Welcome to the inaugural Mercyhealth REACT newsletter.

Our quarterly newsletter will cover many topics, from prehospital care, to critical conditions being admitted to the ICU and much more. If you have a topic you would like to see discussed, please contact our outreach coordinator at Lhinton@mhemail.org.

What is REACT? For more than 30 years, REACT has partnered with emergency responders and hospitals in Wisconsin, Illinois and Iowa. Our flight crew includes a pilot, critical care flight nurse and a critical care flight paramedic. In addition to our fight crew, our specialty Neonatal Team is a regional leader in neonatal transport. REACT crew members are trained to the highest level possible and hold numerous credentials and certifications.

Mercyhealth Hospital–Rockton Avenue is home to the region’s only Level III labor and delivery unit (the highest level of care for expectant mothers), a Level III Neonatal ICU and a Pediatric ICU. Our REACT team is trained to treat patients needing these specialized services, as well as all medical and trauma affected age groups.

REACT crew members are trained in advanced trauma and medical procedures. Crew members are trained to perform procedures including chest tube insertion, surgical airways, ventilator management, cervical checks, swan and invasive line monitoring, and advanced airway management for all age groups.

Educational OpportunitiesIt is only by working together with our EMS, fire, law enforcement, and hospital partners that we will all create an effective system for patient care. REACT is committed to promoting and advancing prehospital, emergency and critical care through education. We support our partners by providing educational programs for organizations in the region.

Throughout the year, REACT offers Night Out educational events throughout the region. Our Night Out events offer Care providers an opportunity to receive free continuing education hours taught by crew members. Past topics have included penetrating trauma and hemorrhage control, pediatric assessment, and chest and abdominal trauma. Lectures are geared for every level of provider.

As your partner in air medical transport, safety is our top priority, and your help is appreciated in ensuring the safety of our crews and your personnel. Mercyhealth REACT is proud to provide helicopter safety and landing zone training to fire services, EMS, and law enforcement agencies within our service area at no cost.

Visit MercyEMS.org for additional information or to request training for your organization.

Welcome

Summer 2018

By K. Jeromie Gass, NRP, CCEMT-P

In the early 19th century, British obstetrician Dr. James Blundell made efforts to treat hemorrhage by transfusion of human blood using a syringe. In 1818, following experiments with animals, he performed the first successful transfusion of human blood to treat postpartum hemorrhage. In 1901, Karl Landsteiner, an Austrian physician, discovered the first human blood groups, which helped transfusion become a safer practice. By performing experiments in which he mixed blood samples taken from his staff, Landsteiner discovered blood groups A, B and O and established the basic principles of ABO compatibility. In 1907, an American surgeon named Reuben Ottenberg suggested that patient and donor blood should be grouped and cross-matched before a blood transfusion procedure.

Between 1914 and 1918, anticoagulants such as sodium citrate were found to prolong the shelf life of blood. Refrigeration also proved to be an effective means of preserving blood. In the 1920s and 30s, the voluntary donation of blood for storage and use was started. Around the same time, Edwin Cohn developed cold ethanol fractionation, a method of breaking down blood into its component parts to obtain albumin, gamma globulin and fibrinogen, for example.

During the Second World War II, blood transfusion was used on a large scale to treat injured soldiers and became well known as a lifesaving procedure.

For 200 years, blood transfusions have been the gold standard while treating hemorrhagic shock. Until recently, this has only been a dream for prehospital care. With recent advances in technology, the idea of prehospital blood administration has come to light. With the development of advanced coolers, packed red blood cells (PRBCs) can be placed into helicopters or ambulances. These units can be delivered to patients suffering from hemorrhagic shock in the field. O negative units can be administered to all blood types. While this idea is fairly new to the prehospital community, it is slowly picking up steam.

This practice doesn’t come without challenges. Strict regulations regarding the storage of PRBCs are very daunting. According to the AABB (formally known as the American Association of Blood Banks), storage of PRBCs for transport needs to maintain a temperature of one degree Celsius to 10 degrees Celsius. This can be a massive hurdle for most agencies to overcome. When attempted, the replacing of blood units not used can quickly become very costly to the agency.

Per ATLS, classes of hemorrhagic shock illustrate that a patient may not show signs or symptoms of internal bleeding until Stage III. What does this mean? From day

one, EMS is taught to look for an elevated heart rate and hypotension. The patient has already lost between 1500-2000 mLs of blood by the time this occurs. When your patient presents with these vital signs, they are already in trouble.

