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May 11, 2016

Humble Beginnings

On June 6, ThedaStar celebrates 30 years serving as a life force in Northeast Wisconsin. For 30 years we have landed at the intersection of precious lives and have flown patients “at the speed of life” to definitive care. We are privileged to be a force among many serving the greater good of critically ill and injured patients in our region.

On June 6, ThedaStar celebrates 30 years serving as a life force in Northeast Wisconsin. For 30 years we have landed at the intersection of precious lives and have flown patients “at the speed of life” to definitive care. We are privileged to be a force among many serving the greater good of critically ill and injured patients in our region. 

It all started in 1972 when some brave rotary angels from St. Anthony’s Hospital would blaze the way for civilian air ambulances to integrate their air medical resources as an essential EMS component. In 1986 ThedaStar would become the third air medical program in Wisconsin and about the 150th program in the United States. To date, ThedaStar has flown just under 13,000 accident-free missions. What have 30 years of experience and care in the air taught us?

It takes a lot of people to save a life. The huge responsibility of healing falls on many throughout the health care continuum. When intact survival of a critically ill or injured patient is our primary goal, integration of care and resources is paramount. As caregivers, we each make our own particular brush stroke on the patient’s canvas of care; but together, in a coordinated effort, we create that patient’s final portrait. 

American medicine is at a crossroad. The technical capabilities, along with education and collaboration from the pre-hospital setting throughout hospitalization and rehabilitation, are beyond anything imagined even 20 to 30 years ago. By working collectively together along the continuum of care and providing evidence-based definitive care, lifesaving therapies now bring people back from the brink of death. We carry O Negative blood and Plasma A on board. Diagnosing heart attacks in the field has revolutionized cardiac care. Babies less than a pound at birth now routinely survive and thrive. Regionalization of trauma, cardiac and stroke centers, along with interventional radiology, have also saved thousands of lives.

Strength comes in numbers. That strength is galvanized by working successfully as a team for optimal patient outcome. Our efficiency metrics are measured in the grateful faces of our patients and families who can resume somewhat normal lives. It is a rewarding feeling to be part of this bigger picture. It will take a lot of selfless people to save one life today.

Time matters. Trauma is a disease of time. As caregivers we have a small window of opportunity to do our patient the most good. With trauma, we often work in the whirlwind known as the “golden hour.” The late Dr. R. Adams Cowley promoted the concept of the golden hour from his capacity as a military surgeon and later as head of the University of Maryland Shock Trauma Center. He said, “There is a golden hour between life and death; if you are critically injured, you have less than 60 minutes to survive.” While literature does not suggest there is any magical time for saving critical patients, I believe we all agree that delays in definitive care are undesirable.  Our patients are glad that we know how to “rock n roll.”

Heart attacks (Code STEMI) and strokes (Code Stroke) also are very time-sensitive emergencies. Rapid intervention in cardiac catheterization labs and stroke centers has saved countless lives while preventing life-altering disabilities. Time is heart muscle or brain tissue!  With the pre-hospital sector and hospitals singing from the same sheet of music regarding patient standards of care, we ensure better outcomes. With rapid transport, we can quickly get patients to definitive care at the most appropriate facility to handle their life-threatening conditions. Helicopter access for medical and trauma emergencies is an expectation of society. 

Saving lives demands our best performance. We must perform properly even when scared half to death. Put your game face on and grab your emotional bootstraps. With more autonomy comes more accountability. We must have a strong desire to stay sharp to perform in our clinical arena. 

There are critical consequences for lack of critical thinking skills. School is always in session, with ever-changing technology and information. Staying current in the discipline of EMS takes significant time, concentration and effort. We must constantly learn from our experiences and add to our repertoire of knowledge to help the next patient. Rather than reserved to memory, protocols and algorithms now are downloaded to our smartphones, allowing immediate access to mountains of medical information. 

We learn to trust intuition and hunches as valid. Part of our professionalism is to “look back to get ahead,” as Winston Churchill said. Our in-depth quality assurance programs help assure that we applied all this knowledge and intuition appropriately. ThedaStar’s theory of relativity differs from Albert Einstein’s version; our tenet is that we promise to take care of you or your family just as we would want to be taken care of. There is a lot of pride in a fine day’s work.

Our ABCs are a lifesaver. We can also thank our hero Dr. Cowley for fueling the notion that a rapid focused ABCDE approach to patient assessment would help pre-hospital providers efficiently assess all trauma patients in order to identify those patients who would benefit from immediate surgical intervention. We are detectives. We find the clues. We operate from the premise that all trauma patients are going to die unless we prove otherwise. Our ABCs help us prove otherwise. Our eyes, ears and hands have proven to be reliable diagnostic tools in the field in identifying life-threatening injuries.   Even if a broken leg is crying out for attention, we must find out where the silent cries are. The ABC algorithmic approach prevents us from being overwhelmed by the big picture or fooled by the obvious small picture (tunnel vision).

Never say never. There is no predicting what the day will bring. Expect the unexpected. We have the scary privilege of working in the sometimes-dark otherworld of pre-hospital trauma or other high-octane situations. One or two intrusive tones and a few words from a voice over our radio differentiate a scene flight from an inter-hospital flight. We prefer brief, concise information to prevent tunnel vision. We will rely on our assessment skills, ABCDE, for the full story.

