Westchester

Editor’s Note: The office of the U.S. Navy has been sending a steady stream of images of our servicemen and servicewomen in action. Today, thought about them working in areas of frigid temps too. I thought I’d share a few along with a pertinent message included in each release–reminding us to be grateful.

“Why Being There Matters”

On our planet, more than 70 percent of which is covered by water, being there means having the ability to act from the sea. The Navy is uniquely positioned to be there; the world’s oceans give the Navy the power to protect America’s interests anywhere, and at any time. Your Navy protects and defends America on the world’s oceans. Navy ships, submarines, aircraft and, most importantly, tens of thousands of America’s finest young men and women are deployed around the world doing just that. They are there now. They will be there when we are sleeping tonight. They will be there every Saturday, Sunday and holiday this year. They are there around the clock, far from our shores, defending America at all times.

Thank you very much for your support of the men and women in U.S. Navy, deployed around the clock and ready to protect and defend America on the world’s oceans.

Very respectfully,

Petty Officer David McKee
Navy Office of Community Outreach

By Grace Bennett

As of February 10th, one patient brought in from the Metro North crash remained in critical condition, according to a Westchester Medical Center spokesperson, Andy Laguardia.

Three more, of the original 12 patients brought in, were in fair condition yesterday.

The prognosis for anyone in fair condition are “favorable,” according to an interview with Westchester Medical Center’s Medical Director of WMC’s Emergency Department, Ivan Miller, M.D. Dr. Miller offered summaries of the American Hospital Association standards WMC follows, per this reporter’s inquiry, to say that the vital signs in a patient deemed in fair condition are considered stable and normal. “The patient is awake and alert; all indicators point to a favorable diagnosis.” A “good condition” is when a patient is ready or near ready for discharge–and all vital signs are “excellent.”

In contrast, in a patient listed in critical condition, Dr. Miller said, vital signs are considered unstable. “The patient is possibly unconscious and the condition is threatening to life or limb or to an organ.” A patient still in “serious” condition, he said, can have abnormal vital signs, but are typically still conscious. “Indicators are more favorable but it is all a matter of degree too.”

At the outset, the WMC team prepared for the worst, as they do for every disaster or patient arrival, he said. On the night of the crash, for example, the hospital related that a team of 100 were standing ready. “This is what we do,” said Dr. Miller. “When patients roll through the doors, we assume the worst and mobilize to stabilize as fast as possible,” he said. “Stabilizing,” he explained, “may be as simple as pulling a broken bone into proper alignment while also preventing damage to the soft tissue around the bone with a cast or a splint.”

If there is excessive bleeding, or signs of a large amount of blood lost, the team may need to resuscitate with an IV or blood transfusion. Pain and pain management is another key factor in determining a patient’s condition. “If the patient is considered in severe pain, he or she is not considered stable either.”

A host of specialized surgeons stand ready to intervene. “A severe blow to the head with bleeding inside the skull” requires a highly trained neurosurgeon in the area of trauma medicine, for example.

Dr. Miller declined to speak of any specifics of the nature of the injuries to any patient admitted to WMC from the Metro North crash itself. Generally speaking, he did explain that in trauma situations, more life threatening injuries are avoided when, as one example, lacerations do not hit a critical area. “A laceration to the arm, for example, may not be life threatening, while one to the neck where a large vein could possibly be ruptured are far more likely to be.” He emphasized that as a transport center from other hospitals without the same staffing and resources available to WMC–a regional trauma center–the hospital was well equipped to handle the Metro North and worse disasters, and have.

By Grace Bennett

All things considered, the news about those injured in the fiery Metro North crash that claimed six lives was heartening, according to an update relayed by a team of experts at Westchester Medical Center (WMC) earlier today.

The team also offered reporters gathered a detailing of the Emergency Room decision making process, otherwise known as triage, that took place behind the scenes as the crash victims arrived.

Dr. Joseph Turkowski, director of WMC’s Burn Center: “We were expecting a lot more and a lot worse injuries; fortunately the staff was mobilized well. Our concerted group effort really worked well.”