According to the American College of Surgeons (ACS), triggers for massive transfusion in trauma patients are scored on four areas (also known as an ABC score). These four areas are: pulse >120, SBP<90, +eFAST exam, and penetrating torso injury. Each of these is assigned one point. A score of two or more warrants massive transfusion protocol activation. In some of these cases, the ACS recommends beginning with universal blood product infusion rather than crystalloid or colloid solutions if universal blood products are available.

Exsanguination is the leading cause of death in trauma patients. Several strategies can be performed to reduce mortality. Per a study by the ACS published in 2015, transfusion of PRBCs prior to trauma center arrival were associated with a nearly five-fold increase in odds of survival at 24 hours and a 72% reduction in the odds of shock.

Tranexamic acid (TXA) is a medication used to treat or prevent excessive blood loss from major trauma and post-partum bleeding. TXA is given as a loading dose (within three hours of injury) of one gram over 10 minutes then followed by a drip of one gram over eight hours. Studies have shown that the use of TXA in prehospital trauma patients has reduced the mortality at six hours (1.9% vs 9.3%), 12 hours (3.5% vs 10.9%) and 24 hours (5.8% vs 12.4%).

When reviewing the literature on the use of TXA and/or PRBCs, it has been shown to greatly improve the outcome of these patients. Mercyhealth’s REACT program carries both TXA and blood to provide our patients with the highest level of care possible. At all times, the REACT crew is able to give PRBCs and TXA to any patient experiencing hemorrhagic shock. The flight crew carries two units of PRBCs and has the protocols in place to use them at a moment’s notice.

References:

1. www.redcrossblood.org/learn-about-blood/history-blood-transfusion

2. http://www.blood.co.uk/about-blood/history/

3. ATLS classification of hemorrhage shock

4. American College of Surgeons

5. Brown JB, Sperry JL, Fombona A, Billiar TR, Peitzman AB, Guyette FX. Pre-trauma center red blood cell transfusion is associated with improved early outcomes in air medical trauma patients. J Am College of Surgeons 2015; doi: 10.1016/j.jamcollsurg.2015.01.006.

6. BMJ (British Medical Journal) volume 2, issue 1 of the Trauma Surgery

& Acute Care Open

Prehospital Blood Transfusions

A quarterly newsletter for REACT staff and friends

REACTNewsletter

Our flight nursesKristi Lohmar, BSN, RN, CCRN, PHRN — Kristi is our chief flight nurse. She has 21 years of nursing experience and has 13 years with the REACT team. When asked why she went into nursing she says, “I chose nursing as a career for many reasons, but the most important reason to me is the fact that

I can share my passion for life with others. When I first started flying with REACT, I seized the opportunity to fly and gain a broader knowledge of nursing practicing with autonomy. I have found, over the last 13 years, not only have I expanded my knowledge, but the patients and family members I have encountered have taught me that nursing is not just about learning, but also accompanying someone through a difficult time such as tragedy or a severe illness.”

Anthony (Tony) Rehberg, BSN, RN, CFRN, EMT-P — Tony has 37 years experience in EMS and the fire service. He was a volunteer firefighter with Cherry Valley for 13 years. Tony worked with a private ambulance service (Metro Medical Services) and was a City of Rockford professional firefighter for a

time. For the last 26 years, Tony has been flying with REACT as a paramedic and RN. “For as long as I can remember, I had a love of all things aviation related. Professionally, I enjoy the prehospital/transport environment EMT-P and RN. Flying with REACT is the best of both worlds.”

Debra Webb, RN, CFRN — Debra has been in critical care nursing since 1984. Deb became a REACT flight nurse in 1991. She was chief flight nurse for 19 years and is now celebrating her 27th year with REACT. She states, “I love flying because I enjoy the broad base and variety of patients, and the critical

care work involved taking care of these patient populations.”

Danielle (Dani) Swenson, AAS, NRP, FP-C — Dani has 16 years in EMS with 11 years as a paramedic. She started her EMS career as a firefighter/EMT in the Air Force. Dani has been flying for eight years, four of those with REACT.

Jon Hartmann, NRP — Jon has been a paramedic since 2002. He worked as a field paramedic until he joined the REACT team in 2014. Jon is completing a paramedic-to-nurse program. “My father was flown by helicopter in 2007 and I observed firsthand how much they helped him. I decided I too wanted

to be able to give to others the help he received from his flight crew.”

Our medical directorJohn Pakiela, DO, FACEP, CMTE — Dr. Pakiela serves as our physician medical director. Dr. Pakiela is also an MD-1 physician for Mercyhealth and serves as Associate EMS Medical Director for Mercyhealth Prehospital and Emergency Services Center in Rockford. He has practiced 20 years

in emergency medicine, 18 years in critical care transport, and has been involved with EMS for 27 years. When asked why he does what he does, he replied, “When I was a kid, I either wanted to be a fireman or an ER doc. I have been fortunate enough to be part of both services in my career. Critical care transport is the perfect blend of both—it is emergency medicine in the field.”

