Friday , December 15 2017
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Tag Archives: William Beaumont Army Medical Center

WBAMC Doctors Perform First TAVR in El Paso

Earlier this year, William Beaumont Army Medical Center doctors performed the first Transcatheter Aortic-Valve Replacement (TAVR) in El Paso at WBAMC.

The procedure is a minimally-invasive alternative to open-heart surgery for patients with severe Aortic Stenosis (AS), a condition involving the narrowing of the heart’s aortic valve which minimizes or blocks blood delivered to the aorta resulting in limited blood flow throughout the body.

The TAVR procedure is revolutionary not only as an alternative to traditional means of treating AS but also as a solution for patients who may not have had an option two years ago.

“It (is) a feasible way to save patients who are not good candidates for surgery,” said Maj. Ryan McDonough, interventional cardiologist and chief of cardiology, WBAMC. “There are patients who are not good surgical candidates but are excellent candidates for a percutaneous approach due to comorbidities, illnesses and previous surgeries.”

Because blood flow is limited in patients with AS, it makes the heart work harder to pump blood through the body, resulting in symptoms such as chest pain, fatigue and difficulty breathing.

Similar to a stent placed in an artery, patients are implanted with self-expanding valves via a catheter usually entering the body through the femoral artery in the groin. The minimally-invasive procedure results in reduced operating and recovery time when compared to traditional open-heart surgery procedures which usually demand for a sternotomy (opening of the sternum) to treat AS.

According to McDonough, as new as the procedure is to medicine, there are two Food and Drug Administration-approved devices available to patients for the procedure: self-expanding and balloon-expanded valves. While both have similar functions, the WBAMC patients were implanted with the self-expanding to minimize risks.

“The valve is stented on a self-expanding metal that reacts to heat. When exposed to heat it expands to a predesigned form and the catheter slowly comes off the valve and expands,” said McDonough, a native of Port Jefferson, New York. “You don’t have to balloon expand or pace (regulate the heartbeat by means of an artificial pacemaker), (the valve) is recapturable and repositionable. The valve deploys to 80 percent first, allowing us to assess whether it’s position and functionality is correct before fully deploying.”

The self-expanding valve also conforms and seals to non-circular aortic valve annulus (passages) and may be safer to use than other TAVR devices due to decreased potential to rupture tissue, decreasing mortality risk.

For 75-year-old Daniel Mooneyhan, the second patient to be implanted with the valve in El Paso, the valve provided relief after suffering with AS for two years.

“I was walking one day and I had to stop and hold on to a tree at a park. I was having a lot of heaviness, a little chest pain here and there,” said Mooneyhan, a 75-year-old retired Army first sergeant.

After a series of tests and exams, Mooneyhan was informed that his aortic valve was failing. Due to previous ailments along with reluctance to open-heart surgery, Mooneyhan didn’t prove to be a good surgical candidate for a bioprosthetic valve, which must be sewn into place during open-heart surgery, occasionally taking hours to complete.

“I didn’t want to be cut open. If I had to be cut open just forget it,” said Mooneyhan.

While this was a first at WBAMC, it wasn’t new to Mooneyhan, who had been researching treatment options for his condition.

“I watched hundreds of videos (regarding the procedure) and talked to the specialists,” said Mooneyhan. “They (perform the procedure) in Tucson, Albuquerque, Lubbock, Dallas, Indianapolis, San Antonio, so why can’t we do this here in El Paso?”

After McDonough spent three years supporting and training for the use of the TAVR device, the device was approved for treatment at WBAMC.

“It’s awesome,” said McDonough, who along with an interdisciplinary team of surgical professionals performed both treatments. “I felt very comfortable with our team doing this procedure and it’s very much a collaborated team approach. It’s not the technical part of deploying the valve, it’s the process.”

On Nov. 15, Mooneyhan received a call to be admitted for treatment at WBAMC the following day. Less than a week later, Mooneyhan was back home, feeling relieved.

“I’m sleeping better, I’m getting a full breath, I’m feeling good and have no scars or anything,” said Mooneyhan, just 10 days past the TAVR procedure. “There’s people here in this city, in this county who probably need this procedure, I think this is the future.”

“Once the valve is in and it’s functional, their heart is fixed,” said McDonough. “The only reason we keep the patient is to make sure they don’t develop conduction abnormalities (electrical impulses which cause the heart to beat), a potential need for a pacemaker and to monitor the access site.”

While WBAMC has already scheduled another pair of TAVR procedures, the success and benefit of the treatment made an emotional impact on Mooneyhan.

“There’s people out there who need this, who are dying,” said Mooneyhan. “To those guys that are retired and any veteran who needs this, they need to come (to WBAMC). These doctors are awesome, they’re good doctors.”

