Wellspring

Prepping for Trauma

2011-10-08T02:10:30Z

Our emergency department team includes Dr. Pete Zopfi, Heather Venezio, Daman Mott and Dr. Seth Kaufman.

Twenty years ago, NorthBay Medical Center was the defacto trauma center for Northern Solano County. Back then, physicians were required to handle emergency calls 24/7, in addition to their regular practices. It just went with the territory. Because the burden was so great, many doctors didn’t mind when helicopter companies offered to swoop in and deliver trauma patients to bigger, metropolitan hospitals.

But not Pete Zopfi, D.O.

NorthBay Healthcare’s new trauma medical director has always thrived in urgent situations. He trained at a large hospital in Dayton, Ohio, and saw more than his fair share of tractor and hay baler accidents, as well as motor vehicle accidents and the "knife-and-gun club" variety. He learned to be ready for anything at any time.

But one doctor does not a trauma department make. Other changes on the medical landscape had to occur in the past decade to bring NorthBay Healthcare to where it is today: Poised to answer all except the most extreme trauma calls.

Now a team of trauma-trained community surgeons, backed by a full field of hospitalists, stand at the ready to deal with everything from broken bones and dog bites to gun shot wounds and industrial accidents.

"Many of the advanced services we already provide, from our Chest Pain Center to our Stroke program, make the transition in trauma planning seamless," says Daman Mott, director of Emergency Services and Trauma.

Actually, NorthBay’s Emergency Department staffs have always handled any trauma that arrived at their doors. Some patients just walk in, while others are driven to one of the local facilities.

But when 9-1-1 is called, and patients are picked up by ambulance or helicopter, emergency medical service workers follow protocol, and some conditions require that patients be sent out of the area for help.

NorthBay has been in the planning stages for several years now to become a Level III trauma center, which means that all but the most serious neurological cases can be handled locally.

"It’s going to make a big difference to the people of Solano County," says Dr. Zopfi. "When you have to leave the county, the travel time alone may take 30 to 40 minutes away from the golden hour of treatment time. We’re developing a system in which people will receive high quality trauma care quicker and more efficiently."

Dr. Seth Kaufman agrees. As NorthBay’s Emergency Department Medical Director he sees a strong benefit for Solano County trauma patients.

Because We Care

"A protocol-driven, well-trained trauma team will improve care by decreasing the ‘door-to-operating room time’ and expanding the available services to the trauma patient," he says. "The hospital is fulfilling its mission of creating excellent, comprehensive trauma care in a county that needs it. We are taking the lead because we care about the community and therefore believe that long transport times do not benefit the patient."

Developing the system has involved a number of mock drills, involving real people playing the role of patients, and simulated patients or mannequins, which are programmed for the exercise. "It may be a mannequin, but it can be as realistic as the real world. You have to think on your feet and respond quickly or you’ll lose your ‘patient,’" says Zopfi.

Even though the Level III trauma facility will only exist at NorthBay Medical Center, at least in the beginning, Mott wants his entire Emergency Department team—52 staff members at VacaValley Hospital and 70 at Fairfield—to be fully trained and capable of stepping in. "If someone gets hurt and has to be taken to VacaValley Hospital because it’s the closest, I want them to receive definitive care and appropriate, timely transfer to the closest trauma center," he says.

The training, he admits, will probably never stop. "Trauma is like a highly skilled dance; the choreography is essential, so you drill and practice
to develop muscle memory and get everyone in synch, so they anticipate their next move because they all have the experience."

"We’re really coming together as a team," says Dr. Zopfi. "We’ve always handled trauma and we’ve done it really well, but now the focus is on making sure everyone knows what to do and when to do it. We’re getting even more efficient as we all understand our roles."

That transformation is a familiar sight for Vice President and Chief Nursing Officer Kathy Richerson. She joined NorthBay in 2000, after helping Mercy San Juan in Sacramento become a Level II trauma center. She knows the challenges well.

First, NorthBay had to make certain that becoming a trauma center was in the best interest of everyone: the patients, the community, staff, physicians and for the nonprofit NorthBay Healthcare.

Fiscally Responsible Decision

"Trauma has to be a fiscally responsible decision for the organization. We have to weigh the mission to the community and our ability to sustain an intense, highly technical program," she explains.

A study made a number of years ago didn’t support the plan, but when it was revisited in 2009, not only was there a need, but a vast deficit of appropriate care in Solano County. "We see trauma patients now," says Richerson. "But many get sent out to other centers, far away from their families. We want to be able to help them here. We are responding to the needs of our community."

In fact, NorthBay Healthcare was the first hospital in the area to declare an interest in establishing itself as a trauma center.

The decision to use a team of hospitalists—doctors with a variety of specialties, from intensive care to orthopaedic and general surgery—proved vital, says Richerson. "We are cutting edge in our use of these specialists," she says. "These physicians are getting the chance to do the kind of work they love and we’re getting the coverage we need to ensure all patient needs are met."

Combine those trauma-trained community surgeons and hospitalists with Emergency Department physicians, nurses, techs and support staff who have now all been trained to handle trauma cases and you have a team that’s not only excited about the prospect, but capable to respond at a moment’s notice.

"Trauma is a reality," says Richerson, "not a new line of business for us. We see it every day. But by meeting the requirements of state and national trauma standards, the patients will be able to stay here and we will deliver the very best and most current treatment."

The Time is Now

2011-10-07T07:10:50Z

The undeniable need for advanced trauma emergency services in Solano County hit home here at NorthBay recently when a typical staff meeting turned unusual.

To build Solano County’s first trauma center the program’s architects must keep track of hundreds of many moving parts—policies, procedures, protocols, staff training, physicians, nurses, new staff recruitment, equipment needs, regulatory hurdles and the massive data collection that is required of a hospital that takes on this responsibility.

There’s a lot of communication and synchronization. That’s why staff members involved in developing our trauma center meet twice a month at NorthBay Medical Center. Of course, this group is just the tip of an iceberg comprising well over 100 folks who have made this project come to fruition.

During one of these meetings, the hospital’s public address system broadcast a "code trauma." A patient had arrived unexpectedly in the Emergency Department. When that code is called, the trauma team springs into action.

At first, I figured it was another drill in preparation of achieving a Level III trauma center designation. But NorthBay’s chief nursing officer, who was in the meeting, assured me that it was the real thing. Our trauma medical director, a surgeon, swiftly departed and rushed to the ER.

Heading back to my office, walking along a long corridor that approaches the emergency services area, there was a great flurry of activity. NorthBay’s trauma team came flying out of the ER on its way to surgery with the patient on a gurney.