Our full-time helicopter mechanicsMichael Whitson, Senior Lead Mechanic — Michael graduated from Colorado Aerotech College in 1981. He then went to Texas for further training with Bell Helicopter and focused his career on helicopter maintenance. After completing his training, Michael began working in the Gulf of Mexico

and Corpus Christi, TX, in a helicopter shop as well as on a natural gas platform. He was responsible for maintaining the Bell 206B, 206C and 212 helicopters. From 1986 to 1987, Michael enhanced his career by working with the Forestry Fire service fighting forest fires. He served on the Nancy Reagan Drug Eradication Task Force. He also

Lois Hinton, BSN, RN, CFRN, PHRN — Lois has 38 years of nursing experience with the last 16 in flight with REACT. She states, “I wanted to be a flight nurse to provide a critical level of care to my patients while being autonomous. I enjoy the level of training and teaching that is expected of us. The

REACT crew is the best group of people I have ever worked with. They are family to me.”

Rachael Wilson, BSN,RN, CEN, CPEN, PHRN has 20 years of nursing experience with 8 months of flight experience. Her clinical experience includes emergency/trauma, ICU, step down ICU and ground critical care transport. She says, “My dream was to be a flight nurse when I went through

nursing school and I am now getting to live that dream with an amazing team of flight nurses and paramedics. I love the autonomy that this job gives me and the ability to help change someone’s life in a very short amount of time.”

Our flight paramedics Mike Stefko, AAS, NRP, FP-C, CCP — Mike, a critical care flight paramedic, has been an EMT since 2006 and a paramedic since 2008. In 2013, Mike began his career as a flight paramedic. “I decided to get into HEMS to further expand my knowledge and apply my skills as a critical care paramedic to

critically wounded and ill patients.”

Jeromie Gass, NRP, CCEMT-P (FP-C, pending) — Jeromie has 17 years of EMS experience. Twelve years were in the public 911 systems in western Illinois and Rockford. He also spent five years in private EMS and with REACT since fall 2016. He states, “I wanted to be a flight medic to be able to advance

my education along with my skill set. From that first day I have been treated not like ‘the new guy,’ but a member of the family. I still can’t believe I get to go to work with these amazing people.”

worked for Omni Flight in Janesville, WI, serving as crew lead for reconfiguring the interiors of brand-new BK117 helicopters for medical use. In 1988, while still employed by Omni Flight, Michael joined the REACT team as the Lead Mechanic. Michael is celebrating his 30th year with REACT.

Ryan Wachsmuth, Base Mechanic — Michael graduated from Blackhawk Technical College’s aviation program as an airframe and power plant mechanic in 2005. He is also IA (Inspection Authorization) certified. Ryan’s factory training includes Airbus EC 135, EC 145, Gulfstream GII, GIII, GIV, Engines

Arrius, Arriel, Rolls Royce Tay (611-8), and Spay (511-8). Ryan has worked nearly six years in 145 repair stations performing depot-level maintenance and repairs. He became a night shift supervisor at Andrews Air Force Base where he maintained four Gulfstream Executive aircraft for a 24-7 mission operation. He spent a year as a Quality Control Inspector for the C-20 program in Afghanistan, supporting the Commanding General of operation OEF and OIF. When Ryan returned to the US, he went to work on an Experimental Flight Test Bed program for the FAA Certification of the new SAFRAN Silvercrest Engine. While on the FTB program, his duties were to create an AAIP program, serve as maintenance manager for direct employees and contractors, and as a liaison to engineering and program management. In 2013, Ryan joined the REACT team as a well-qualified base mechanic.

Our program directorSam Nepple, EMT-P, MHA — Sam earned his BA Economics at the University of Wisconsin and his Master of Health Management degree at the University of Washington. Sam has been with the REACT team since July 2017. When asked why he likes working with REACT, he replied, “Starting

as a volunteer EMT at 19 years old, I have always been passionate about emergency medical services and helping people. With REACT, I am able to continue that passion and provide high-quality air medical transport services to the residents of Southern Wisconsin and Northern Illinois. It is a privilege to work with an experienced team of nurses and paramedics who are dedicated to REACT’s patients and the mission of clinical excellence and safety.”

Introducing the REACT Team The REACT team is a multidisciplinary team, including a medical crew, pilots, mechanics, and behind-the-scenes staff.