Author –  Marcy Sanchez – WBAMC / U.S. Army

William Beaumont Army Medical Center’s CNSs Recognized, Defined

In the United States there are approximately 72,000 Clinical Nurse Specialists (CNS) and approximately 2.7 million nurses. That’s one CNS to every 37.5 nurses.

What is a CNS you may ask?

Clinical Nurse Specialists are Advanced Practice Registered Nurses (APRNs) who not only provide patient care but specialize in mentoring, educating and progressing clinical practices in specific patient populations. Sept. 1 – 7 marks the annual National CNS Recognition Week.

“They’re not the same as other (APRNs),” said Col. Gayla Wilson, chief nursing officer, William Beaumont Army Medical Center. “They focus on their clinical areas. They’re spectacular in what they do. One of the key roles, as educators, is bringing the latest and greatest evidence-based practices to the fight.”

Clinical Nurse Specialists are one of four APRNs which include nurse anesthetists, nurse midwives and nurse practitioners. While CNSs in a civilian capacity are capable of diagnosing and prescribing medication, Army CNSs focus on progressing Army Medicine as a whole and employing best-practice in their respective specialties.

“I think the biggest difference (for Army CNSs) is shifting focus from single patient care to advancing the care of all patients,” said Lt. Col. Patrick Marlow, CNS, Emergency Department, WBAMC. “While others work full time with patient care, (being a CNS) gives us the education and time to implement programs and efforts (to advance their clinical areas).”

Recently, Marlow, a Milwaukee native, was instrumental in implementing an Emergency Department program which decreased wait times for beneficiaries while increasing primary care engagement with active-duty service members. Although CNSs do take an active role in patient care, their greatest impact is improving overall proficiency and efficiency of their units.

“(CNSs) create strong foundations for the staff,” said Wilson. “I don’t have to depend on the (officer in charge of a unit) to carve time out of their day to make sure all of their staff understand the latest practices.”

“We are considered expert clinicians at the bedside but one of our more significant roles is to help guide and mentor newer nurses,” said Maj. Maria Pescatore, CNS and officer in charge, Medical-Surgical Unit, WBAMC. “CNSs help improve new nurses’ skills and critical thinking while increasing their capabilities and development, breaking them out of a novice role to an advanced one.”

While CNSs continuously research for best practices in their fields, their expertise goes beyond clinical practices as they play a role in improving safety measures in their units as well. Wilson also points out this year’s CNS Week theme “Leading Changes to Healthier Living,” is embodied by WBAMC CNSs in their vigilant staff education including raising awareness of proper patient lifting techniques, increasing communication among staff and building resilience.

“My favorite part (about being a CNS) is being with the new nurses and mentoring and guiding them through their nursing practice,” said Pescatore, a native of Binghamton, New York. “The best part is to watch them grow; it reinvigorates why we do what we do.”

One unique challenge WBAMC CNSs face is preparing to transition to the Fort Bliss Replacement Hospital, which is slated to open in 2019, by providing input regarding development of clinical areas to maximize best practices by healthcare professionals. Additionally, Wilson states CNSs are active in mitigating costs by researching and endorsing more efficient equipment and supplies.

“(CNSs) improve efficiency, competency and throughput capabilities by going with the best product and educating staff on utilization of the best product,” said Wilson. “(CNSs) are definitely moving us in the right direction and moving us as a team.”

There are currently six CNS roles at WBAMC covering the hospital’s Critical Care Unit, Medical and Surgical Units, Perioperative Nursing Services, Maternal Child Health Services and Emergency Services. As WBAMC transitions from Level III Trauma Center designation to Level II, their roles are crucial as subject-matter experts to train and educate nursing staff on efficient practices to prepare for more comprehensive or definitive care.

Because of the continuous advancements CNSs provide to clinical practices, their actions sometimes require an interdisciplinary approach to formulate changes which improves overall patient care at WBAMC.

Over the course of this year’s CNS week WBAMC CNSs educated beneficiaries and fellow staff members as to how the role they have in the hospital impacts patient care and readiness for service members.

Author: Marcy Sanchez – WBAMC

WBAMC First Texas-based DoD Hospital Recognized for Vaccination Efforts

William Beaumont Army Medical Center was recognized as the first Military Treatment Facility (MTF) in the state of Texas to be qualified for the Immunization Action Coalition’s (IAC) Hepatitis B Birth Dose Honor Roll.

According to the IAC’s website, WBAMC is also the first Army Medical Center to be recognized and the second DoD MTF to qualify. From June 2016 through June 2017, 96 percent of infants born at WBAMC were vaccinated with the hepatitis B vaccine following birth.