Our trauma program director, a registered nurse, was helping with the patient. Another NorthBay staff person was atop the gurney compressing the patient’s chest. Other staff scurried along side and ahead of the tempest. NorthBay security personnel cleared the path. NorthBay was doing its best for this patient.

It was dramatic, particularly for people in an adjacent waiting area. What they saw looked somewhat like what you see in a television show, except this was reality, not TV. I could tell by the looks on their faces that they were concerned by what they had just seen. It was a matter of life or death – right there, in person, in real time.

While local hospitals treat trauma patients all the time, NorthBay Medical Center is now the first Level III trauma center in Solano County. And we hope to eventually move up to a Level II designation. Until then, many patients must be put on helicopters and flown out of this county for care.

Trauma services have been missing for too long in our community. In this issue of Wellspring, we will tell you how we intend to fulfill our mission of providing advanced medicine, close to home. And it will include more advanced trauma services.

Life in the Emergency Department

2011-10-07T07:10:48Z

It’s 6:45 p.m. on a warm Fairfield evening…

The retractable doors to the ambulance bay slide open and an unresponsive "Code 3" patient is rushed into the NorthBay Medical Center Emergency Department. Within seconds, the patient—a heavy-set man in his 60s—is surrounded by a team of caregivers working feverishly to save his life.

Paramedics inform Arnold Cruz, D.O., the attending physician, that the man was discovered lying face down in the kitchen by his wife—and that family is en route.

With calmness and clockwork precision, drugs are administered, vital signs are assessed, medical information is procured and copious notes are recorded as members of the ED team take turns frenetically performing chest compressions.

Meanwhile, in the adjoining hallway, a long-haired man wearing handcuffs is being ushered in by a police officer. His face is bloodied, his eyes glazed. Just moments before his arrival, nurses were busy tending to an elderly woman with a 104-degree temperature and a patient suffering from a life-threatening pregnancy. In the hallway, one family waited to find out what was causing their baby’s allergic reaction, while a mom, her son and a niece, seated on a gurney, were waiting for a physician to check out a case of ringworm.

Through it all, the waiting room remains crowded. Welcome to the ED, where controlled chaos is a way of life and the ability to think quick, handle stress and be empathetic and ever-versatile are prized personality traits.

"People who work in the ED have to be ready for anything," says Heather Venezio, NorthBay’s Trauma Program director. "You can’t afford to specialize. We see a lot of things here that other areas of the hospital never see. We have to be able to take care of everybody."

NorthBay Healthcare operates two Emergency Departments around the clock—the one in Fairfield and one at NorthBay VacaValley Hospital in Vacaville—staffed with 122 employees, a team of surgeons, attending physicians and specialty hospitalists. In 2010, more than 60,000 patients were treated.

Dr. Mark M. Popil, M.D., a 40-year veteran of the ED, knows the terrain better than most. "To succeed here, you have to like the style of the practice—dealing with the unknown and uncontrolled situations," he says, adding that teamwork is essential. "If you can’t work together, you can’t take care of the patients. It’s that simple," Popil says.

That’s why every member of the NorthBay team who plays a role is important. The hub of the ED is a U-shaped counter adorned with computers, monitors and telephones that rarely stop ringing. The night’s lead nurse, Jean Johnston, R.N., is stationed here, along with ED technician Shawn Vasquez. Johnston runs the electronic tracking board, a large, wall-mounted screen that provides a rundown of each patient and which of the department’s 19 rooms they occupy. Relying on a system of colorful icons, she is able to instantly alert doctors and nurses to any updates with a simple click of a mouse.

Vasquez, a self-described "adrenaline junkie," is a whirlwind of activity—paging doctors, calling other hospitals for medical records and serving as the ED traffic cop.

Tethered to a long to-do list, she estimates she’ll take and make about 100 phone calls during her hectic 12-hour shift. "I’ve got six things going at once," Vasquez says. "You have to be able to multitask big-time."

ED Nurse Missy Smith, attending patient Akemi Kenney of Fairfield, pauses to give Donna, the woman’s daughter, a reassuring smile.

Later that same night, in the VacaValley ED, things are just starting to calm down. Doctors and nurses found themselves tending to a 60-year-old woman who came in experiencing "heartburn-like" symptoms, only to learn she was having a heart attack.

Now, lead nurse Jennifer Erickson is on the phone to NorthBay’s Cardiac Catheterization Lab in Fairfield, providing EKG results and other medical information as the patient is transported there.

"If you’re missing anything, call me," she says. "I’m here ’til 7 in the morning."

Meanwhile, in a nearby room, Christine Lowe, R.N. is checking in on her patient, Dan Johnson, and proving to be a soothing presence. He’s a Vacaville resident who arrived in the ED complaining of stomach pain and discovered he had pneumonia.

Cases such as these underscore the worst-case-scenario approach to which ED caregivers adhere. "We can’t afford to miss anything," says Venezio. "You assume the worst possible thing and then work your way down. If a patient comes in with chest pain you automatically assume it’s a heart attack."

Despite the drama, the overall pace in Vacaville this night is slow and steady.

But Erickson and fellow nurse Gina Hosking know that can change at a moment’s notice. They both recall working a late shift in September two years ago that became a wall-to-wall frenzy.

"There was a big storm, so no helicopters could fly and it was just the craziest night," says Hosking. "We had four codes in a row—back to back, no joke. It reinforced in me just how important trauma work is. It was the fastest 16-hour shift I ever had," Erickson remembers, adding, "I went home and just passed out."

Erickson insists that ED nurses need to treat every case as an emergency, no matter what the severity might be. Whether dealing with a sore throat or a gunshot wound, she respects the fact that a patient’s anxiety level is elevated, and that they would much rather be somewhere else.

Through the years, she and her co-workers have experienced the anguish of watching patients take their final breath. But they also have felt the thrill of sending patients and family members out those ED doors with a sense of relief or even joy.

"That’s when you really get a sense of satisfaction," she says. "That’s when you get off your shift and go home feeling fulfilled."

Care in the Air

2011-10-07T07:10:18Z

CALSTAR Flight Nurse Ernie Acebo is part of the team trained to handle all medical emergencies.

Helicoptor Flight Crews Handle All Circumstances

Five minutes. From the warning bell in crew’s quarters to lift-off from the tarmac, that’s all the CALSTAR flight crew has. Even if they have been jarred from a deep sleep, the pilot and two flight nurses are up, dressed and flying off in five minutes or less.

