses Lake and Pullman, Washington. All flights are conducted by, and operational control over all aircraft is exercised solely by Metro Aviation, Inc.

For more information on Northwest MedStar visit: www.nwmedstar.org

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Stroke Survivor Improves with Help From St. Luke's Rehabilitation Institute



submitted by: Jerrie Heyamoto
[email protected]

Dick Hilton had the scare of a lifetime. What started as making a pot of coffee turned into Dick’s left leg shaking and falling to the floor pinning his right arm underneath his body. Dick had suffered a stroke.

Soon after the paramedics arrived they called Northwest MedStar to transport Dick to Providence Sacred Heart Medical Center in Spokane, WA. After his stay at Sacred Heart, Dick moved to St. Luke’s Rehabilitation Institute to begin his recovery.

When Dick arrived at St. Luke’s he couldn’t walk. After three weeks of intense inpatient physical and occupational therapy Dick’s prognosis was much better. He can now walk by himself without a cane.

Dick said it was the dedicated staff that helped him to get better. “You have to learn it all over again and they [the therapists] take you through that process… I didn’t think I could do it, but by golly I did.” Dick said.

While proud of his progress Dick does not sugar coat the experience. “It’s hard work. You don’t get anything accomplished unless you do hard work. You can’t just skip through it. If you do you won’t ever get better. They’re here to make you better. That is their primary job.”

Dick became close to the St. Luke’s staff who aided in his recovery, whom he now views as friends and plans on visiting in the future.

Dick lives on 40 acres of land with his wife, two dogs, and some horses. Dick is grateful to be able to return home and continue his recovery.

View Video Story: https://vimeo.com/69482008

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Washington State Public Health Association Training Events and Resources


submitted by: Betsy Skoda
[email protected]

As a professional organization for the broad public health community, Washington State Public Health Association (WSPHA) is dedicated to supporting the professional development and education of health professionals throughout the state. Our annual Joint Conference on Health offers a unique opportunity to learn and connect with health professionals from around the state who are dedicated to improving community health. This year’s conference, our 20th, will take place October 13-15 in Wenatchee. Featuring evidenced based best practice and practical skills workshops, the conference offers something for everyone. Highlights of this year’s event include 6 skills workshops and 48 break-out sessions on topics such as health care partnerships, assessment and quality improvement, health equity and local policy development. Visit our website (www.wspha.org) to view the program schedule. Looking for other training resources? Our website also features links to formal education programs and trainings in Washington and beyond.

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Exceptional Skills and Fast Thinking Save a Young Woman's Life



image: Survivor Andi Wilkins meets her Life Flight Network critical care team of Tom Cornatzer, Flight Nurse and Rick Taylor, Flight Medic.


submitted by: Erick Borland
[email protected]

article by: Lindsay Steele, Life Flight Network Customer Service Manager

It was a mostly sunny spring day in Boistfort, WA (Lewis County) when Andi Wilkins nearly lost her life in a tragic accident. While riding an ATV up a gravel logging road near her father’s property, she struck a braided steel cable strung across the road at 25 mph. The cable struck Andi directly across neck and knocked both her and her boyfriend off the quad.

Andi immediately knew something was wrong and told her boyfriend to call 9-1-1. He recognized the seriousness of the situation, later describing Andi’s voice as “scratchy” as she gasped for air. During the initial 9-1-1 call, Andi stopped breathing and death was imminent without intervention. Andi’s boyfriend received instructions from the dispatcher on how to perform CPR, just prior to losing cell reception. Hopefully help would come soon.

Andi’s father, John Wilkins, a career firefighter and EMT with SeaTac/Kent Fire, and a Battalion Chief for Lewis County Fire District #13, was running a drill for volunteers at the station and recognized his address when the call for help came through. Hearing CPR was in progress was disturbing. John arrived on scene and immediately recognized his daughter was gravely injured.

The incoming ambulance was in transit from Chehalis. Based upon dispatch information, the ambulance requested a helicopter from Life Flight Network’s Longview, WA base. Neither could arrive soon enough.