“We’re promoting excellence to our infants and military families,” said Maj. Laquincyia Key, clinical nurse specialist, Maternal-Child Health Services (MCHS), WBAMC. “We ensure they are educated before they leave our hospital by providing them the most up-to-date information so they can make an informed decision regarding the Hepatitis B vaccination.”

The IAC launched its Hepatitis B Honor Roll initiative in 2013 to recognizing hospitals and birthing centers for attaining high rates of hepatitis B vaccines at birth.

Mary Anderson (center), regional medical director, Department of State Health Services, presents a recognition letter to Col. Erik Rude, commander, William Beaumont Army Medical Center, and Maternal-Child Health Services staff in recognition of the hospital’s efforts. Photo Credit: Marcy Sanchez

One of the main efforts leading to WBAMC’s successful hepatitis B vaccination program is due to the MTF’s whole-team approach to educating patients on the benefits and risks of vaccination.

The chances of an infant acquiring hepatitis B, through transmissions such as sexually-transmitted diseases and sharing syringes, are low so some parents delay vaccinations, said Key, a native of Jeanerette, Louisiana. The WBAMC MCHS staff takes it upon themselves to educate parents so they understand the risks involved.

“If the nurse is told ‘no,’ it’s elevated to the pediatrician. The pediatrician then counsels the patient and makes sure that the patient understands the risks of not receiving the vaccine after birth,” said Key, who spearheaded the efforts toward recognition. “It is common practice but they have the option to not vaccinate or wait for a follow up appointment.”

According to the Centers for Disease Control and Prevention, hepatitis B is caused by a virus that attacks the liver which can cause lifelong infection, cirrhosis of the liver, liver cancer, liver failure and even death. Furthermore, the World Health Organization (WHO) claims hepatitis B resulted in 887,000 deaths in 2015 with an estimated 257 million people living with the virus.

Because the risk of chronic infection is higher for infants and children, WHO recommends all infants receive the hepatitis B vaccine as early as possible after birth, preferably within 24 hours, followed by a two or three-dose schedule.

In addition to educating patients, MCHS staff also began to educate within their ranks to equip staff with the knowledge necessary to inform patients and improve communication within the unit.

“We’ve always educated, now we’re just streamlining the education process and having everybody saying the same thing, everybody is getting the same information,” said Key.

Prevention of a perinatal transmission, when a mother is infected with the hepatitis B Virus (HBV), requires the administration of the hepatitis B vaccine and immune globulin to the infant within a 12-hour window after birth. To reduce the probability of perinatal transmission, the Maternal-Child staff ensures the mother’s original hepatitis B test results are present at time of delivery to prevent possible human error and ensure infants are treated properly.

William Beaumont Army Medical Center averages 150 births per month and provides high-quality, evidence-based newborn care with around-the-clock pediatricians. The hospital is in the process of receiving baby-friendly recognition as part of the World Health Organization and United Nations Children’s Fund Baby-Friendly Hospital Initiative, while aiming to provide immediate skin-to-skin contact after delivery.

The facility was honored on Thursday, August 10, 2017

Author: Marcy Sanchez – William Beaumont Army Medical Center

William Beaumont AMC First Medical Center in Continental US to Earn Army SOH Star

William Beaumont Army Medical Center was recently recognized as an Army Safety and Occupational Health Star site, becoming the first Army Medical Center in the Continental United States to receive the title.

In 2012, U.S. Army Medical Command adopted the Occupational Safety and Health Administration’s Voluntary Protection Program, a program promoting effective worksite-based safety and health, into its own Army Safety Management System (ASMS).

Shortly after, WBAMC rolled out ASMS to empower employees to take charge of safety in their area by self-identifying hazards; allowing staff to become a part of the hazard analysis process.

Organizations achieving the ASMS Star are recognized for the development, implementation and continuous improvement in the prevention and control of occupational safety and health hazards.

Leaders at William Beaumont Army Medical Center unveil the Army Safety and Occupational Health Star site flag, recognizing WBAMC as the first Army Medical Center in the Continental United States to be labeled as a “Star Site” at WBAMC | Photo courtesy U.S. Army/Roberto Johnson

Because of the organization’s size, achieving a culture of safety was no easy task, said Henry Ford, safety manager, WBAMC. In order to engage more than 4,000 employees at 52 geographically-separated facilities, the WBAMC’s safety plan included implementing Additional Duty Safety Officers (ADSOs) as representatives for the safety office and to streamline safety concerns within the organization.

WBAMC’s safety philosophy also integrated every staff member into the role of safety officer. Not only did employees become responsible for safety in their workspaces, they underwent training to understand how to recognize, identify and react to unsafe work environments.

Strides toward star recognition also involved improved accessibility to filing safety concerns through the inclusion of a “safety button” on each computer desktop in the hospital while increasing transparency of previous safety reports in order to encourage best practices in resolving reoccurring conflicts.