Added Dr. Ivan Miller, medical director of WMC’s emergency department: “Injuries were confined to those who were in the first car. The rest of the train was spared which made a huge difference.”

As of the 12:30 p.m. update, Patricia Wrobbel, Chief Nurse Executive, said one patient remained in critical condition, one in serious, four in fair, and two in good. Four patients were discharged by morning.

Beginning at 7:20 p.m. Tuesday, as the injured arrived, Wrobbel said 9 of the 12 patients presented with injuries severe enough that these patients received what is referred to as “Level 1 trauma activation.”

“After closer evaluation the triage specialists found that five of those patients were still in need of Level 1 activation: basically, mobilizing operating room resources and a group of specialists into action including a trauma surgeon. “Level 1 activation doesn’t mean the patient will be critically ill; we mobilize just in case,” said Dr. Miller.

As a regional trauma center, the WMC teams were prepared to receive dozens of patients when news of the crash reached them. “Our mission is to be prepared; every day, we get patients transferred to us from other facilities with fewer resources,” said Dr. Miller.

The 12 patients (all adults) arrived via ambulances from the Valhalla station. The WMC teams then began the time honored method of triaging. “Anytime you have multiple patients, you have to prioritize and see where the most diagnostic and treatment energy needs to be spent.

“Reports from the EMS technicians allowed us to pre-plan, direct patient to right staff, with doctors and nurses working together to redirect patients,” said Dr. Miller. There were also 40 patients already in the Emergency Room, including some children, upon the arrival of the crash injured victims. “Obviously those patients have needs too so all of this had to be done very carefully,” said Dr. Miller.

He said patients arrived with “burns, lacerations, flame and smoke inhalation, fractures, including open fractures–bone exposed to the air–with sometimes bone sticking out, crush injuries, dislocations, minor head injuries and scrapes. The degree of injuries ranged from stable to serious, said Dr.Turkowski, and ‘a silver lining’ was that the extent of the injuries were generally not as severe as they could be. “We have seen much more serious injuries here that can and do result in death.”

Helping Patients Battle the Pain of Burns
Still, three patients remain in the burn unit where managing pain is a key challenge. “There’s a lot of pain with burn injuries; there’s a whole side of the treatment plan dedicated to pain management, with wound care the most painful aspect,” explained Dr. Turkowski.

“The pain is there all the time. Patients are asked to walk around as much as they can too so they don’t lose function.” Smoke inhalation can complicate a burn victim’s recovery as well, he added.

Commenting on anticipated recovery time for the crash victims who sustained burn injuries, Dr. Turkowski answered: “I’m expecting a few patients to spend a week or two at the hospital; others will be sent home in a day or two.”

Dr. Miller made an observation about the wherewithal of some of even the most injured patients. “One theme in talking to people even with severe injuries: People focused on what they saw. I’m sure those people will never forget what they saw…it was almost like a wartime experience when you see people die right in front of you.”

Patricia Wrobbel noted: “A team of Chaplains and whole crew of social workers were available to speak to patients and also help family members who arrived wondering if their loved ones are ok.”

Dr. Miller pondered those who perished. “We know a number people died at the scene. I wish I’d had had the chance to treat six more patients…”

Assemblyman David Buchwald (D-Westchester) announced that a total of 23 Assembly members, himself included, have put forth a series of questions to the candidates running for Assembly Speaker. These questions have been delivered to every member of the Assembly Democratic Conference so that they all have an opportunity to sign on.

“When I was elected to the State Assembly in 2012, I promised to bring a fresh approach to Albany so that we could restore public trust and foster a culture in which government functions responsibly and ethically,” said Assemblyman David Buchwald. “While recent events and allegations have been troubling to say the least, this upcoming race for Assembly Speaker presents a vital opportunity to present a reform-minded approach. I’m very pleased to join my Assembly colleagues in asking the Speaker candidates for their priorities when it comes to institutional reform, and to continue making progress on our broader effort to make Albany work for the people of New York. The time has come for a change.”

View the reform letter (PDF)