As they strap into their helicopter seats, do they know where they are headed and to what kind of situation? "Sometimes. But usually we don’t get that information," says Tim Castelli, a CALSTAR flight nurse. "What we get are general directions—dispatch may tell us to head toward Fairfield
or Dixon, for example. So, we just lift and point."

Once in the air, the pilot contacts dispatch again to receive actual latitude and longitudinal directions and the name of a ground contact.

"At first we’re in flight mode—getting clearance from the tower and talking with dispatch—and the closer we get to the scene we then shift to a medical mentality," says Ernie Acebo, CALSTAR flight nurse. "If we know we will have a pediatric patient, or a burn or hypothermic patient, we can make special preparations in the aircraft."

Flight rescue has been called to assist for a number of reasons, but usually it’s because of ground traffic delays, the accident is far from a trauma center, or because they can provide additional medical interventions at the scene.

As for what kind of medical situation awaits when they do land, frequently "we may have to open the ambulance door to see if it’s a pediatric patient or an adult, if it’s a car crash or a gun shot wound," says Castelli. "So we have to be equipped to handle anything. If it were a perfect world, flight nurses would always know if they are headed to care for
a child or multiple injuries, so we could get set in our frame of mind."

Either way, the crew is trained to handle all circumstances: they are Certified Critical Care Registered Nurses, Certified Flight Registered Nurses, and certified in Pediatric Advanced Life Support, Advanced Cardiac Life Support, and Neonatal Resuscitation.

CALSTAR has 10 bases throughout California; Northern Solano County is served by a base located at Vaca-ville’s Nut Tree Airport. From here, a three-person crew could be called to the Delta waterways or Lake Berryessa, from Fairfield to Winters or Woodland in Yolo County. Some flights have even gone as far north as Fort Bragg.

"We do whatever we can to save a person, to get them to a trauma surgeon. Our goal is to be overhead the scene ASAP," Castelli says. In large emergencies, CALSTAR could receive backup flight rescue assistance from other CALSTAR bases, or helicopters from REACH or the California Highway Patrol, based in Contra Costa, Napa or Sacramento.

Most times, the flight crew is on scene for only minutes. "We keep the engine running, load the patient fast and do all interventions in the aircraft, so as to not delay the time to the trauma center." Other times, take-off will be delayed. "There could be extenuating circumstances, such as a combative patient. Each case is different."

Castelli has been a flight nurse for 10 years, but it wasn’t his original career path. As a nursing student at UC Davis, he saw the helicopters landing at the nearby medical center and became curious about their mission. After going on a "fly along," he was sold on the concept.

Although the medical cases can be uncertain and the hours long—he works two 24-hour shifts a week—the work continues to challenge him, because "every call is unique."

Acebo has been in the emergency response field since 1988, and finds his work incredibly rewarding. "People who respond to emergencies are confident in their ability to make a person better, or at least not let them get worse. Something awful happened to put them in this situation; we’re going to do the best we can to get improvement."

Morgan’s Gift

2011-10-07T06:10:53Z

Donor’s Mantra: Save Lives!

Daman Mott, director of Emergency Department/Trauma Services, poses with the Gallegos family (left to right) Tim, Margot, Austin and Michaela in the trauma bay now dedicated to Morgan’s memory.

It was the last day of their vacation in Puerto Vallarta, Mexico, and Morgan Gallegos couldn’t wait to get on the water. The adventurous 14-year-old was eager to try all things fast: roller coasters, motorcycles (Mom always said no) and even zip lines. So, with her brown eyes sparkling, she jumped at the chance to spend the last few hours of vacation on the water with her father and brother while her sister and mom went shopping.

But shortly after the adventure began, there was a collision, and Morgan fell off her personal water craft, hit her head and went under.

It took 15 minutes for a doctor to arrive on the beach, where her distraught father Tim and her brother, Austin, watched in horror as efforts to revive Morgan proved futile.

When her mother, Margot, and sister, Michaela, arrived, all they could do was wait for the ambulance that carried Morgan and her mother to a Mexican hospital for brain scans.

The news wasn’t encouraging, but they weren’t ready to give up. Later, a prop jet took Margot and Morgan to a San Diego hospital, where they waited for the rest of the family and friends to arrive.

Donor’s Mantra: Save Lives!

"Save lives, Mom," was how Morgan said goodbye every time Margot left for a shift in the NorthBay Medical Center Emergency Department. "She was so proud that I went back to school and got my nursing degree at age 40," recalls Margot. "She’d even leave me little purple sticky notes that read, "Save Lives!" and "I Love You!"

So when Margot kissed her daughter goodbye for the last time in the hallway at Rady Children’s Hospital, she whispered words that resonated: "Go save lives, Morgan."

The family never doubted that Morgan would want to be an organ donor.

"Morgan always went out of her way to make people feel comfortable. She was amazing, caring and compassionate. Her brother and sister didn’t hesitate in helping us make the decision," says Margot. "It was the right thing to do."

Morgan’s generous gift has saved lives: five so far, and counting.

"Thank you for allowing such a precious part of your daughter to be given with the hope that someone else might live," a 51-year-old woman wrote to the Vacaville family. "I am the lucky someone who received her heart, and I am beyond grateful."

Her letter came in October 2010, just seven months after Morgan’s tragic accident. "I feel very close to your daughter’s heart," she wrote. "Because of her I can now look forward to a longer and healthier life. Because of her, I can do things without chest pain, shortness of breath, dizziness and sudden trips to the ER Because of her, I can now see a future filled with many new and wonderful things."

A 66-year-old man received her lungs. Before the transplant, he couldn’t even walk to the mailbox. Now he’s off the oxygen tank completely. "His friends and family threw a party for him, and he asked everyone to write notes to us," says Margot. "They all shared what a wonderful man he is and how much it meant to them that our daughter saved his life."

A 10-year-old boy with congenital liver disease can now do things he couldn’t before. Two other recipients benefited from her kidneys. And one more gift, still waiting to be used, are her corneas, says Tim. "She was such an avid reader," recalls Margot. "We hope whoever gets her corneas will also love to read."

Morgan Nicole Gallegos was a triplet, born a minute ahead of her brother Austin and sister Michaela, as she often reminded them, smiles Margot. She was a huge Johnny Depp fan, and her purple bedroom was plastered with posters reflecting that admiration. She saved up her own money so she could go to the Solano Community College’s Tom Hanks Program and was shaking with nerves when it began. She loved soccer, books, writing, and was inducted into the National Junior Honor Society at Jepson Middle School.