Other steps included mandatory leader walkthroughs, on-the-spot recognitions for safety excellence and creating friendly safety competitions within WBAMC.

The Rusty Star Award (literally a rusty star on rebar Ford mounted to a two-by-four) is one way the safety office has encouraged safety best practices, said Ford. The award is presented to the most active department submitting safety discrepancies or concerns through the MTF’s safety portal.

Proactive safety measures leading to the recognition also included updating Job Hazard Analysis (JHAs) to determine risks associated with individual occupations.

Not all occupations pose the same safety risks to the employee, said Ford. WBAMC has supply technicians who operate heavy machinery which face different risks than Medical Support Assistants who assist patients.

Author: Marcy Sanchez – William Beaumont Army Medical Center

WBAMC Nurse’s Persistence Prevents Deadly Outcome

Only six months on the job and a nurse with William Beaumont Army Medical Center’s Orthopaedic Clinic is being recognized for her tireless attention to detail, possibly saving a patient’s life earlier this year.

Megan Jackson, a licensed vocational nurse and native of Oxnard, California, was recognized for her efforts in treating a patient who was suffering from a Pulmonary Embolism (PE), a life-threatening blockage to one of the pulmonary arteries in the lungs caused by blood clots.

The patient had recently undergone knee surgery, but had recovered well. Following a short stay at the hospital the patient was discharged but a few days after began feeling delusional.

“The patient came in saying he did not feel well,” said Jackson. “He was a little out of it, sweating a lot, had a fever and chills.”

Jackson’s first steps were to check the patient’s vital signs.
“All vitals were fine except for O2 (blood oxygen levels),” said Jackson. “He was a young gentleman and doesn’t smoke so it was very alarming.”

Normal oxygen levels range from 95 to 100 percent, the patient’s levels were fluctuating between 79 and 92 percent, which raised red flags for Jackson.

While below-normal blood oxygen levels may be a sign of hypoxemia, one of the underlying problems in hypoxemia cases is related to circulation. Jackson immediately called for a doctor who ordered an ultrasound and CT scan for the patient. While the ultrasound didn’t show anything of concern, the CT scan images revealed the PE.

“(Following surgeries) we watch out for deep vein thrombosis (DVT),” said Carmen Salcedo, head nurse, Orthopaedic Clinic. “DVTs can lead to a PE.”

According to the Centers for Disease Control and Prevention, while the number of Americans affected by PE is unknown, it is estimated 60,000-100,000 Americans die from PE each year. Approximately 25 percent of those figures are sudden deaths where the cause of death, a PE, is first discovered.

Because of the post-operation risks associated with surgeries, the Orthopaedic Clinic has an open-door policy for post-operation patients feeling any kind of excruciating calf or lower extremity pain, both of which are early signs of DVT. One mistake post-operation patients may make is remaining sedentary for long periods of time following surgery, a common cause for DVTs and other blood clots.

“We want (post-surgery patients) to move, they need to keep the blood flowing,” said Salcedo. “We try to remind patients that pain is a good sign as long as they’re not suffering.”

Thanks to Jackson’s instincts, the patient was treated and recovered fully. Jackson credits her training and tenacity in helping the patient in what could have been a fatal oversight.

“When I was at nursing school I didn’t think it was for me until I had an actual patient,” said Jackson, a mother of two. “I just knew (what to do) and went by my gut feeling. If I think about it I start to second guess myself.”

Jackson’s knack for caring is evidenced by her reluctance to discharge a patient if they still have concerns.

“If someone says they don’t’ feel well, (Jackson) will hold them in the room all day, if she has to, in order to get them seen,” said Salcedo, also Jackson’s supervisor. “In the (PE) case that’s exactly what she did, she held on to the patient until a doctor came to see him. Nurses with her (tenure as a nurse) may have dismissed it, (LVNs) may not have thought critically like that. For a lot of nurses it can take them years to get to that point.”

Jackson, who has been an LVN for just over a year, has also broadened her experience beyond the Orthopaedic Clinic. Jackson’s participation in WBAMC’s nursing float pool has provided her with experiences in other wards throughout the hospital.

“I worked every chance I was able to,” said Jackson.

“(Jackson) knows what each (Orthopaedic Clinic provider) likes and it’s helpful for her to go up to the floors and assist,” said Salcedo. “(Jackson) has earned a reputation in the hospital and any (hospital ward) would be happy to take her.”

Author: Marcy Sanchez – WBAMC

WBAMC Neurosurgeon Helps Soldiers Return to Duty

William Beaumont Army Medical Center’s Neurology Clinic is taking a different approach to beneficiaries suffering from neck pain.

Neurosurgeons at the clinic are combating cervical disc disease, a common condition among the military population, by performing cervical disc arthroplasty (CDA), or disc replacement surgery, on beneficiaries who may be experiencing the painful effects of the wear-and-tear condition.

