Wednesday, March 9, 2011

Rural but ready for anything

Wood River ER serves 5,000 square miles of remote Idaho

Express Staff Writer

Nurses at St. Lukeís Wood River Medical Centerís emergency room finish taking blood from between the toes of 10-month-old Charlie Burgan. His mother, Emma Burgan, holds him and says heís had a fever topping 102.3 degrees for three days. Rural but ready for anything Photo by Willy Cook

The emergency room remains quiet, all 10 rooms empty. Yesterday, Sunday, was the opposite.

"There was ski equipment in every room," says Michelle Hartman, ER nurse at St. Luke's Wood River Medical Center, while sitting at the main counter, waiting. "We were busy all day."

Skiers and snowboarders dominate the ER traffic during winter months, made evident by the sign hanging in the waiting room.

"For your safety, please remove ski boots before entering the emergency room," reads the sign hanging above a box stuffed with what look to be blue shower caps. "Please wear a blue traction-cover over each foot before going back."

ER secretary Mégan Davis, wearing a T-shirt reading "heart of Hearts" in big letters on the front, also sits behind the main counter, surrounded by radios scanning ambulance, fire and police frequencies. Another radio is tuned to the Sun Valley Ski Patrol. Davis, a 13-year ER veteran, doesn't keep her ear glued to the radio chatter but merely lets it buzz in the background. When something unusual happens, it will stick out.

An urgent voice then fills the empty airways, grabbing Davis' attention: An 11-year-old girl has injured her back while snowboarding on Dollar Mountain and is on her way. A Ketchum ambulance—equipped with a ski/snowboard carrier on the back—pulls in a few minutes later. Tom McLean and another paramedic step out and wheel the girl in on a gurney, her neck immobilized in a brace. A doctor and a few nurses then simultaneously pull her onto a hospital bed as he asks her where it hurts. A nurse takes off her boots. The mother, fright filling her eyes, stands at the foot of the bed as another nurse closes the curtain.

McLean, a Ketchum paramedic of 25 years, leaves the room to fill out some paperwork before hitting the road. He comments on the irony. Wood River Valley residents are unusually healthy, he says, but they also engage in dangerous activities.

"People here like to ski fast, bike fast, go fast," he said. "The faster the better."

Many of his calls are for trauma injuries. That pertains particularly to the Wood River Valley, but the hospital is also the sole source of emergency services for 5,000 square miles of remote Idaho towns from Challis and Stanley to Arco, Fairfield, Shoshone and Jerome.

"We're the rural frontier," McLean says.

That responsibility comes with some inherent risks.

The small ER only serves an average of 20 patients a day but experiences the same gamut of injuries coming through an urban ER, according to Dr. Deb Robertson, who worked in a Portland, Ore., ER for eight years before coming to Wood River more than a year ago. Heart attacks, strokes, outdoor accidents and even the outrageous—piranha bites and cockroaches in ears—come through the doors.

However, Wood River doesn't have enough business to provide all the services of an urban ER. For example, it's without a cardiologist or neurosurgeon.

"Anything could come through that door and you have to be ready," said St. Luke's Dr. Mike Ross, who mostly works in Boise and Meridian's ERs but fills in at Wood River every once in a while. "You'd be surprised. It can get real busy in there."

And only one ER physician is on duty at a time, accompanied by two nurses. Ross said that even though he's busier in Boise, Wood River can be more challenging for that reason.

"You're to a great extent alone," he said, which forces doctors to sometimes work at the edge of their capabilities. "It takes a different kind of personality to survive in that environment."

Robertson is an example of that personality.

"If I had a cardiac case in Portland, I would have a cardiologist standing next to me in two minutes," she said.

That's not the case at Wood River. Here, she's the only physician on duty during her usual 12-hour shifts. And if someone's willing to drive 200 miles to the ER, it's going to be serious.

"You don't get many people coming in here with a hangnail." Robertson said. "They're not making that drive for nothing. Just yesterday, I had a broken tibia from the day prior."

If something is completely beyond her scope, patients are Life Flighted to either Twin Falls or Boise, sometimes Salt Lake City.

Even that can weigh on Robertson because, in the case of a massive heart attack, each passing moment lessens a patient's chances. She said the chance of survival isn't good even in an urban area.

"You might not make it to the next hospital and probably won't make it to the next after that," she said.

For that reason, the ER wants to treat as much as it can as soon as it can. The ER reports transferring only 1.5 percent of its patients to other hospitals.

Even then, weather can prevent Life Flighting patients, forcing them to sacrifice an ambulance for the trip. Robertson recalls such a case. She said two patients—one being septic and the other having a heart attack—needed to go to Twin Falls, but she had only one ambulance. Who would go first? The decision was up to her.

"You can lay awake at night thinking, 'Did I do the right thing?'"

Trevon Milliard:

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