Small Town Feel, Big City Care
December 12, 2016
Emergency & Urgent Care at VVMC continues to evolve with our community
by Stephen Lloyd Wood
It’s certainly not what many people living in, or visiting, Vail imagine when they find themselves in need of emergency healthcare services — after a skiing or automobile accident, perhaps, or a heart attack — but the care they receive here in this remote mountain community in Colorado rivals that of any large metropolis. In some cases, it’s even better.
“Here at VVMC, it’s high tech meets high touch; there’s really no system quite like it,” says Mark Goldstein, director of emergency services at Vail Valley Medical Center, overseeing staff operations at the hospital’s main facility in Vail, as well as others in Beaver Creek Village, Avon and Gypsum. “We’re very fortunate in this valley to have world-class destination mountain resorts — and a world-class destination hospital.”
Indeed, VVMC’s Emergency Department is unique, having evolved since the early 1960s to serve a unique, fast-growing resort community that was created to attract people to unique, fast-growing and sometimes dangerous winter sports, namely skiing, then snowboarding.
Now, serving a community of about 60,000 full-time residents — but with tens of thousands of adventurous tourists on any given day at high season, as well — the hospital's 24/7 Level III Trauma Center has evolved into a microcosm, actually, of its counterparts in major urban areas, such as Colorado’s Front Range, but with intimacy and quick access, a dichotomy, of sorts, between big city expertise and small town feel. VVMC’s Emergency Department is the fourth busiest Level III Trauma Center in the nation and the second busiest in Colorado.
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“We see the same amount of traumas and heart attacks relative to anywhere in the nation,” Goldstein says. “The nice thing about VVMC is it has the same services as a big city hospital.”
To understand what makes VVMC’s Emergency Department unique is to know its roots, first as a rudimentary clinic in Vail, in the basement of the Red Lion restaurant and bar, the heartbeat of an outpost in the 1960s primarily created to serve a few hundred locals building a ski resort, along with the occasional injured or ailing skiers from Vail Mountain.
Back then, Ski Patrollers typically had no training in trauma care, and patients requiring anything more than minimal medical attention had to be driven by highway to Aspen, at least two hours’ drive by ambulance on a good day, or to Denver, up to eight hours away, up and over Vail Pass and Loveland Pass on old U.S. Route 6, depending on weather.
Things changed with the arrival of Dr. Jack Eck, a flight surgeon from Pennsylvania in the U.S. Army, who moved to Vail in 1971 after tours of duty in Vietnam to become the town’s third full-time doctor. He didn’t know how to ski very well, but he learned enough right away to join the Vail Ski Patrol that year as its medical director — mainly so he could deliver a mobile medical kit to the scene of a trauma, then have the wherewithal to use it effectively.
One day, while riding Vail’s Highline Lift, for example, he heard on Ski Patrol radio — an innovation at the time — a male skier was in cardiac arrest somewhere above Mid-Vail. Dr. Eck skied directly to the scene, where he joined two other doctors to stabilize the patient.
“Just before I got there, a cardiac surgeon skis up to help, too. He had no idea what we had on the mountain, but then a Ski Patroller skis up with a defibrillator we had in a cardiac kit at the top of the mountain; then I ski up with the drugs and an anesthesiologist skis up, too, and we’re all working on the guy and getting him stabilized,” Dr. Eck says. “The cardiac surgeon looks at me and says, ‘Where did all this stuff come from? We don’t have this much stuff in the emergency room at home.’ He couldn’t believe what we had on the hill, and we saved a life.
“That was really something in its time; today, it’s normal,” Dr. Eck adds. “Back then, we had one kit on the whole mountain; today, we have a kit at every Ski Patrol HQ — there’s six of ’em.”
Before that, Dr. Eck’s role with the Ski Patrol was called into play when a skier from Michigan, Gerald Ford, began visiting Vail to ski, first as President of the United States in 1969, then, more often, years later, in retirement at Beaver Creek. As Ford’s personal doctor whenever the president was in town, it was Dr. Eck’s responsibility to organize communications and medical services — including Flight for Life helicopter transport, if necessary — not only for Ford but his family and the entire Secret Service entourage.
“That really beefed up our services as an incentive to make sure our system really worked. We were able to show the Secret Service what we were able to do here,” Dr. Eck says. “In fact, we were doing it so well they actually copied the kits we had here and followed Ford around with them the rest of his presidency.”
Perhaps the defining moment for VVMC’s fledgling emergency services back then came in 1976, poignantly, when two gondola cars fell from the cable high above Lionshead’s Born Free ski run and plunged to the snow below, killing four people and seriously injuring eight more.