One of her last assignments was for English class, when she was asked to comment on an excerpt from "The Diary of a Young Girl," by Anne Frank. She selected the famous quote,
"I want to keep on living after my death!"

"I think almost everybody wants that," wrote Morgan. "But Anne said it in perfect words. Even I want to keep on living after death. I want people to remember me and know my name. I want to make a difference, big enough that people outside my family will be sad that I’m gone."

The tears flowed on Monday, Aug. 15, when
a plaque in Morgan’s honor was dedicated at NorthBay Medical Center and placed just outside Room No. 1 in the Emergency Department.

"Not everyone at NorthBay had a chance to meet this amazing young lady, but her story inspires us to be greater than we are. Our hearts go out to the family," said Daman Mott, director of Emergency Services and Trauma.

"Morgan’s spirit and her generosity made her immortal. Her unselfish gifts of life embody the heart and soul of NorthBay, which vows compassionate care and advanced medicine, close to home. Daily we will remember and honor Morgan’s memory and the ideals she embraced in her all-too-short life."

Return to Tranquility

2011-10-07T06:10:16Z

Marriage of Cardiac and Vascular Solutions Help Monk

Dr. Seph Naficy shares a light moment with Khamphanh Nettavong during a followup appointment after his surgery.

Spread over 5 acres amid a stretch of fertile farmland just outside the Central Valley city of Ceres is the Wat Lo Buddhist temple and monastery. There’s no place in the world where 74-year-old Laotian immigrant Khamphanh Nettavong feels more at ease. For the past 10 years, he has made a home here as a monk, leading a quiet life of austere routine and meditative tranquility.

That sense of calm, however, was shattered one spring morning last year when he experienced recurring chest pain and numbness in his left arm. He phoned his eldest daughter, Anna Nettavong, a Vallejo resident who had him transported to Solano County. Eventually, he wound up at the NorthBay Medical Center Emergency Department.

After a series of tests ruled out a heart attack or pneumonia, Nettavong’s case came to the attention
of Seph Naficy, M.D., a member of NorthBay’s Heart & Vascular Team. Via a CT scan, Dr. Naficy determined that the monk’s pain was being caused by an enlarged thoracic aorta with a large penetrating aortic ulcer.

"It was an ugly looking thing—a knuckle-sized out-pouching that may or may not rupture," Dr. Naficy recalls. "Potentially, it was a loaded gun that could off at some point." Says the softspoken Nettavong, "If it blew up, I could have died."

The defect had been spotted previously by doctors at other institutions. But they told Nettavong that there was little they could do about it, aside from monitoring his condition and prescribing blood-pressure medication. That the aortic ulcer was wedged in a bed of calcium and close to the main blood vessel that comes off the arm, apparently made surgery too risky.

Ana Nettavong listens to her father, Khamphanh, talk about his life in the monastary.

But Naficy thought otherwise. "I’m looking at this and saying, ‘I know how to fix this,’" he says. "I’d fixed similar things before. I knew I had the skill set."

A graduate of Georgetown University Medical School, followed by general surgical training at the Mayo Clinic, he continued in cardiac surgery training at the Cleveland Clinic and UC Davis, followed by vascular training at
the University of Tennessee.

Dr. Naficy traveled an offbeat path to NorthBay. After training extensively as a cardiac surgeon, he craved something more and began a two-year training stint at University of Tennessee, Memphis, Tenn., with an emphasis on endovascular technologies. There, he developed an intense interest in "hybrid" approaches to the treatment of cardiac and vascular diseases.

"I saw a change coming that presented new ways to marry cardiac and vascular techniques," he says. "I think there’s a synergy between the two that hasn’t been tapped."

Dr. Naficy was convinced that a hybrid approach was the best way to deal with Nettavong’s case and the anatomical complexities it presented. "The standard way of dealing with this would have had us opening the chest as you do in a heart operation," he says. "You’d arrest the heart, freeze the body, and drain it of its blood. In a brief window of time, you’d open the aortic arch and replace that segment with a synthetic graft, and re-implant the vessels. It wasn’t the method I wanted for this patient."

Dr. Naficy preferred a relatively unusual alternative, but one that would present fewer complications, less stress on the heart and lungs, and a reduced risk of infection or renal failure. His plan: Combine elements of open surgery with elements of minimally invasive endovascular surgery. He would re-route the blood going to the patient’s head and place a stent in the arch of the aorta, which is a large artery that carries blood and oxygen throughout the body. This would be done without opening the chest or arresting the heart.

This 3D CT scan shows the patient after the procedure, which included bypass of both neck and left arm vessels, followed by stent graft placement in the aortic arch, through one small groin and two small neck incisions.

Anna Nettavong remembers her family being "very nervous" when Dr. Naficy explained his plan. But after conducting some research, she placed her confidence in him. "I knew that if we didn’t do it, there was a chance my father could die," she says.

Following the procedure and a stint in rehabilitation, Mr. Nettavong was able to return to the colorful surroundings of his beloved monastery and the company of his fellow monks.

"It was the best feeling—like I was reborn. My spirit just rose," says Nettavong, who, reportedly is pain-free and more active than he had been. "I can’t keep up with him," Anna says.

Meanwhile, Dr. Naficy regards the successful procedure as a testament to teamwork and the hybrid approach that he hopes will be more prevalent in coming years.

"It takes the techniques of two areas, and creates a solution that is better than either would be alone," he says. "I know that, in the case of this patient, it truly helped. Where it can go in the future remains to be seen."

Patient Beats the Odds

2011-10-07T05:10:36Z

That Richard Kean is alive is nothing short of a miracle. So says his wife, Laura, one of his doctors and a host of medical workers who responded after his wife dialed 9-1-1 on June 21, 2011.

The couple was at home that morning and Richard was sipping coffee on the porch when he came in and sat down. He said his chest felt "weird."

"I asked him if everything was OK," recalls Laura. "He said, ‘Oh, it’s gone now.’ But when I started to move away, it was back again. So I told him, ‘You’re going to the doctor!’"

She left the room and was partly dressed when she decided to peek in on him. "I still can’t remember why I came back into the room, but he was in cardiac arrest."

Laura, a former certified nurse assistant (CNA), leapt into action. She tilted back his chair, ran to unlock the back door, and dialed 9-1-1. Then she started compressions and was working away when a voice answered. "I was so confused, I forgot to put the phone on speaker. I remember the gal telling me I needed to listen, but I was already busy pushing on his chest and praying."