“I believe in the procedure because it promotes faster recovery, and reduces the chance of degenerating the disc above and below,” said Dr. Pedro Caram Sr., senior neurosurgeon, WBAMC.

The joint replacement surgery involves replacing damaged cervical disc(s) with prosthetic disc(s). The treatment may provide relief for patients by decompressing or relieving pressure on the spinal cord or nerves and restoring stability and alignment.

Other symptoms from a degenerative disc may include increased pain in shoulders, arms and in some cases may even lead to migraines.

Dr. Pedro Caram Sr. (left), senior neurosurgeon, Neurology Clinic, William Beaumont Army medical Center, performs a multilevel hybrid cervical disc arthroplasty on a patient suffering from multilevel cervical disease during a surgery at WBAMC. (Photo Credit: Marcy Sanchez)

“I’ve treated people with what they thought were migraines but really their necks were causing the problem,” said Caram, a native of Houston. “(Staff) examines patients very carefully in the clinic. I don’t let them get away without an exam and look to find out what they’ve done from a conservative (management) standpoint, find out if they’ve had any trauma and go over medications.”

The initial examination also includes a look over pain history, spasms and a test of strength, the results of which alarms most patients.

“(Caram) proved I was a lot weaker strength-wise on my first visit,” said 1st Sgt. Joseph Phillips, C Company first sergeant, 1st Battalion, 6th Infantry Regiment, 2nd Brigade Combat Team, 1st Armored Division. “The pain limited my ability to do pushups, sit-ups, wear body armor for long durations, it would hurt.”

When he began noticing a consistent pain in his neck and shoulders, Phillips, a native of Prince Frederic, Maryland, began seeking medical attention and was eventually referred to the Neurology Clinic. Phillips was also suffering from tingling of the hands, numbness of the arms and the aforementioned loss of strength.

“It was pretty consistent, everyday all day like a five or six (on a pain scale of one to 10),” said Phillips.

After a visit with Caram, Phillips, an 18-year Calvary Scout veteran, was recommended for surgery.

Caram favors CDA over the traditional treatments which may lead to delayed recovery.

A prosthetic cervical disc is shown (Photo Credit: Marcy Sanchez)

In 2007, the Food and Drug Administration approved CDA as an option for treating cervical disease. In 2009, Caram spearheaded the procedure at WBAMC and has since performed dozens of surgeries.

According to an article Caram and colleagues published in the Journal of Surgical Orthopaedic Advances, in a study of 34 single-level CDA patients, 30 returned to duty with an average 8.5 weeks of recovery time. In a multilevel cervical disc disease study with a hybrid approach to treating the disease, meaning CDA and cervical spinal fusion applied, out of 30 patients, 24 were able to return to active duty with an average 15.6 weeks of recovery.

For Phillips, a 37-year-old father of two, results were immediate following his multilevel hybrid cervical disc arthroplasty.

“I had no more issues, no more tingling and my strength came back immediately,” said Phillips.

Prior to the surgery, Phillips would struggle to throw a ball and play with his two daughters, said Phillips. Six weeks into his post-operation recovery, Phillips is able to participate in more physical activities at home than before.

“It proves that us older guys should have got fixed a lot sooner, we should have paid a little more attention to our bodies over the last 18 years,” said Phillips.

“(Phillips) will be fit for duty. That’s what our goal is: to make them fit for duty,” said Caram.

Author: Marcy Sanchez – WBAMC / DVIDS

Video+Story: Fort Bliss Replacement Hospital holds Dry-In Ceremony

Leaders with William Beaumont Army Medical Center, Fort Bliss, 1st Armored Division, Army Medicine, and the U.S. Army Corps of Engineers participated in a Dry-in ceremony at the Fort Bliss Replacement Hospital, July 12.

During the ceremony leaders presented command coins to be placed in a shadow box along with a signed project scroll slated to be featured in the replacement hospital once completed.

“It’s a beautiful Army day to celebrate a significant milestone for the completion of a new world-class medical center here at Fort Bliss,” said Col. Michael Brennan, commander, U.S. Army Health Facility Planning Agency. “It’s due to the hard work and dedication of many hard-working individuals that this magnificent hospital is rising out of the ground.”

The dry-in ceremony, a construction milestone, signifies the hospital’s exterior being dried in and sufficiently completed enough to keep water from entering the building’s enclosure. The exterior’s drying also allows for weather-sensitive construction to begin in the interior of the hospital.

“Staff at WBAMC are working in a facility that was designed decades ago that did not envision modern technology, modern practices, spacing needs and evidence-based designs,” said Brennan. “These features will be included in this new world-class facility.”