John recalls Andi being in respiratory arrest with a pulse. Her pupils were dilated and nonreactive, her color was cyanotic. John attempted to provide ventilations via bag-valve mask but quickly realized Andi had a significant tracheal injury. Subcutaneous air was filling her neck and chest. He knew she would likely not survive her injuries.

Shortly after the AMR ambulance arrived, an endotracheal (ET) tube was placed but the paramedics were unable to ventilate her. They quickly removed the ET tube and placed an emergency back-up King Airway while moving to the helicopter landing zone. Life Flight 7 from Longview arrived with the crew of Tom Cornatzer, Flight Nurse and Rick Taylor, Flight Medic as the ambulance was pulling up to the landing zone.

The flight crew and John agreed Andi should be transported to the nearest Level 2 Trauma Center, PeaceHealth Southwest Medical Center in Vancouver, WA. Once en route, with 25 minutes of flight left, Andi became progressively difficult to ventilate again. The flight nurse and paramedic noted a dramatic increase in subcutaneous air along with decreasing oxygen saturations. The flight team made the decision to divert to the closest available hospital for emergent airway management. PeaceHealth St. John Medical Center in Longview was less than five minutes away.

The trauma team at St. John Medical Center had little notice but did a superb job stabilizing Andi. They utilized a GlideScope to place a 6.0 endotracheal tube and immediately placed bilateral chest tubes. Just 32 minutes after arriving in Longview, Andi was once again en route to the Level 2 Trauma Center where Dr. Riyad Karmy-Jones and the trauma team were waiting.

Upon arrival in Vancouver, Andi went to the operating room for an exploratory laparotomy. She spent the next several days in the ICU before returning to the operating room for further exploration of her neck. Dr. Zwart found a complete trachea separation, typically a lethal injury. Only the endotracheal tube bridged her upper and lower airway. This airway injury was successfully repaired.

Andi recalls waking up 12 days later unable to comprehend how she had been minutes away from certain death. Many visits with a vocal cord specialist at the University of Washington to treat partially paralyzed vocal cords have followed, but she is progressing well. Andi has since returned to Kent with her boyfriend, where she hopes to find work as a phlebotomist.

In June, Andi and John were invited to the trauma breakfast at PeaceHealth Southwest Medical Center. They met those involved with saving Andi’s life. As her emotional story was shared, Dr. Karmy-Jones, Trauma Medical Director of PeaceHealth Southwest Medical Center, remarked, “Most patients with disruption of the airway die before they can get to a facility. In this case, a series of fortuitous events occurred. The primary responders and Life Flight Network crew maintained ventilation and then astutely diverted to PeaceHealth St. John. This was the first lifesaving step. The second was gaining control of the airway with an endotracheal tube at St. John, for which the ED team and anesthesiologist should get great credit.”

Andi thanked the many people who came together to give her a second chance. John was especially grateful to the emergency responders and flight crew for their on-scene professionalism, and for treating Andi as if she were their own daughter.

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Two of Life Flight Network's New AW119KX "Koala" Helicopters: Already Serving Washington State Communities



image: Life Flight Network’s new AW119Kx helicopters can transport a two-person critical care team and two patients with full-body access.

submitted and written by: Erick Borland, Life Flight Network Marketing Director
[email protected]

Life Flight Network’s (LFN) eagerly awaited new AgustaWestland 119Kx “Koala” medical helicopters are being placed into service at all of the company’s bases during the months of June and July. LFN’s bases in Sandpoint, ID and Pendleton, OR received early delivery of these exceptional aircraft. Dominic Pomponio, Regional Director for LFN states, “Our new AW119Kx helicopters are designed to ensure our critical care teams deliver the highest quality air transport for communities in Washington, Idaho and Oregon. They provide a spacious patient cabin with the finest suite of mobile critical care medical equipment available. The Koala helicopters offer the important benefit of transporting two critical care team members and two patients with full-body access.”