Paramedics got to their Vacaville home within minutes and took over for Laura. As the cardiac catheterization lab is in Fairfield, the typical procedure is to send patients suffering a heart attack directly to NorthBay Medical Center, but in this case, paramedics didn’t think there was time to spare. Richard was whisked away to VacaValley Hospital, where he went on to have two more cardiac arrests.

After that, he was sent by ambulance to NorthBay, where he went directly to the cath lab.

But when he arrived, he had no blood pressure. He suffered another cardiac arrest just after he arrived. "The doctor told me it didn’t look good," remembers Laura.

But then, what Laura calls Richard’s miracle happened. Despite compressed arteries and a total lack of blood pressure, Dr. Harry Dassah was able to run a catheterization line through Richard’s veins to place two stents in an artery that was totally blocked.

The team watched as blood flow returned and blood pressure climbed to 40, 50, 60 and 70.

One of the main concerns, of course, was that Richard had been without oxygen too long, but that’s another miracle, says Laura: "He didn’t suffer any brain damage."

Richard, now 69, doesn’t look like your typical heart attack patient. He’s slender, athletic and strong.
A co-owner of a drywall business in Vacaville, he works hard, says
his wife. But his family has a long history of cardiac issues, so he didn’t take things for granted. In fact, he had just completed lab tests the week before and was planning to get his chest x-rayed prior to his attack.

"His labs came back normal. Nothing could have prepared us for this," says Laura. "We were blindsided."

But thanks to her training in the 1980s as a CNA, Laura had more than a passing familiarity with CPR, and when Richard needed her most, she was quick on her feet.

"She did everything right," said Dr. Dassah. "She called 9-1-1, she acted in time, and she helped save his life."

In a way, Laura says she was returning the favor, because Richard saved her life three years earlier when she was choking on a piece of food. He performed the Heimlich maneuver and got her breathing again.

"We’re even now," chuckles Laura. "No more one-upping. We’re even and that’s fine."

Next Step for Chest Pain Center

Dr. Paul McWhirter

What Richard Kean suffered on June 21, 2011, was a "STEMI"—which stands for ST Elevation Myocardial Infarction, otherwise known as a major heart attack. In recent years, it was protocol to send patients suffering STEMIs out of county for treatment.

"Transferring patients away takes a big bite out of the ‘golden hour,’" says Diana Sullivan, service line director for NorthBay’s Heart & Vascular Center. "The Golden Hour is that first hour of care—the time when, if given clot-busting drugs or other artery-opening treatments, the patient has the greatest chance of survival. Patients sent by ambulance to Sacramento or Walnut Creek have a 45-minute delay in getting treatment. If we can treat them here, we’ll cut the response time dramatically."

At Wellspring’s deadline, NorthBay was poised to become a STEMI-receiving center, which means that in the future, patients suffering major heart attacks would be brought directly to NorthBay first. "It goes hand-in-hand with our becoming a nationally certified Chest Pain Center for thrombolysis in 2009. We were certified to use drugs to dissolve blood clots. We also started doing primary angioplasty, interventional cardiac procedures, in August 2009, such as placing balloons and stents into blocked heart arteries. The purpose of these procedures is to help re-establish blood flow. In these cases, we’re speeding up the provision of life-saving cardiac care, often saving vital heart muscle and improving survival benefits in high-risk cases," says Sullivan.

Plans call for the team to support the national public education campaign, Early Heart Attack Care.

And earlier this year, NorthBay joined forces with Dr. Paul McWhirter and a team of physicians to bring 24/7 physician coverage to the cardiac cath lab.

As the evolution of NorthBay’s Chest Pain Center continues, plans call for the team to support the national public education campaign, Early Heart Attack Care. The primary goals are to teach how to recognize the early signs and symptoms of heart attack, the critical importance of calling 9-1-1; and the need for prevention.

"We’re taking our message to the people. We’ll be providing lectures, using posters, ads and we’re happy to visit service clubs to share our message, which is this: "Minutes Matter. Don’t wait more than a few minutes to call 9-1-1."

Know the signs and symptoms of a heart attack:

Discomfort or pain in the center of the chest.
Discomfort in the arm(s), back, neck, jaw or stomach.
Shortness of breath.
Breaking out in a cold sweat, nausea or light-headedness.

Don’t delay, call 9-1-1.

A Real Victory for the Citizens of Solano

2011-10-07T03:10:02Z

Emergency Department/Trauma Services Director Daman Mott confers with Chief Nursing Officer and Vice President Kathy Richerson.

After years of planning, hundreds of hours of staff training, drills and paperwork, NorthBay Medical Center is Solano County’s first Level III Trauma Center.

"This is a real victory for the citizens of Solano County who will no longer have to take their injured 45 minutes away to a trauma center," says Gary Passama, president and CEO of NorthBay Healthcare.

The designation came after a team from Solano County toured NorthBay’s facility to ensure that all the requirements and criteria are met.

The process was initiated by NorthBay in July with a formal letter to the county seeking designation as a Level III trauma center. "This process was not just new for NorthBay, it’s new to all of Solano County," explained Ted Selby, Solano County’s emergency medical services administrator.

The county had to create standards, and did so by reviewing the health and safety code regulations that all healthcare organizations must meet to be designated as a Level III trauma center. Selby then sent his team to Washington state, where they were able to shadow a team of surveyers who were visiting a hospital seeking to renew its designation.

"We thought it would be beneficial to see firsthand how other government agencies conduct their designation process to ensure a high quality process for Solano County," said Selby.

The designation means that emergency medical services personal will be able to bring most trauma patients, with the exception of neurological cases, to the Fairfield facility’s Emergency Department for treatment.

Both of NorthBay’s hospitals—NorthBay Medical Center in Fairfield and NorthBay VacaValley Hospital in Vacaville—handle trauma cases already, but those are "walk-ups," or "drive-ins," with the transportation handled by the patient or family and friends. Once an ambulance or helicopter team is involved, (such as when 9-1-1 is dialed) protocol previously required serious trauma be sent to the nearest Level I or Level II trauma center. That has meant a ride or flight to Walnut Creek or Sacramento. Now NorthBay will be able to handle the majority of these cases right here in Fairfield.

"That’s the very definition of advanced care, close to home," says Daman Mott, director of Emergency Services and Trauma, referring to NorthBay’s mission statement. "In medicine, we have a ‘golden hour’ of time to provide the most help for critically wounded patients. If a patient spends 45 minutes of that hour traveling, it greatly diminishes their chances for survival."

There are about 1,000 trauma cases a year in Solano County, according to state statistics that show 42 percent are transferred out of the county. Most are a result of traffic accidents (50 percent) and falls (39 percent). Less than 7 percent of traumatic injuries are a result of assaults.