A shadow box displaying command coins and a project scroll, slated to be featured in the Fort Bliss Replacement Hospital, commemorates the replacement hospital’s dry-in milestone during a ceremony at Fort Bliss | Photo Credit: Marcy Sanchez

The replacement hospital campus encompasses six major structures consisting of a seven-story hospital, clinical buildings, an administrative building, clinical investigations building and a central utility plant. In addition to the six buildings, a centralized rotunda will connect four of the buildings to provide beneficiaries a seamless transfer of care if needed.

“The WBAMC family and I are eager to see this new hospital’s completion and this ceremony signifies a huge movement in the right direction,” said Col. John A. Smyrski III, commander, WBAMC. “It is fitting that Americas’ Tank Division, our Soldiers and their families, retirees and veterans, and the members of the WBAMC family will have such a magnificent complex to have as their own.”

Once complete, the Fort Bliss Replacement Hospital will join over a century of Army Medicine at Fort Bliss. In the late 1800s the Fort Bliss hospital was erected on Fort Bliss followed by William Beaumont General Hospital located just east of the current WBAMC building in 1921 and the current hospital in 1972.

“Each time I walk through (the replacement hospital) there is always something amazing to see, each time we were closer and closer to completion of our future home,” said Smyrski. “We look forward to writing the next chapter of (WBAMC) history at this new hospital complex.”

The Fort Bliss Replacement Hospital, a campus with over 1.13 million square feet, is slated to replace the current William Beaumont Army Medical Center in late 2019. In addition, the replacement hospital is slated to contain 138 inpatient beds, 10 main operating rooms, 322 exam rooms and 30 specialty clinics to include: women’s health services, behavioral health, physical and occupational therapy, gastroenterology, oncology, hematology, general surgery, family medicine, vascular surgery, plastic surgery, and more.

Author: Marcy Sanchez – US Army

WBAMC “Iron Majors” Selected for Competitive AMEDD Course

Three distinguished majors from William Beaumont Army Medical Center were selected to attend Army Medicine’s Iron Majors Week Post-Professional Short Course Program (PPSCP).

The selectees, a surgeon and two nurses, were chosen over their respective Army Medicine peers, out of single-digit allocations for each Corps, speaking highly of their professionalism and service.

The five-day leader development opportunity exposes Army Medicine majors or promotable captains, to a variety of interagency activities and discussions with key/ senior leaders, executives and experts from multiple fields at the Defense Health Headquarters in Falls Church, Virginia. The course will also build the experience and knowledge needed to address future complex issues within Army Medicine and the Department of Defense.

“I’m really interested in going and learning some strategic-level information (in Army Medicine),” said Maj. Tammy Fugere, clinical nurse specialist, Department of Nursing, WBAMC, and native of Danbury, Connecticut. “I hope to get a better understanding of where they think we’re going and how we can implement that at our level.”

During her 14-year career in the Army, Fugere has deployed in support of Operation Iraq Freedom and contributed to increased readiness and initiatives for improved practices at WBAMC.

Fugere along with Maj. James LaCombe, were two of eight nurses selected to attend the course from majors or promotable captains in the entire Army Nurse Corps.

“We’ll come back with more of a big-picture, AMEDD view,” said LaCombe, chief, Army Public Health Nursing, Preventive Medicine, WBAMC, and native of Lake Arthur, Louisiana.

LaCombe said he wishes to broaden his horizons through knowledge gained from the course in order to contribute to Army Medicine’s strategic planning and vision in areas beyond his own.

With multiple deployments under his belt, LaCombe’s efforts in leading a public health campaign in one of the largest garrison populations in the Army contributed to his selection for the Iron Major PPSCP.

One WBAMC surgeon, Maj. Shaun Brown, nabbed one of the few allotted spots for the Iron Major PPSCP reserved for the Medical Corps.

“I think (Iron Major) is a great opportunity to recognize leaders in the Medical Corps, while giving us more exposure to the (Office of The Surgeon General) and senior commands at the Pentagon,” said Brown, chief, Colon and Rectal Surgery, Department of Medicine, WBAMC.

Brown, a native of St. Louis, Missouri, recently completed a Colon and Rectal Surgery Fellowship at Ochsner Medical Center, New Orleans, and is getting ready for an upcoming assignment as a surgeon with the United States Special Operations Command.

The majors’ efforts are evident in WBAMC’s reputation as one of the Army’s premier Medical Treatment Facilities.

“(WBAMC) is a great place to practice medicine and is certainly heading in the right direction,” said Brown

Author: Marcy Sanchez – WBAMC

WBAMC’s Behavioral Health Opens Doors to more Beneficiaries

For the past 10 years, William Beaumont Army Medical Center beneficiaries who weren’t active-duty service members had one choice for their behavioral health needs, get a referral.

On Aug. 10, William Beaumont Army Medical Center presented a certificate of appreciation to the El Paso Behavioral Health System for their continued support in treating beneficiaries with behavioral health issues at WBAMC. The certificate of appreciation not only signified 10 years of support but also a new chapter for WBAMC’s Inpatient Behavioral Health ward, as it once again begins to admit inpatient behavioral health patients other than active-duty service members.

Due to conflicts overseas, the ward had limited inpatient services to strictly active-duty personnel returning from deployments, while referring other beneficiaries to services in the city of El Paso. Since the deployment tempo has decreased and Soldiers are seeing less and less conflict, the utilization of the ward has decreased, allowing others to be treated at WBAMC.

Lt. Col. Toddy Ingram (center), chief, Multiservice, Nursing, William Beaumont Army Medical Center, presents a certificate of appreciation to staff members from the El Paso Behavioral Health System for the services they have provided to WBAMC patients for the past 10 years. | (Photo Credit: Marcy Sanchez)
Lt. Col. Toddy Ingram (center), chief, Multiservice, Nursing, William Beaumont Army Medical Center, presents a certificate of appreciation to staff members from the El Paso Behavioral Health System for the services they have provided to WBAMC patients for the past 10 years. | (Photo Credit: Marcy Sanchez)

“Over the course of the last few years our bed utilization has gone down,” said Lt. Col. Toddy Ingram, chief, Multiservice, Nursing, WBAMC. “The implementation of community behavioral health centers on post also allows Soldiers to get treated closer to their units.”

On Fort Bliss, there are seven outpatient behavioral health clinics where Soldiers may receive a variety of behavioral health care including psychiatric care, medication management, individual and group psychotherapy, diagnostic evaluation and psychological testing, neuropsychological services, child and adolescent care, command evaluations, Medical Social Work Services and child and spousal abuse services.

The more accessible inpatient behavioral health services at WBAMC are limited to beneficiaries over the age of 18. For more complex cases, referrals are still available to patients who may require specialized care.

“We still believe in patient-centered care and support the wishes of patients,” said Ingram, referencing the referral process. “It improves our coordination of care with external behavioral health facilities.”

The availability of behavioral health inpatient services at WBAMC also improves access to care for beneficiaries. Currently WBAMC’s inpatient behavioral health ward has a capacity for 18 patients with plans to expand in the near future.

“We maintain relationships with local mental health services in case of full capacity and for any special medical needs of our patients,” said Ingram, a native of Americus, Georgia. “It’s not about just filling the beds; it’s about getting our beneficiaries the care at the appropriate time with the appropriate resources.”

In addition to opening its doors to more beneficiaries, the department is still looking toward the future with wishes of implementing more evidence-based mental health practices.

“Mental Health and behavioral health are very important to us,” said Ingram. “(Beneficiaries) have a choice; we want them to know that WBAMC is also a place to get care.”

Author: Marcy Sanchez –  William Beaumont Army Medical Center Public Affairs Office

Patient Credits William Beaumont Army Medical Center with Saving Life

“I came in on a Wednesday,” said 51-year-old Staff Sgt. Joseph Spencer, an Army Reservist with the 5th Armored Brigade, First Army Division West.

An estimated 610,000 Americans die of heart disease every year. That’s one in every four deaths. Heart disease remains the leading cause of deaths in the U.S.

On the morning of June 1, 2016, Spencer was rushed to William Beaumont Army Medical Center complaining of chest pains. Earlier that morning, Spencer began to feel nauseated as he drove home after a rigorous workout. He then began sweating profusely and vomited, all symptoms consistent with a heart attack.

“It was just like a punch with a big plate of steel to my chest,” said Spencer, a combat medic and native of El Paso, Texas. “I knew I was having a heart attack.”

A year and a half earlier, a local hospital had placed a platinum stent in the Right Coronary Artery (RCA) when Spencer had suffered his first heart attack. This time, Spencer was suffering from a myocardial infarction, or heart attack, due to acute stent thrombosis, or blood clot, at the stent’s edge.

ST- Segment Elevation Myocardial Infarction, or STEMI, is a type of heart attack. Treatments include coronary artery bypass grafting (bypass surgery) and balloon angioplasty (mechanically opening the blocked artery) as well as thrombolytics (using medicine to open the blockage).

In Spencer’s case, immediate angioplasty was necessary.

1000w_q95On that day, the Department of Cardiology at WBAMC reacted to Spencer’s case with a remarkable 16-minute door-to-balloon time, possibly saving Spencer’s life. Door-to-balloon is the measurement of time from the point of patient arrival to the time the artery is opened. Shorter times can lead to less damage, better outcomes and are a marker of quality.