The acquisition of these state-of-the-art aircraft was initiated in February of 2012, when LFN signed an agreement with AgustaWestland to acquire 15 AW119Kx helicopters. Prior to deciding on the Koala, LFN conducted substantial research in order to ensure the new platform would meet and exceed the needs of LFN’s Pacific Northwest service area. A decision was made early in the process to incorporate the high-tech Garmin G1000H avionics package with synthetic vision and satellite weather reporting. These capabilities provide the pilot with greater situational awareness, which is so important with the changing terrain and weather conditions found within the Pacific Northwest and Intermountain West.

Highlights of LFN’s AW119Kx helicopters and critical care teams include:

  • Ability to transport a two-person critical care team and two patients with full-body access
  • Speeds up to 175 miles per hour for faster emergency transport
  • A state-of-the art Garmin G1000H avionics package with synthetic vision, enhancing safety and situational awareness
  • Night vision goggles, satellite weather and tracking, and Helicopter Terrain Avoidance Warning System (HTAWS)
  • Appareo video and data cockpit recording system
  • A fully-equipped emergency medical cabin, including a LTV 1200 ventilator, blood products, an IV infusion pump, Zoll Propaq MD cardiac monitor and a C-MAC PM video laryngoscope
  • Critical care Flight Nurses with a minimum of five years of ICU, ED, and Trauma experience and Flight Paramedics with a minimum of five years of experience
  • LFN’s highly-skilled critical care teams have the ability and resources to provide a multitude of advanced medical treatments during transport of pediatric and adult patients

A number of LFN’s bases throughout the Northwest are strategically positioned to provide communities in eastern and southern Washington with critical care transportation for seriously ill or injured patients. All of LFN’s 15 bases throughout Washington, Oregon, and Idaho are dispatched from the company’s Communications Center in Boise.

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Cambia Health Foundation Awards Grant to Integrate Primary Care and Behavioral Health Services in Rural Washington



submitted by: Jacqueline Barton

In January of 2013, the Cambia Health Foundation, the corporate foundation of Cambia Health Solutions, awarded a $98,000 grant to the Critical Access Hospital Network (CAHN) to coordinate the care of chronically ill patients with co-occurring mental health needs. Established in 2002, the CAHN is an integrated network of four hospitals and eight rural health clinics in Eastern Washington that collaborate to achieve significant administrative, operational and clinical efficiencies that would not otherwise be possible for the members acting individually. By developing solutions in unison, the members aim to improve the quality of patient care; improve the health of their rural population; and reduce the per capita costs of care.

The goal of the Cambia Foundation grant is to improve chronic disease outcomes and reduce the cost of care for high need patients through integrated care. Grant money will be used in Grant, Lincoln, Garfield, and Pend Oreille counties to bring mental health specialists into the primary care setting. This grant will facilitate partnerships between rural care providers to identify high utilizing patients via health information technology and deliver integrated and targeted chronic disease management and mental health interventions. Leveraging the CAHN regional infrastructure, the project’s goals are to : 1) deliver targeted, enhanced chronic disease management and behavioral health interventions 2) streamline access to patient and population level health information across provider settings, 3) facilitate partnerships among local primary care, mental health providers and patients and 4) evaluate the program’s impact and implementation process. These goals will further the triple aim by increasing access to comprehensive, preventative care for rural patients that will pay dividends in decreased emergency care utilization by the highest cost patients.

Implementation is already in process in Pend Oreille County. In response to community need, Pend Oreille County Counseling Services, with primary care clinics operated by the Pend Oreille County Public Hospital District, began co-locating primary care and behavioral health providers two years ago. This Cambia Foundation grant will allow Pend Oreille to build upon and expand its co-located services, and specifically focus on a subset of patients with the highest use of emergency services. This grant also provides an opportunity to share Pend Oreille’s experiences and lessons with neighboring communities, fostering a learning community amongst rural providers. When patients identified as high users come to the primary care clinic for a regularly scheduled appointment, the primary care provider discusses the availability of on-site behavioral health services with the patient and gives them the option of seeing a counselor immediately. Patients who elect to participate are then given individualized counseling services that compliment the chronic disease management strategies in the primary care setting. By having behavioral health services on-site, this grant increases access to vulnerable patients while simultaneously reducing the stigma faced by individuals seeking mental health care in small rural communities.

