At left is Dr. Paul Willette, general and fellowship trained trauma surgeon at Box Butte General Hospital, shaking hands with Dr. Jerry Jurkovich, Chief of Surgery and Trauma Services at Denver Health’s Rocky Mountain Regional Trauma Center. Dr. Jurkovich recently visited BBGH.

Staff from the Box Butte General Hospital (BBGH) Emergency Department, medical providers and other health professionals recently attended a three hour presentation at BBGH by Dr. Paul Willette on “Shock and the End Points of Resuscitation” and Dr. Gregory Jerome (Jerry) Jurkovich on “ABCDE – Trauma’s Primary Survey.”

Dr. Willette is a general surgeon at BBGH. He is also the only fellowship trained trauma surgeon in Greater Nebraska.

Dr. Jurkovich is Chief of Surgery and Trauma Services at Denver Health’s Rocky Mountain Regional Trauma Center, a Level I Trauma Center. The Center and its trauma team care for more than 2,000 of the region’s most severely injured patients each year. Dr. Jurkovich came to Denver Health from Harborview Medical Center in Seattle, WA, where he served as Chief of Trauma since 1994. He is also a professor of Surgery at the University of Washington School of Medicine. He graduated from the University of Minnesota School of Medicine and completed his post-graduate training at the University of Colorado School of Medicine. Dr. Jurkovich is a Director of the American Board of Surgery and serves as an Associate Editor for the Journal of the American College of Surgeons. He has also served on the editorial boards of the Journal of Trauma.

Dr. Willette and Dr. Jurkovich have been in frequent contact over the past year, with Dr. Willette invited to Denver Health to take an active role in presentations on a variety of trauma care topics. The visit to BBGH in December by Dr. Jurkovich was his first.

Dr. Willette’s presentation was designed to introduce Dr. Jurkovich to how well the BBGH Emergency Department staff provides trauma care. He was also informed of the triage procedures used to determine what level of care is needed, be that care given locally at BBGH; a Level II trauma center such as Regional West Medical Center; or a Level I trauma center such as Denver Health’s Rocky Mountain Regional Trauma Center. Dr. Willette’s presentation was very detailed and technical in nature for the health care providers present. He explained the types of shock found in trauma patients; how to determine what type of shock the trauma patient was exhibiting; and how that type of shock should be treated. Resuscitation procedures were also discussed in depth.

“My presentation was designed so that Dr. Jurkovich could see that not only can we do trauma well at BBGH, we can also provide resources to the region in shock treatment and end point resuscitation,” Dr. Willette said. “In trauma, it’s all about getting the right patient to the right place at the right time. Eighty percent of the time we can treat trauma patients here at BBGH. If, during the triage process, it’s determined that Level II trauma care is needed, we’ll continue to transport patients to RWMC as we’ve always done in the past. We want Denver Health to know that when we send a patient to them, it’s because that patient needs Level I trauma care and that we aren’t wasting their time and resources.”

He said having Denver Health on board as a partner with BBGH in trauma care is important. “Of people ages zero to 40, more die from trauma than anything else,” he said. “Whatever we can do here, we’re going to do here. But then part of our job is to triage what is the appropriate higher level of care, if needed. Sometimes it’s Level II, sometimes Level I. You want partners in both those levels of care. We’ve long been a partner with Regional West. That relationship will continue. Having a partner like Denver Health for Level I care now gives us choices and capabilities for our patients. Being associated with Dr. Jurkovich and his team of trauma surgeons and intensive care unit personnel gives us a certain level of security and assurance that we can be as capable as we can be, and yet when it’s too much for us or the hospital, his team is there to help us.”

Dr. Jurkovich also provides lectures via web conferences that will be of great value to Emergency Department and medical staff at BBGH. “We are exposed to a very talented group of people at Denver Health for trauma and critical care; an educational system we can use as a resource in a very effective way,” Dr. Willette concluded. “That will help us not only in the Emergency Department, but other departments as well, such as respiratory care or intensive care. Every team member at the hospital can benefit from this association.”

The head of Denver Health’s Trauma Center spent most of his presentation quizzing staff members on the A (airways) B (breathing) C (circulation) D (disability) and E (exposure) acronym used by Emergency Department teams across the nation during primary surveys of trauma patients. The following is a synopsis of his presentation.

“Checking a trauma patient’s airway is always first,” Dr. Jurkovich said, “simply because if it’s obstructed, you can’t put in any oxygen. And a patient can only last five minutes without air.” After making sure the airway is clear, the next step of the survey is breathing, assessing airway patency and breathing adequacy through clinical observation. The next major part of the survey is circulation. “The very first thing you do at this stage is to stop any bleeding,” he said. “It’s not putting an IV in; it’s not taking blood pressure. It’s stopping the bleeding. Once stopped, then you can concentrate on assessing them, e.g. blood pressure, whether transfusing is needed to increase blood volumes and all the rest that comes with circulation.” He went on to explain Disability (assessing the level of consciousness in the patient, along with determining any motor or sensory deficits) and Exposure (undressing the patient and looking for injuries). “This primary survey procedure is the systematic approach used for trauma patients across the nation, be they adults or children; in both blunt and penetrating trauma cases; in the old and the young. It’s the same for all of us. The only time it’s different is in the military, where circulation is often placed first because of the nature and severity of injuries incurred in combat.”

After conducting the primary survey, trauma teams then conduct a secondary survey, which is a head to toe physical examination. “If the patient is still not doing well, then what do you do?” Dr. Jurkovich asked. “Simple … you start all over again with the ABDCE primary survey. As Dr. Willette said during the blood pressure part of his shock treatment presentation, there could very well be internal bleeding going on that wasn’t caught the first time around. So you start, again with airways, then on to breathing, circulation …so on and so on. The key is having and adhering to this systematic approach when treating the trauma patient.”

Dr. Jurkovich concluded by saying he was pleased to be able to meet and visit with the medical staff attending the lecture.

BBGH is a non-profit, county owned 25-bed Critical Access Hospital. The mission of BBGH is to lead and innovate in healthcare delivery and community wellness.