Solano County is one of the few counties its size within California that did not have a designated trauma center within its boundaries.

During the process, NorthBay has worked closely with the county Emergency Medical Services agency and with providers and first responders who will bring trauma patients to NorthBay Medical Center.

"We value their input as we craft our program," says Passama. "It’s been a real team approach within NorthBay and with our partners outside the hospital."

There are four levels of trauma centers
in California:

Level IV facilities are capable of providing emergency care and have agreements in place to transfer trauma patients to higher level facilities.

Level III facilities are capable of handling most trauma cases, offering surgical, cardio-vascular, obstetrical and orthopaedic care. Level III facilities do not offer neurosurgery on a 24-7 basis.

Level II facilities are capable of tending to all kinds of trauma, including neurosurgery cases.

Level I facilities handle all types of trauma cases and serve as both teaching and research facilities.

Meet NorthBay's Trauma Team

2011-10-07T03:10:27Z

A collection of medical professionals has been hard at work at NorthBay Healthcare the past couple of years handling all the planning that goes into the creation of a Trauma program. Meet our team:

NorthBay’s Trauma Team (left to right): Mary Hernandez, Donna Nayduch, Dr. Pete Zopfi, Kathy Richerson (seated), Heather Venezio, Jackie Nelson, Dr. Seth Kaufman (back row), Daman Mott and Sandy Bauman.

Kathy Richerson, R.N., M.S.

Vice President and Chief Nursing Officer

Richerson joined NorthBay Healthcare in 2000, knowing that a Trauma Center was on our radar. The former Emergency Department and Intensive Care Unit nurse helped Mercy San Juan qualify as a Level II facility, so she knows the terrain. Her role has been to spearhead the trauma implementation project, and provide the link between administration and Trauma Services. The Vacaville resident earned her bachelor’s and master’s degrees at UC San Francisco. She’s provided the vision and organization and helped NorthBay focus on creating a program that is evidence-based for sound clinical outcomes while remaining fiscally responsible.

Dr. Pete Zopfi

Trauma Medical Director and Chief of Surgery

No stranger to Solano County, Dr. Zopfi is happy to step into his role on the trauma team. A general surgeon, he was trained in trauma during his residency in Dayton, Ohio, and now makes Fairfield his home. He’ll be in charge of the trauma surgeon schedule and will perform surgeries, too. He’s in charge of peer review, the quality performance improvement initiatives, medical review of all trauma patients and chairs the Trauma Team’s ongoing meetings.

Dr. Seth Kaufman

Emergency Department Medical Director

Overall, Dr. Kaufman is responsible for the Emergency Department operations from the medical side of the house, and for all resuscitations until relieved by the trauma surgeon or until the patient is admitted to definitive care. He earned a bachelor’s degree in neurobiology from UC Berkeley, his medical degree at
UC San Francisco, and focused on emergency medicine as a resident at the University of Chicago.

Daman Mott, R.N., M.S.N.

Director of Emergency Services and Trauma

Overall, Mott has cross-campus fiscal and administrative nursing responsibility for emergency and trauma services for NorthBay Healthcare System. A captain in the U.S. Air Force, Mott served as a certified Emergency Department/Critical Care nurse, Emergency Room manager, Special Procedure nurse for Endo, Cardiac Cath lab, house supervisor and department head at Air Force hospitals around the world from 1990 to 2007. The Vacaville resident was director of clinical support services and infection control at NorthBay Healthcare prior to his current role. He serves as the bridge between nursing administration and the operational practice
of emergency and trauma nursing.

Heather Venezio, R.N., M.S.

Trauma Program Director

The trauma program director’s job is to implement policies and procedures and track education, review trauma cases, ensure the registry data is accurate, and follow the trauma patient from Emergency Department through post discharge and rehabilitation, coordinating the span of caring for trauma patients. Prior to accepting the director position in February, Venezio was clinical lead nurse in the VacaValley Emergency Department. The Vacaville resident received her bachelor’s degree in nursing from the University of Louisiana and has a master’s from Virginia Tech. She gained extensive experience in trauma as a nurse at a Level II Trauma Emergency Department at Lafayette General Medical Center in Louisiana. She is an instructor for advanced trauma care for nurses through the UC Davis Medical Center Trauma Department and a national speaker for the Emergency Nurses Association.

Donna Nayduch, R.N., M.S.N.

Interim Trauma Program Consultant

Our interim program director is a national trauma
consultant and author who has been retained to provide oversight and insight into the details of the framework of the trauma system, both internally and externally, and to serve as a mentor to the trauma program’s leadership. Nayduch has filled roles as regional trauma director, acute care nurse practitioner, trauma nurse coordinator and clinical associate at hospitals and medical centers in Colorado, Virginia and North Carolina.

Sandy Bauman, R.N., M.S.N.

Clinical Manager of NorthBay’s Emergency Department

New to NorthBay Healthcare, Bauman brings a host of trauma experience. In Pennsylvania, she was unit manager for the Emergency Department of Ephrata Community Hospital and served as an assistant nurse manager for the Reading Hospital and Medical Center’s Emergency Department and held leadership roles in the Pennsylvania emergency nurses association. At NorthBay, the new Fairfield resident will be responsible for the daily clinical and administration operations of the Emergency Department.

Jackie Nelson

Trauma Registrar

With data entry as her specialty, Nelson has to populate the registry, filling in more than 200 data points for every trauma patient who is treated at our facility. At NorthBay, the Vacaville resident has held positions of clinic access specialist, quality assurance specialist and supervisor-patient access before taking this data analyst role with clinic infomatics.

Mary Hernandez, R.N., M.S.N.

Clinical Practice Manager for Emergency and Trauma Services

Hernandez is in charge of the clinical educational aspects of the Chest Pain Center and STEMI (major heart attack) program and acts as the Emergency Department liaison to the other clinical departments that these programs touch. Hernandez, who earned her bachelor’s in nursing from Sacramento State University and a master’s in science of nursing in healthcare education from University of Phoenix, has been with NorthBay Healthcare for the past 10 years, working as a nurse in the Emergency Department, and was night shift team lead for five years. She accepted the role as Chest Pain Center Clinical Practice Manager two years ago. She is instrumental in the development and delivery of staff education for all of our specialty programs in the Emergency Department, including trauma.

The Golden Hour

2011-10-07T02:10:52Z

Emergency Medical Service personnel rush a patient in to the NorthBay Medical Center Emergency Department.

In emergency medicine, the "golden hour" refers to the first 60 minutes after a trauma has occurred. It is widely believed that a victim’s chance of survival is greatest if he or she receives emergency care within the first hour.