“That’s when having our act together meant everything. There were some people lost, and it happened before we were even a hospital; we were just a clinic and didn’t have an ER,” Dr. Eck says. “Without the interconnectivity we had from the mountain to the clinic, we would have had many more deaths, I believe. But it proved we weren’t just a clinic that took care of broken bones off the mountain.”
That spirit of “interconnectivity” and the on-mountain protocols it spawned make up the hallmark of what today is one of the most advanced trauma-scene-to-operating-room systems in the world, says Dr. Barry Hammaker, surgeon and chief medical officer for Mountain Surgical Associates, a group of doctors at VVMC known not only for their expertise in emergency care, but for assessing and managing a patient’s situation from the scene of the trauma, during their transport by ambulance to the emergency room and either on to the operating room or a helicopter for a flight to Level I facilities in Denver.
“The helicopter is just one piece of the system, just like transporting an injured skier off the mountain is another,” Dr. Hammaker says, adding similar measures with the Vail and Beaver Creek Ski Patrols have continued to evolve, now with paramedics, local law-enforcement agencies, Vail Mountain Rescue, even the Eagle County SWAT Team. “In general, if we’re in contact, we’ll know who that person is, or, if anything, what their capabilities are. That’s important in terms of assessment of what’s going on wherever the patient may be and what we need to get set up in the emergency room or operating room to move efficiently and quickly and proceed to a life-saving intervention.”
A critical part of this combination of state-of-the-art communications among hospital staff and other agencies in oft-extreme mountain conditions and the teamwork involved is what distinguishes VVMC’s Emergency Department from others, says Dr. John “Chip” Woodland, a 24-year veteran of emergency services, now medical director for the department’s physicians.
“One thing I’ve noticed after working at bigger hospitals in big cities — everybody’s here because they want to be here,” Dr. Woodland says, adding mountain camaraderie tends to manifest itself in the service an emergency department’s dedicated staff provides. “People just seem to be happier here. There’s a great team sense and collegial sense in this department.”
Mary Jastrab, a full-time charge nurse and staffer at VVMC’s Emergency Department for 26 years, agrees.
“My favorite description is ‘pit crew’ — you have an accident or illness and when you come to us we have a team that works to get you back to your life, vacation, wedding, work, whatever,” Jastrab says. “Patients comment on how well we work together and know each other. I think that makes them feel more secure.”
“Taking care of your own is an honor and a privilege,” Jastrab adds. “I think our ED does a great job making you feel like you are one of us.”
Goldstein, meanwhile, points to the department’s patient satisfaction scores, among the best in the United States. In 2015, for example, Vail Valley Medical Center’s emergency care services were ranked in the 95th percentile, he says.
“We focus on exceptional customer service and care. This is a huge feat,” Goldstein says. “We all have the same mission — to provide high-quality healthcare — but here, we provide a heck of a lot better guest service. Just go sit in the waiting room for four hours at a big city emergency room just to get seen, instead. Here, we’re seeing you faster and we have a very personal touch.”
Lee Olch, VVMC cath lab patient
In March 2015, Lee Olch was enjoying a quintessential bluebird morning on Vail Mountain.
"It was just a glorious day," says Lee, a longtime Seattle resident who's owned a condo in Lionshead since 2013. "It had a snowed a few days before and we had it all to ourselves."
Lee, who retired in 2008, is a lifelong skier who enjoys the vast, almost limitless terrain Vail has to offer. On that particular day, he and a friend had skied several runs before he went inside for a short break. When he noticed he felt "a little off," he walked himself right into Ski Patrol Headquarters. An otherwise healthy guy, Lee had suffered a heart attack a year and a half earlier, and he didn't take chances with his health.
"Then it just hit," Lee recalls. "I had this massive pain in my throat and chest. I'd be dead, but these guys were just incredible. The next thing I knew the patroller was helping me outside and they already had the sled for me."
Patrol went "100 miles an hour" to get him down the hill and directly to the cardiac catheterization lab at VVMC, a relatively new addition founded just days before Lee's heart attack. The pain was unbearably intense after a sled ride that "felt like it lasted hours and hours," Lee says, and the cath lab staff moved just as quickly as the patrollers when he arrived. He was the cath lab's second heart attack patient and says, "It was absolutely a miracle that the lab was open on that day."
"If that cath lab had not been open, the only thing they really could've done was put me in a helicopter and send me to Denver," says Lee. "I would've been dead by then. The cath lab virtually saved my life and I believe that 100 percent."
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