Implementation of this grant in all eight of the rural health clinics will continue through June 2014. For more information please contact Bonnie Burlingham, Washington State Hospital Association Rural Project Manager, [email protected]

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Urgent Pediatric Fracture Clinic


submitted by: Damon Pilgrim
[email protected]

Spokane, Washington (for immediate release) – Shriners Hospitals for Children® — Spokane introduced its Urgent Pediatric Fracture Clinic in April 2013. In the three months since, its popularity and growth have exceeded all expectations.

The program gives priority scheduling to documented cases of stable fractures in the Outpatient Clinic. The availability of expedited care has become popular with the area’s referring providers. Shriners Hospital knows that providers often see fractures under urgent circumstances and do not have time to research specialty care options or make phone calls to set up appointments. The fracture clinic provides a reliable solution for busy providers.

The process is simple. Once a fracture case is confirmed and documented, providers simply fax the Fracture Clinic Referral Form and give their patients an information sheet. The next business day, patients bring that documentation to Shriners Hospital between the hours of 7:30 – 9 am. After checking in, they will receive priority scheduling with no prearranged appointment required.

“The Fracture Clinic makes it easier for ER doctors to offer the Spokane Shriners Hospital for expert pediatric fracture care, which could include reduction, surgery, casting and post-fracture follow up as needed.” Paul Caskey, M.D., Orthopaedic Surgeon and Chief-of-Staff at the Spokane Shriners Hospital.

Much of the popularity of the Fracture Clinic among providers is due to the dedicated effort of the hospital staff. The registration staff, new patient nurse and surgery scheduler coordinate scheduling. The providers, nurses and radiology staff are excellent at treating patients while keeping wait times to a minimum. Physician Relations Liaison, Trina Olson works tirelessly teaching the surrounding medical community about the purpose and function of the Fracture Clinic.

“We want to be sure our referring providers are aware of the ease of access to our Urgent Fracture Clinic — it’s just a simple fax. We will provide total fracture care. Families look to their providers for advice during times of stress and urgency; providers can feel confident in knowing their patients are our priority”. Trina Olson, Physician Relations Liaison.

The importance of the Fracture Clinic extends beyond increasing awareness. When a child experiences a fracture, it is important that they receive expert pediatric fracture care without delay. If the fracture is in a growth plate, a pediatric orthopaedist will recognize when more than a simple cast may be required.

“Children are not just small adults; their bones heal faster than adult’s bones. This means that a child with an injury should see an experienced pediatric orthopaedic specialist as quickly as possible. The child needs proper treatment before the bone begins to heal, because the long-term consequences may include limbs that are crooked or of unequal length.” Bryan Tompkins, M.D., Orthopaedic Surgeon.

The Urgent Pediatric Fracture Clinic highlights the expert services and streamlined processes that the Spokane Shriners Hospital already embodies. Shriners Hospital has always offered the highest quality pediatric specialty care. It already has a simplified intake process. The Fracture Clinic concentrates these qualities into a well-focused solution to a common problem for referring providers.

Spokane Shriners Hospital is home to the region’s only fellowship trained pediatric orthopaedic specialists. The hospital treats conditions ranging from serious orthopaedic issues requiring multiple surgeries, to fractures or sports injuries easily corrected through same-day surgery. Shriners Hospitals for Children treats children ages 0-18 regardless of ability to pay.

For more information on the Fracture Clinic or Shriners Hospitals for Children, call Trina Olson at (406) 565 – 1778 or visit www.shrinershospitalsforchildren.org/spokane.

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Contact: Damon Pilgrim, Public Relations Specialist
Direct: 509.623.0403
E-mail: [email protected]

About Shriners Hospitals for Children
Shriners Hospitals for Children is a health care system of 22 hospitals dedicated to improving the lives of children by providing pediatric specialty care, innovative research and outstanding teaching programs to medical professionals. Children up to age 18 with orthopaedic conditions, burns, spinal cord injuries, and cleft lip and palate are eligible for care and receive all services in a family-centered environment, regardless of the patients’ ability to pay. Shriners Hospitals for Children relies on the generosity of donors to deliver this mission every day. For more information, please visit www.shrinershospitalsforchildren.org.

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