Real life ‘ER:’ a day at Tahoe Forest
Hordes of skiers and snowboarders blanketed the slopes of area ski resorts during the holidays. Some walked away with happy holiday memories and others with casts, splints and memories of the inside of a Truckee or Donner Summit ambulance.
Memories left behind at Tahoe Forest Hospital were of injured weekend warriors lining the hallways in the emergency room and nightmares of short supplies for its staff.
“At one point people were just camped out in the hallway,” said staff nurse Beverly Brink. “We were completely overwhelmed, but kept the flow going.”
Brink said the emergency room saw between 95 and 119 patients each day. A “normal weekend” day brings in about 70 patients.
Tahoe Forest reported 119 patients were treated in the emergency room New Year’s Day, filling the available 26 beds and chairs behind the swinging white doors.
“We’ve done everything we’ve could to accommodate patients so that they don’t have to wait in the waiting room,” Brink said.
And it’s worked, according to the emergency room’s goal to make sure patients are seen by a nurse within one hour. When patients begin stacking up at the registration desk, a triage nurse starts taking vital statistics and performing medical checks of patients waiting for treatment. Many times there is no need for the patients to go any farther.
“It’s like the checkout line at Safeway,” she said. “If patients have to wait more than an hour, another doc is called in.”
Dr. Michael Knott said he is sometimes amazed at how well patient care flows in the emergency room at peak times.
“We rise to the occasion and work like a well-oiled machine,” he said.
Most of the staff has been with the hospital for about 15 to 20 years, since the emergency room wing was built.
In that time the nurses have perfected ways to take off ski boots from fractured legs and remove one-piece skiing clothing without cutting the clothes.
“We’ve come a long way,” Brink said. “We want to make sure our patients are treated as gently as possible. We can appreciate nice ski clothing and would rather keep it intact. I don’t know why ski patrollers always need to cut jackets off people, when there are other ways to remove the clothing.”
The staff has adapted to dealing with seasonal fluctuations in the number of patients that come through their doors, either by ambulance or by walking up to the desk.
By staffing up and having additional staff on-call, the department has been able to deal with the crunch. Medical emergencies tend to happen in the morning and trauma emergencies tend to happen in the afternoon. The staffing adjusts for the cycle.
Nine nurses, two doctors, three clerks and two radiologists handled the injured Saturday.
The crunches these days seem to be evidenced by the number of broken wrists and upper extremity fractures caused by snowboarding.
Even the son of a Tahoe Forest Hospital orthopedic surgeon was treated for a wrist fracture Saturday. Dr. Jim Fischer left the OR to see his son in the ER.
“Snowboarding injuries are generally wrists,” Brink said.
“With skiing there used to be lots of tib-fib (tibia-fibula) fractures, then we went to hip fractures, now we’re back to tib-fibs. It’s interesting to see how injuries change as equipment changes.”
When the snow is hard as it has been, more faces see abrasions, more “bells get rung” and more bones break.
“But this is just one part of the entire system that gets busy,” Brink said.
Ambulances run constant circles to and from the hospital, and the hospital’s maintenance and food service staffs get hopping.
“We all have to work harder when the emergency room is packed. Dietary takes good care of us when we’re too busy to eat.”
The ER staff works on shifts that last between eight and 12 hours, and throughout the day shifts rotate in and out of the schedule.
Knott said in addition to the ski and snowboard injuries inundating ER, during the holidays, more people seek advanced care for colds, flus and gastrointestinal problems.
“When people are clustered together, they get sick together.”
Brink said that in addition to the medical staff, the clerks fill in to make sure the emergency room stays organized.
“Without the clerks, we would be lost,” she said. “While we are taking care of the patients, the clerks are notifying relatives and arranging lodging in addition to doing a million other things.”
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