Trauma is a graphic disease. We are exposed to the most startling reminders of human mortality. We deal with fractured bodies and fractured lives. We are guardians of all. We must be emotionally flexible and have open-minded empathy. We take care of people who make poor choices, and of some who didn’t get to make any choice at all. Taking care of children humbles us with “what if” just for a second.

Plan B is often more important than plan A. We work tirelessly on scene and process “the roller coaster ride” later. Initially we are insulated by the call to action and the adrenalin rush, only to depend on each other later to find our emotional reset buttons. We appreciate the opportunity to reboot, utilizing the formal process of CISD (Critical Incident Stress Debriefing).

Words matter and compassion cures. There is much healing energy in words and actions. Oftentimes we are the quiet voices in the dark, encouraging our patients to hold on. They hang on our every word. We forge immediate bonds based on the trust that we will be their best advocate in such critical and compromising situations. We advocate for the whole person. We become our patients’ best cheerleaders. Nursing, like society, has witnessed an increase in the power of technology; all the technical aspects of care can take priority over compassionate or holistic care delivery. Yes, we need to execute advanced clinical skills when caring for patients, but it’s our actions that make our patients feel cared about. Compassionate care begins with us and brings dignity to both the patient and caregiver. 

There’s no place like home. Safely completing a mission is our first concern. We seek zero preventable accidents in a 24-hour, seven-days-a-week operating environment with urgent and demanding med-evacuation missions. As air medical crew members, an aviation mindset is as important as the clinical caring component for patients in the back of the aircraft. Our everyday focus is overall safety enhancement, utilizing state-of-the-art safety technology in our aircraft, along with optimum crew coordination and teamwork. Our twin-engine aircraft allows redundancy in systems in the event of engine failure, and is enhanced with an autopilot feature that reduces the pilot’s workload so he can multitask and process more data. 

We have better weather reporting, along with exact satellite tracking, so our communication center “sees” exactly where we are at all times. We utilize night vision goggles on every night flight to starkly enhance visibility. All flight requests are subject to a daily and an individual flight risk matrix — in conjunction with Petroleum Helicopters International’s Emergency Operations Center located in Phoenix — before acceptance. We religiously practice PHI’s lifesaving behaviors to minimize distractions to safe flight. We utilize crew resource management techniques, which optimize all available human factors and other resources to promote safety and efficiency of flight operations.

Crossing the threshold of becoming a synergistic crew requires honesty, learning and depending on each other’s reliable strengths, while owning what you did well and also what you can improve on. We learn to see things through the perspective of others, even our critics. A dose of humility goes a long way. Preoccupied with who, what, where and why when lifting off for a call, I didn’t always say a prayer; but I always thanked God when we returned home safely. Mission accomplished and a life saved — we will sleep well tonight.

Prevention is the vaccine for the disease of injury. You don’t have to join the circus to do death-defying acts. You just have to buckle your seatbelt … or wear a helmet … or choose not to drink and drive. Simple rules are sometimes hard to follow, as evidenced by trauma statistics. As professionals, we preach a lot about the consequences of risky behavior. Our trauma department continuously measures injury data and identifies initiatives to help people modify these life-altering choices.  

Kathi Hegranes, Injury Prevention Coordinator at ThedaCare, is a very dynamic person dedicated to making a significant impact on area teens through the PARTY program, which has reached more than 50,000 people! Good news to report: We see less young people ejected from cars today or drinking and driving. Now we need to address the national epidemic of texting and driving, which is quickly becoming one of the country’s top killers. Drivers assume they can handle texting while driving and remain safe, but the numbers don’t lie.

And the real paycheck for this job is … all the amazing people. We work with a lot of shining stars. We witness the greatest of human character and compassion on the front lines. Many times the people behind the scenes are the unspoken EMS heroes who stand ready at any time to answer any call amidst the darkest of circumstances. We are reminded daily what a group of dedicated professionals can accomplish without any expectation of recognition while the rest of the world sleeps. They make volunteering look like the richest profession on earth; then they go home, put on their regular clothes and go to their real jobs. 

Tonight when you go to bed and hear sirens in the distance, be assured hope is on the way to someone out there. Our organization and doctors endlessly help us raise the bar for quality care by teaching and mentoring us. We are so close to both living and dying every day in this industry. Our co-workers, or work families, keep us grounded and the fire burning in us to keep doing these jobs. Like Dionne Warwick sang, that’s what friends are for, and I can count on mine for sure!

Gratitude goes both ways. We have forever bonds with our patients. Our patients and families are ever grateful for our care, and we are inspired everyday by these resilient people. You don’t have to turn on the national news for epic stories of recovery, courage and determination — they happen right here in the Fox Cities!

We will not forget our humble beginnings and lessons learned. We are proud and extremely thankful for what we do. We care for critically ill and injured individuals. We will continue to improve and advance our foundation of knowledge and experience with the cogs of time to serve our patients and communities most effectively. Your support and vision has made our mission possible for 30 years. Thank you!

By Pam Witt-Hillen, ThedaStar Flight Nurse