Patient brings hospitals together Published Dec. 8, 2016 By 2nd Lt. Geneva Croxton 60th Air Mobility Wing Public Affairs TRAVIS AIR FORCE BASE, Calif,.--When patients need care the most, the medical professionals at David Grant USAF Medical Center at Travis Air Force Base, California, are prepared to get them the help they need, no matter how many teammates they need to get involved. Recently, a patient at DGMC needed to be put on an extracorporeal membrane oxygenation machine (ECMO) because the patient’s heart and lungs were struggling to function on their own. The enduring relationships between the staff at DGMC and Stanford University Medical Center allowed the proper procedures to take place, allowing an ECMO transport team from Stanford to transfer the patient successfully, ensuring the best care the Air Force could offer was received. The process of putting a patient on an ECMO machine is a complicated one. Airmen from all areas of DGMC were called upon to help make the mission happen. “(They are) the sickest of the sick,” said Lt Col. (Dr.) Curtis Wozniak, one of DGMC’s two cardiothoracic surgeons. “Those are the patients that really require this serious of treatment.” Though DGMC frequently handles difficult heart and lung operations, this patient required much more advanced support. “We are occasionally called on to do ECMO procedures,” said Wozniak. “Every flu season, there are a select number of folks that get so sick that they need to go on the ventilator and a few of these patients get so sick that the ventilator doesn’t work. When patients get to the point that the ventilator doesn’t work, ECMO can help. Typically, someone that goes on ECMO has a difficulty oxygenating their blood.” The team at DGMC was able to quickly assess the severity of the patient’s case and recognize the patient was a prime candidate for support from the ECMO machine. “Some people would consider it heroic,” said Wozniak. “But, as heart surgeons, we are trained and well-versed in these situations, so when it comes to somebody with lung failure, we can use this technology and hope that they can recover from whatever is causing their lungs to fail.” What stands out the most about this situation was not the expertise of the surgeon or the outstanding care provided to the patient, but how quickly the Airmen at DGMC reached out to their partners at Stanford and made sure the patient would be cared for. The ECMO circuit requires around-the-clock care, which is difficult for a hospital without a specific ECMO care team to provide. The relationship between Stanford and DGMC allowed for a DGMC patient to have access to the highest level of care. “The ECMO circuit is a huge manpower draw,’ said Wozniak. “It’s an army of people that literally need to be at the bedside 24 hours a day, seven days a week.” Wozniak urges his peers and subordinates to understand the community resources available to them. When the teams at DGMC and Stanford stepped up to the challenge, there was no additional therapy to offer. A very sick patient in the Intensive Care Unit’s health was declining rapidly. “In that scenario, you do not have many options,” said Wozniak. “You either hope for the best … or, in certain select patients, there is the option to use ECMO.” The coordination to find a hospital available to accept the patient after being put on ECMO was challenging. “It was a complicated deal,” said Wozniak. “I had to call three different centers, but on the third call, I was able to get ahold of the folks at Stanford University and they have a very robust system for ECMO.” The Stanford has a dedicated ECMO team, capable of deploying a helicopter to pick up patients. Comprised of two nurses and an ECMO perfusionist, the team provides the ECMO machine to the on-site cardiothoracic surgeon. Wozniak was on call that day, set up on the machine and prepared the patient for transportation to Stanford. “It is important to know what your resources are locally,” said Wozniak. “This capability to come here on a helicopter with a perfusionist and all the equipment provided is a rare capability. … This patient was incredibly sick and the safest thing to do was to put them in the ECMO support and transport them by helicopter.” Wozniak credits much of the success of both the DGMC team and the Stanford team to the work of the charge nurse on duty at the time. “One of the things that was instrumental was that while I was coordinating the procedure, and conducting the procedure, the ICU charge nurse was coordinating with Stanford how they would accept the patient,” said Wozniak. Capt. Daniel Williams was the nurse on call. Williams, who has been an ICU nurse for three years, orchestrated the patient’s transfer. Serving as the centerpiece for communications through the many departments that were involved, Williams ensured mission success. Though the department has standard procedures for transferring patients, this case was especially complicated due to the complexities of transferring a patient requiring so much care. “I just had to start calling people” said Williams. “It was one of those things where we heard it was going to happen, and made it work. “There were multiple departments working together at once to make sure the mission was successful. Coordination takes place on all levels for events like this. One example of this was that the emergency room staff had to go to the helicopter pad and pick up the flight crew and coordinate how to get the patient back to the helicopter after the procedure took place.” The whole team at DGMC was involved in providing the patient with expert care. “From the lab, pharmacy, blood bank and ER, the flight nurses to the Stanford transfer center, there were multiple moving pieces,” said Williams. Even with many puzzle pieces, the transfer was a success. “As soon as Dr. Wozniak was finished with the procedure, there was no delay,” said Williams. “Everything was ready to go” The case was far from the usual for the team, but with teamwork and dedication it was handled flawlessly. “It was not a standard day or even a routine transfer, but it was like ‘this guy is leaving, and we’ve got to make sure it happens, without delays,’ ” said Williams. “Everybody pulled together and made it happen.” Without the efforts of DGMC, the patient would not have been prepared for transport and moved to Stanford.