The golden hour was first described by R. Adams Cowley, M.D., at the University of Maryland Medical Center in Baltimore. Dr. Cowley’s personal experiences and observations in post-World War II Europe, and then in Baltimore in the 1960s helped him recognize that the sooner trauma patients reached definitive care—particularly if they arrived within 60 minutes of being injured—the better their chance of survival.

The concept of the golden hour comes from U.S. military experience. MASH units and medevac helicopters in the Vietnam War contributed to increasing survival rates. Improvements in medications, techniques and instruments were key to survival, but none of these were of any value if the patient remained separated from the surgeon.

A Matter of Priorities

2011-10-07T02:10:37Z

Triage Nurse Calls Shots in ED

ED nurses Mika Miriani (left) and Missy Smith assist a patient.

Emergency departments are organized to care for the most critical patients first. That’s why if you come to an ER and your problem is not life-threatening, you may not be seen immediately. The order in which you are assessed by an emergency department practitioner, in a full emergency department, is determined by the triage nurse.

"Triage" is a French term used for the quick assessment and assignment of level of care for patients according to the resources needed to care for that patient. "An experienced triage nurse can assess a patient in less than two minutes," says Erica Taylor, R.N., an ED nurse at NorthBay VacaValley Hospital. "You’re acting as an investigator, trying to gather as much information as you can to navigate the patient to the correct resources."

Pulse, respiration, mental status and skin signs are the four keys used to assess a patient’s condition. Mental state is determined by asking if the patient knows their name, the date, and where they are. By touching the patient’s wrist, pulse rate and quality are assessed, while at the same time the nurse is observing the patient’s rate of breathing. Skin signs, including whether the skin is cool, clammy or hot, or if bleeding is present, help provide valuable clues to the patient’s stability and help to determine the patient’s route to care.

"I also ask questions I call the five ‘Ws,’ Taylor says. "Who, what, when, where, why. Who are you, what happened, when did it happen, where did it happen and why or what brings you in today?"

Who are you, what happened, when did it happen, where did it happen and why or what brings you in?

Both NorthBay Medical Center and NorthBay VacaValley Hospital have a triage nurse available 24 hours a day to monitor the ED waiting rooms.

It is the hospitals’ goal to triage every patient within 15 minutes of their arrival and get them to see an ED practitioner as soon as possible.

NorthBay uses five official triage levels, ranked from Level 1 to Level 5.

Level 1 is the highest priority. The patient needs immediate physician evaluation and intervention. Level 1 case includes cardiac arrest, respiratory arrest, stroke, heart attack, critically injured trauma patients and patients having an anaphylactic reaction (a reaction that causes swelling in the airways, usually an allergic reaction).

Level 2 recognizes the patient in a high-risk situation. It could be active chest pain, an overdose, an asthma attack, trauma from a motor vehicle accident or a patient who is confused, lethargic or disoriented.

Level 3 is for the patient who needs two or more resources (lab work, x-rays, IV fluids, etc.) but who can safely wait awhile to be seen by the ED practitioner.

Levels 4 and 5 are reserved for the patient who needs one or no resources. They made need a wound evaluated, sutures, simple cough and/or runny nose, and a possible prescription refill. Patients with minor complaints usually fall into this category and when the ED is busy, they have the longest wait times for treatment.

Never a Dull Moment

2011-10-07T02:10:01Z

Maria Miralles, R.N., provides a little TLC to patient Dixie Doss of Fairfield.

Maria Miralles, R.N., cut her teeth in a busy Detroit hospital, where her colleagues would see a dozen or more gunshot wounds a day. That was on top of all the other trauma and emergency cases that would blow through the doors, easily filling up their 120 emergency department beds.

It was a far cry from her start in the business as a dialysis nurse. But somewhere along the line, someone saw potential in her ability to corral chaos and redirect the energy into an efficient, streamlined process.

And it’s those skills that make her so valuable in NorthBay Medical Center’s Emergency Department, say her colleagues, especially as a trauma program is being crafted.

"She’s dynamic," says Daman Mott, director of Emergency Services and Trauma. "She knows what needs to be done, and she gets it done. She brings high energy and compassionate care and instills those values in her team."

Mika Miriani, R.N., agrees. "Her experience in trauma is extensive," she says. "You really want to be
her friend because she has so much knowledge to offer."

That may be because Henry Ford Hospital in Detroit, where she learned her skills, was a Level I teaching facility.

"When I started there I thought I wouldn’t last three months. It was new, scary and intimidating. But I went in and learned everything I could. I studied and learned that I really liked it," says Miralles. "I guess I’m a strong person, and I like looking at the big picture and prioritizing."

On a busy Friday night in June, she’s doing just that. Although her day is just winding down about 5 p.m.,
she’s still juggling the needs of several patients, and directing traffic as it pulses around the busy nurses’ station.

Miralles puts an arm around Dr. Mark Popil’s shoulders and asks if he will promise to have a quiet night so that when she returns at 6 a.m., it won’t be too frenzied.

He just smiles.

"I actually like it when it’s busy," she confides. "I love helping staff, teaching them what they need to know to get the job done."

Although NorthBay’s Emergency Department facilities are much smaller than Detroit (a combined 36 beds), there are still plenty of challenges, she notes. In addition to a steady steam of traffic and a wide variety of cases that you’d find in any ED, she’s excited about the new programs NorthBay is adding.

"In Detroit, we already had a stroke program, a trauma program and a STEMI (heart attack) program. Here, we’re just adding those things, so I can volunteer my input and be involved as we create our systems. It’s really a very exciting time to be here."

Language is No Barrier

2011-10-07T02:10:55Z

Rodney Manko, R.N.

If you ask Rodney Manko, R.N., a question, you could get your answer in English, Spanish or with a flash of his hands. He is quadrilingual, if you count the fact that he can sign in either English or Spanish. And in a pinch, he can converse in Italian or Portuguese, although he’ll be the first to tell you he has a "funny" accent and that something might be lost in translation.

Manko has been with NorthBay off and on since 2004, even though he owns a home in New Orleans and travels "home" nearly every six weeks. Since Hurricane Katrina wiped out a number of hospitals in the area, he’s enjoyed the steady work at NorthBay. He was one of the lucky ones. He lost only a dozen shingles off his home, which is about 20 blocks outside the French Quarter.

He loves his work in the Emergency Department, because you never know what might come next. And with his special skills, he’s often called to intercede and help clarify the situation.