“What STEMI means is the artery that feeds part of your heart is completely occluded and if we don’t open it up in time part of the heart may die and so may the patient,” said Maj. Ryan McDonough, interventional cardiologist and chief of cardiology, WBAMC. “It’s a life-threatening heart attack—a real cardiac emergency.”

While the national guideline for door-to-balloon time is 90 minutes or less, WBAMC’s Department of Cardiology has maintained a 50-minute average door-to-balloon time over the past two years, making it the fastest in the Department of Defense.

According to the American College of Cardiology, decreased door-to-balloon time is directly correlated with significantly improved patient outcomes. For WBAMC, decreasing door-to-balloon time has involved analyzing the door-to-balloon process and cutting seconds off the clock through performance reviews and initiatives over the past five years.

“We have quarterly STEMI meetings within the hospital between cardiology, our paramedics and the emergency department,” said McDonough, who was also Spencer’s attending physician. “You can really analyze the patient process from arrival to treatment and see where any potential improvements lie.”

Quick activation may determine life or death. A new trial process, with paramedics transmitting electrocardiogram (EKG) results from the

Maj. Ryan McDonough (background), chief of cardiology, William Beaumont Army Medical Center, inserts a guide wire through the femoral artery of a patient during an ST- Segment Elevation Myocardial infarction, or STEMI, procedure at the catheterization laboratory, WBAMC, June 29.
Maj. Ryan McDonough (background), chief of cardiology, William Beaumont Army Medical Center, inserts a guide wire through the femoral artery of a patient during an ST- Segment Elevation Myocardial infarction, or STEMI, procedure at the catheterization laboratory, WBAMC, June 29.

point of initial contact with the patient, improved Spencer’s door-to-balloon time drastically, allowing the cardiology team to respond appropriately.

“The paramedics were savvy,” said Spencer, a father of five.

“First responders from a nearby El Paso Fire Department station recognized the signs and symptoms on a STEMI, did an EKG, took vitals and opened an (IV) line on me,” said Spencer. “They did all the right things.”

The paramedics transmitted the EKG results to WBAMC while rushing Spencer to the hospital in 7 minutes (normally a 15-minute drive).

“The catheterization lab team met me at the ambulance as it was rolling up. The entire staff was right there,” said Spencer. “They were aggressive, on the spot and ready to rock and roll.”

WBAMC is leading efforts to initialize “out-of-hospital” activations, or initiating the door-to-balloon process in the field. Paramedics arriving at the incident scene are capable of transmitting EKGs to the emergency department. There, doctors receive the report and activate the response team. WBAMC’s Cardiology department is currently working with the Border Regional Advisory Council (BorderRAC) to implement this initiative city-wide.

“My catheterization laboratory (cath lab) nurses and I are putting together educational material to improve awareness of field activations,” said McDonough. “Many places are trying to measure from the time paramedics first see the patient to the time they employ the balloon, making out-of-hospital activation even more important to meet first-contact-to-balloon standard.”

“(McDonough) knew what was happening and that time equals muscle,” said Spencer. “They humped it to the cath lab where a team of eight was occupied getting me hooked up. All of them were personable and professional.”

Spencer said the cath lab team’s actions made him feel confident he had a highly qualified and trained team treating him.

Once Spencer was in cath lab, the team completed their treatment in about half the time it takes to watch a sitcom.

“It was like a night and day difference; I could breathe again,” said Spencer. “I was able to get blood cruising through my heart and able to get it to my lungs.”

Although McDonough, a native of Port Jefferson, New York, was able to alleviate Spencer’s heart attack, he also noticed two vessels on the left side of Spencer’s heart that needed treatment.

“(McDonough) told me I had two other heart attacks waiting to happen,” said Spencer. “I had an extra stay at the ICU; he went in and placed two new stents in the vessels.”

Spencer describes the before-and-after pictures of the vessels as “amazing.”

“They now look like a four-lane highway; they’re straightened out,” said Spencer.

According to Spencer, during his first heart attack doctors noticed the complications in the other vessels but were hesitant to implant the stents because they were “in a really tough spot”.

“(McDonough) saw the bigger picture and said he wasn’t going to let me leave out of here until they took care of them,” said Spencer. “A month later, I’m walking around. I’m breathing and feeling really good.”

While their efforts to decrease door-to-balloon times definitely paid off in the case of 51-year-old Spencer, the cardiology team is still working to further decrease times through paramedic education and improving out-of-hospital activation.

“These guys are at the spearhead of treatment. I would call them the ‘A’ team,” said Spencer. “They know their business, and their hearts are in it.

“I came in on a Wednesday and left that Friday with three new stents in my heart,” said Spencer. “Between the (cath lab team) and the paramedics, they saved my life.”

Author:  Marcy Sanchez – William Beaumont Army Medical Center Public Affairs Office

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