Joey Wahler (Host): It can help save lives. So we're discussing critical access and trauma care. Our guest is Dr. Kathy Goner. She's emergency department medical director for Tahoe Emergency Physicians at Carson Valley Health. This is Valley Vitals, the pulse of healthy living in our community, brought to you by Carson Valley Health.

We're going beyond the checkup to bring you real conversations with the experts you trust. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Welcome.

Kathi Glauner, MD: Hi. Thanks for having me.

Joey Wahler (Host): Great to have you aboard. We appreciate the time. So first, Carson Valley Health recently was designated as a level four trauma center. So how exciting is that And for those unfamiliar, what exactly does that mean?

Kathi Glauner, MD: So it's very exciting for us. Um, we are the first level four trauma center in Nevada. that legislation was just passed at the end of last year, so we're very excited. to be able to achieve that designation. what it really means is that we have, protocols in place and personnel to be able to provide 24 hour a day trauma care, to the patient's of the area.

Joey Wahler (Host): And when we say level four, maybe give us a perspective please, of what that means.

Kathi Glauner, MD: Okay. there are four levels now in Nevada. before this, there were just three. Level one is the highest level of care, so they're required to have, all the surgeons that they would need to take care of a trauma patient. Really all of the specialties. everyone in house and ready to go.

as you move down through the levels, the requirements are less for all those specialty services. and level four is really a designation that allows us to provide emergency stabilization, surgical care when we are able to do so. and very importantly also transfer to higher level of care.

Joey Wahler (Host): Absolutely, and we'll ask you more about that in a moment. But first, just take a quick. Step back, doctor, can you remind us in a nutshell what constitutes an emergency room visit? Because unfortunately, many wind up in the ER that don't necessarily need to be there. Right.

Kathi Glauner, MD: I have. A pretty generous attitude toward what constitutes an emergency department visit. I really do feel that if someone is at home and feels they're having an emergency, they should come to the emergency room. You know, there's not a lot they can do to decide this isn't an emergency when they're at home, especially if they don't have the information they need to make that distinction.

so anytime someone's feeling really scared about what's happening to them or their family member, they should come in. that said, there are some things that are. More emergent medically than other things. those would involve anything that seems like it could be a heart attack. so chest pains, real shortness of breath, feeling lightheaded, those kinds of things could be indications that someone's having a heart attack.

and they would need to come to us if you go to urgent care, they won't be able to take care of that complaint. stroke symptoms. So confusion, difficulty speaking, facial droop, weakness on one side of the body, or some of the classic symptoms of that kind of thing. anything that involves kind of concern for losing your life or part of your body would certainly constitute an emergency department visit.

Joey Wahler (Host): So I appreciate your response there because you're basically saying, when in doubt, if you're not better informed, come to the emergency room. Right.

Kathi Glauner, MD: Right. That's what we're there for. We're really there to make sure that what is happening is not an emergency, and if it is that you're getting the care that you need for that emergency.

Joey Wahler (Host): So better safe than sorry there. Now, why is this level four designation particularly important to a rural facility like CVH And the community that it serves?

Kathi Glauner, MD: the trauma designation is something that really kind of puts together a whole group of services that can now reach out to the people who are in our rural area. So the patient's that we have aren't necessarily really close to a fire station or a fire truck or an ambulance.

they might be a little further out. And so each minute along the way of getting help to them. Is an important minute. having our service closer to them so they don't have to go all the way to Reno to reach a trauma center just means that they can get care a lot faster.

so we can receive them at our hospital, do whatever's needed to stabilize them and move them onto the next hospital, or perhaps keep them at our hospital and provide care closer to their families.

Joey Wahler (Host): Absolutely. Now, can you explain what the so-called golden hour means and why CVH is now better able to deliver the quick response that's needed to. Rest that.

Kathi Glauner, MD: Sure. so the golden Hour in trauma, is a belief that the quicker a person can receive care, especially definitive care. The more likely they are to survive their injuries and have a meaningful life afterward. so it's been called the Golden Hour. Traditionally we moved a little bit to more the golden period because that time required to save a person.

You know, the shortness of time is more dependent on what that individual's injuries are. so it's a golden period was still the goal being that care would be received. In the shortest amount of time possible. and if you can do that, then you can really decrease loss of function, loss of quality of life.

so the things that go into that are all the things that we've been working on at Carson Valley to try to help the people of our area. So getting EMS services more quickly to the patient's, getting them treated at a hospital more quickly. Okay. And that treatment doesn't have to mean you're getting surgery right away.

It can mean we're doing things like stopping loss of blood, getting blood pressure stabilized, treating infection, You know, if there's an open fracture, so a bone is broken And the skin is broken on top of it, that's high-risk for serious infection. So if we can get antibiotics on board right away.

Before they're sent to wherever they're having their surgery, then that helps survival rates as well. so having our services more nearby And the whole network of services now set up to be able to facilitate transfer to our facility or to renowned, kind of depending, just makes all of that possible in a much more rapid timeframe.

Joey Wahler (Host): Absolutely. So what did it take for CVH to obtain this level four designation? How did that come about?

Kathi Glauner, MD: this has been a really long process. It's been years in the making, I think maybe seven years or so. So, it precedes me as the medical director. Targe OBAs was our director before, and she kind of got it started, along with Jeff Prater, who's our CEO. they worked on really like trying to get all the protocols together And the care together people that we needed within the emergency department And the facility so that we could provide this care to our patient's even without a level four trauma designation.

So that's something that didn't exist those seven years ago. she really kind of set this all in motion to get a trauma director in the emergency department to have someone really. Taking care of, documenting what the trauma protocols were, how many patient's we were seeing, what we were doing for them, how are we getting them to definitive care.

so it's been a huge investment of time, and effort on the parts of people in the emergency department, the executive team at the hospital, reaching out to legislators, and, trying to get this level four designation approved by the state

Joey Wahler (Host): what's the biggest difference now for your trauma center as a result of this designation to be able to deal with all of that?

Kathi Glauner, MD: Right. So if we're talking specifically about trauma, I would say kind of the. preparation of protocols and guidelines that really help the whole team to follow a very standard procedure of here's what we're seeing, here's what we're doing. What's the next step? We have the radiology tech available right away.

We have lab available right away to get that blood drawn and sent over to lab. We have respiratory therapy. We have the emergency physician, we have the nurses, we have technicians. All of those people know when a trauma comes in, This is what my role is, these are the tasks that I need to complete.

these are the critical steps that I need to perform when that patient comes in. And so a lot of it is really, as emergency physicians, we're all trained in this, but coming into a smaller, more rural area, not all the nurses have a lot of training. And so, and not the radiology techs, the lab technicians, they don't have that training.

Helps them to step by step, go through, these are the really important things to do. So now we have that set in protocols and guidelines for all of the staff who respond to traumas and it works more efficiently, right? Everyone knows what they're doing. They're not scared as a first response.

It's really like, okay, here's what we have the protocol for. Let's get this done. Let's treat this patient and get them to their correct location. Let's make sure we get all the testing done that we can. Do here, that's appropriate to do, and let's make sure they're stable and ready to go or ready to go to the OR here or into the hospital or home.

Joey Wahler (Host): Gotcha. So, It sounds as though. There's no question. There is a method to being prepared to handle just about anything despite that unpredictability. Right. Couple of other things for you. You touched on it earlier. I'd like you to expand, please. How well equipped is CVH now to transfer patient's to a level one, two, or three trauma center if that's what's needed?

Kathi Glauner, MD: we're very well equipped for that now. it's something that Jeff Prader. Has been very involved in making sure that we have all the resources we need on the outside. And we work in conjunction with Battle Borne Medevac, which is one of the, air medical companies. So they transport patient's in.

To us from these remote locations. and can also transport to, we generally go to Reno, which is a level two trauma center in Reno. we also use Care Flight, so we have two helicopter companies available to us very nearby. we also worked with East Fork, which is our, ambulance and ground.

Transportation, and their dispatch to make sure that the calls go out appropriately, that we're getting the services that we need in. they work closely with Battleborn to get us either helicopter or ground to transportation. So, it's really very well set up to get the patient's moved out. we also have a close relationship with renown and are able to very easily transfer to their emergency department generally for the trauma patient's.

Joey Wahler (Host): what would you say is the most rewarding part for you and your team about being part of this new chapter? Right.

Kathi Glauner, MD: it's amazing in a few different ways. We are all emergency medicine trained physicians in our group. This is part of what we want to do as physician is really provide the best care in the most rapid manner possible, And the most efficient manner possible and be able to get patient's the care that they need.

so it's been really wonderful to have an administration that supports that in our hospital. It's great for our patient's because now they can receive care closer to home, which makes a huge difference to a family that lives a little bit further away, to not have to go an additional distance.

Maybe they can visit from home instead of having to find a hotel. it's been really amazing to just feel that support and now have, you know, the guidelines in place And the support of the state itself, And also to feel like we've been a part. part of this hospital in helping to move this legislation forward so that the entire state now really has the opportunity to have trauma centers closer to home.

So it's not just us anymore. It's really the whole state.

Joey Wahler (Host): Definitely sounds like something that perhaps in other parts of the country where it's more heavily populated and there are more medical facilities. Perhaps people take it for granted sometimes, but certainly a big deal for you and yours right near home. Well, folks, we trust you are now more familiar with critical access and trauma care, Dr. Lanner, congratulations.

Good luck with everything. We hope you can come back and talk to us again when things are further along with this, and thanks so much again.

Kathi Glauner, MD: All right. Thank you.

Joey Wahler (Host): Absolutely, and to subscribe to our podcast to share and connect with us on social media, please visit carson Valley podcast. Stay tuned for more engaging discussions with us as well, signing off from Valley Vitals. Let's move mountains.