One case he remembers was a deaf woman with a rapid heart beat. "She was trying to communicate by writing on a piece of paper, but she was stressed.
I was able to come in and calm her down, and take care of her."

Another time, he was called in for a deaf woman about to deliver a baby. "The only problem trying to communicate with her is that she’d keep closing her eyes every time she had a contraction," he chuckles.

When language is a barrier, NorthBay employs the Cyraphone, which offers an interpreter any time of the day or night, in dozens of languages.

"It’s a wonderful device," says Rodney. "But sometimes it’s just better to be there in person to help translate and to be able to ask questions and get answers faster."

New Emergency Services Director Shares Insights Online

2011-10-07T02:10:38Z

When Daman Mott first started blogging for NorthBay Healthcare in 2009, it was all about the H1N1 flu. As director for infection control, it then was his job to make sure the public understood how to protect themselves and their loved ones against the dangerous virus.

Mott has accepted a new position as Director of Emergency Services and Trauma. So the focus and name of his blog changed.

Instead of "Flu Facts," it’s now "Matters of Health," and can be found on www.NorthBay.org with updates once every week or two.

"I focus on various aspects of health that are informative and interesting to the reader. Lately the discussion is about creating a trauma program," says Mott, whose military background often creeps into his posts. The former Air Force captain has written about the critical connection between the military and trauma care. He’s also explained Emergency Medical Services in Solano County, and trauma department drills as his team prepares for NorthBay Medical Center to become a Trauma Center.

"It’s a great opportunity to share the behind-the-scenes stuff. We have an amazing crew here, and I want to showcase their efforts, and keep trauma in the spotlight—in a positive way."

When to Visit the ER

2011-10-07T01:10:45Z

More than half of the visits to hospital emergency departments nationwide are not emergencies. That’s true also at NorthBay Medical Center and NorthBay VacaValley Hospital Emergency Departments, according to Emergency Physician Caesar Djvaherian, M.D.

Because emergency departments are staffed with physicians and nurses with the advanced training to care for any emergency that comes through their doors, unnecessary emergency care is the most expensive care you can receive—especially if you just have a bad cold or the flu.

While no one plans a visit to the emergency department, everyone can learn the warning signs and symptoms of true emergencies. These include difficulty breathing, shortness of breath, fainting, sudden dizziness or weakness, changes in vision or difficulty speaking.

If you’re alarmed by unusually severe symptoms, it’s best to seek immediate care, Dr. Djvaherian advises. In the case of stroke, quick treatment can reverse the damage, but only if treatment is given within the first three hours following the start of symptoms.

Other reasons to visit the emergency room include any sudden or severe pain, uncontrolled bleeding, severe or persistent vomiting or diarrhea, coughing or vomiting blood, unusual abdominal pain and suicidal or homicidal feelings.

"I really think it was a matter of everything lining up," Michael says. "That’s why I believe in a higher power. I’m not done yet."

When is Pain an Emergency?

If you have been injured and are in pain, or experience a new pain, especially in your head, chest or abdomen, call 9-1-1 and get to a hospital emergency department, says Emergency Physician Caesar Djvaherian, M.D. Quick action when you suspect a heart attack or stroke will give you the best chance of making a good recovery.

However, if you have chronic pain, or have braved a pain for two weeks or longer, your best course of action is to visit your own physician. "The Emergency Department doesn’t have a comprehensive way to treat chronic pain," Dr. Djvaherian says.

Many health plans have an advice nurse available by phone for consultations. An advice nurse may be able to determine whether heading to the Emergency Department is appropriate for your pain.

Treating Children in the ER

If you think your child is having a medical emergency, always seek immediate medical attention. Children may display different symptoms than adults, and what is mild for an adult could be serious for a child. And, young children may not be able to communicate how they feel, which means adults must interpret their condition.

"Often parents just need reassurance that their child is OK," says Dr. Djvaherian. "We will evaluate the child and advise the parents on any medical care that is needed."

Children with serious illness or injury are stabilized and transferred to hospitals that specialize in childhood medical care. These include Oakland Children’s Hospital and the UC Davis Children’s Hospital in Sacramento.

OK, Call an Ambulance

Why should you call an ambulance instead of driving to the Emergency Department? It’s tempting to pile into your car and rush to the hospital when you or a family member is ill or injured, but you’re actually delaying important treatment.

Calling 9-1-1 alerts the emergency medical community that help is needed. When the ambulance arrives, the patient immediately receives an expert evaluation and any treatment can begin. The paramedics will know how to move a patient without causing further injury. And, en route to the hospital they will monitor the victim’s condition and be ready to act should it worsen or become life-threatening.

What hospital should the patient be taken to? Depending on the illness or injury, the ambulance crew may choose the hospital for you. For example, a patient with a possible heart attack may be routed to a hospital with a Chest Pain Center where heart experts are waiting to provide care.

The ambulance crew also alerts the hospital about the patient’s condition and what they need to be prepared for. This gives the ED time to alert any special staff that may be needed.

When you call 9-1-1, the dispatcher will ask a number of questions. Be prepared to give your name, the address, phone number, location of victim (such as upstairs in the bedroom), and nature of the medical problem. Speak calmly and clearly and answer any questions the dispatcher asks.

Wellspring

Prepping for Trauma

Because We Care

Fiscally Responsible Decision

The Time is Now

Life in the Emergency Department

It’s 6:45 p.m. on a warm Fairfield evening…

Care in the Air

Helicoptor Flight Crews Handle All Circumstances

Morgan’s Gift

Donor’s Mantra: Save Lives!

Donor’s Mantra: Save Lives!

Return to Tranquility

Marriage of Cardiac and Vascular Solutions Help Monk

Patient Beats the Odds

Next Step for Chest Pain Center

Know the signs and symptoms of a heart attack:

A Real Victory for the Citizens of Solano

There are four levels of trauma centers in California:

Meet NorthBay's Trauma Team

Kathy Richerson, R.N., M.S.

Dr. Pete Zopfi

Dr. Seth Kaufman

Daman Mott, R.N., M.S.N.

Heather Venezio, R.N., M.S.

Donna Nayduch, R.N., M.S.N.

Sandy Bauman, R.N., M.S.N.

Jackie Nelson

Mary Hernandez, R.N., M.S.N.

The Golden Hour

A Matter of Priorities

Triage Nurse Calls Shots in ED

Never a Dull Moment

Language is No Barrier

New Emergency Services Director Shares Insights Online

When to Visit the ER

When is Pain an Emergency?

Treating Children in the ER

OK, Call an Ambulance

There are four levels of trauma centers
in California: