“Ski patrol to dispatch…” The radio at the nurse’s station comes alive and the nurses within earshot walk closer to listen while the EMTs nearby get ready for their next ambulance call.
“Go ahead ski patrol,” dispatch responds.
“We’re going to need an ambulance for a 16-year-old male who hit a tree while skiing. He is conscious, but vomiting. He was wearing a helmet and does not remember what happened.”
The “tones” as we call them sound off in the Emergency Room and the ambulance is already on its way to Lutsen Ski Hill, a 20-minute drive.
On a typical weekend day in the winter, our ambulance service brings in several patients from the Lutsen ski area, and there are even more that come in private vehicles. According to Karla Pankow, director of the Emergency Medical Services for North Shore Health, most of these injuries are tibula/fibula injuries (tib/fibs for short) and concussions. But we also see a lot of knee, femur, and shoulder injuries. In the ER, we know this to be ‘ortho’ season.
According to Pankow, we are also seeing an influx of diabetic emergencies at the ski hill. And of course, any other medical problem that you would see at any other time—cardiac problems, stroke symptoms, migraines, and abdominal pain.
I say “we” because I am a registered nurse here, working three 12-hour shifts a week as I have been since 2018 when I obtained my nursing license through Northland Community College, a task accomplished by taking classes remotely and also driving one weekend a month to Bemidji for clinicals and labs. This was a full year program accomplished as a bridge to completing a remote LPN program.
I started working as an LPN at the Care Center in 2016, but I won’t lie, I wanted to work in the Emergency Room, and the first day I saw my name on the assignment board “ER Nurse: Erin,” was a good one. Like many of us here, I am excited about a busy day and a challenge.
Pankow feels this way as well, and has a sign on her desk that reads “Chaos Coordinator,” and she says she thrives on figuring out the puzzles: finding staff, training staff, true emergencies, and helping people.
In the ER, we often see things come in groups of three: three patients with abdominal pain, or three with broken legs. If there’s two, there is often a third on the way. But sometimes, there is just general chaos.
Example: ER A has a patient with cardiac symptoms who has been getting a full work-up—this takes several hours and he has been there for some time. ER D has a
possible urinary tract infection. The front desk calls and says they have a patient who is bleeding and needs immediate attention. I run up there, and bring the patient right back to ER C. When I take off the dressing, the wound starts spurting blood, so I call for the doctor and nursing assistance. We need to place a tourniquet. At the same time, someone pulls into the garage. I run out there to see what is happening, and there is a woman with an obvious lower leg deformity in the back of a pick-up truck who will need to be pulled onto a gurney. She is in a good deal of pain. The other nurses are in C at this time, along with the doctor. I start running around the hospital trying to find any help I can find. It’s a busy shift, but unusually so? Not really.
Our hospital is at minimum staffed with three RNs during the day and two at night. There is one doctor and usually EMTs who can help out, if they aren’t out on a call or a
transfer. This is for both the hospital and the Emergency Room. If the Emergency Room gets full (four rooms plus overflow), that overwhelms our small staff fairly quickly. But sometimes, the ER is empty, so how do you staff for these fluctuations?
Staff must be ready to go from zero to 100 in seconds. One moment we might be sitting here, the ER empty, and it’s a slow afternoon. Then someone shows up at the side door who is in full blown anaphylaxis. We must save his life in a matter of minutes.
For Kia Gruber, registered nurse, fixing people is one of the most gratifying parts of the job. “When people come into the ER and they’re in bad shape, we piece them back together and that’s fulfilling.” We can’t always fix people, but in regards to orthotic injuries, specifically something like a dislocated shoulder, we can. “We put it back in place and we’ve fixed them. It’s gratifying,” Gruber said.
Of course, it’s a small town as well, which has its many facets. Connie Koppenhaver, a registered nurse, remembers a woman with an injury from the ski hill coming in one day and then the next day her husband coming in with a matching injury. They both had matching braces by the end of the weekend. And it’s not uncommon to know our patients personally.
A huge challenge of working at one of the most remote critical access hospitals in the country in terms of transfer time to a larger facility is just that: transfer time. Because North Shore Health does not do surgeries and has limited diagnostic services (MRI only comes once every two weeks and ultrasound is infrequent as well), many patients must go to Duluth for a higher level of care and to see specialty services.
Half the days of the year, the weather is inadequate for flying. So, imagine you have suffered a trauma. Ideally, an EMT or paramedic on scene identifies that you have a life-threatening condition from the site of your accident, whether that’s the ski hill or the woods at the site of a snowmobile accident. Maybe you fell off a deck. In any case, the EMT calls in to the hospital and requests a helicopter. The helicopter can launch from its home base and be at the hospital at almost the same time as the ambulance…on a good day.
Or maybe the weather is iffy, the helicopter turns around halfway. The ambulance arrives at the hospital and the staff begins to stabilize the patient. Another helicopter or airplane attempts to fly here. They also bail. Now valuable time has been spent and finally the decision is made to transport the patient by ground, aka ambulance, to Duluth. Most days there is a paramedic here and everyone moves quickly to get the patient moving down the road.
On a bad day, such as one I remember several years ago, a critical patient came in who wouldn’t have survived without transfer to Duluth. Luckily, we had a paramedic willing to take the patient to Duluth through a blizzard. In Duluth, the crew had to push the patient on the gurney through a snowbank to get her inside the hospital. The patient survived, but the ambulance was stuck in Duluth overnight.
For Pankow, it is the partnerships between the various entities in the county—different ambulance services (Grand Portage and Gunflint Trail), Search and Rescue, Lutsen and Tofte EMS, and the various fire departments that gets her excited. She says in the few years that she has been working as a paramedic here, she has been on snowmobiles, snowshoes, canoes, ATVs, and foot to reach patients in all kinds of remote places around the county, and it’s largely when all these entities work together that “we make things happen.”
“The community just rallies and puts themselves in uncomfortable situations,” she says.
Given how many of these partners—firefighters and first responders—are volunteers, it is impressive how many are willing to risk their own safety for the good of others. There have been multiple Gunflint Trail responders that have gone out in the middle of large thunderstorms to rescue patients caught by fallen trees or in rough waters. It is not uncommon for responders to carry patients on a gurney over rough terrain for a mile or two or three.
This is emergency medicine—teamwork, caring, challenge, and problem-solving and we wouldn’t have it any other way.