Tri-County Health Care Recognized as CALS Hospital


Featured in the CALS recognition photo (from left to right) are Assistant Director of Nursing, Sharyl Rinkel, Family Medicine Physician, Dr. Keven Walters, Emergency Department Supervisor, Deb Zacharias, Family Medicine Physician, Dr. Stephen Davis, CALS representative, Dr. Paul Van Gorp, Interim Chief Nursing Officer, Laurie Bach, and Emergency Department Physician, Dr. Amadin Osayomore.


Tri-County Health Care Recognized as CALS Hospital

Wadena, MN – November 8, 2016 — Tri-County Health Care has once again been designated a Comprehensive Advanced Life Support (CALS) hospital by a coalition of Minnesota health care organizations and individuals. Minnesota’s CALS program provides advanced life-support education to rural health care providers.

“We are proud to be one of the eight CALS certified hospitals in Minnesota,” said Deb Zacharias, ER Nursing Supervisor. “This designation recognizes our commitment to the care of rural emergency patients and emphasizes teamwork.”

The CALS educational program includes extensive print and electronic material, interactive education, and hands-on skills training. Features that distinguish CALS from other life support courses are:

  • CALS is comprehensive: While other courses are limited to a single type of emergency such as trauma or cardiac problems, CALS prepares the participant to deal with trauma, cardiac, general medical, OB, pediatric and neonatal emergencies as well.
  • CALS maintains a rural focus: the program is designed for health care teams working in rural areas and other settings in which the full complement of resources such as specialists and specialized equipment may not be readily available.
  • CALS adheres to the team approach to training and real-world practice. Some life support courses train just part of the team; others provide uniform training to all participants, regardless of scope of practice. CALS brings together teams of physicians, nurses, PAs, NPs and paramedics and provides practical training that includes development of the team itself.
  • CALS advocates a systems-based approach that links health care institutions and providers at all levels and stages of emergency care in a continuous network of support for the victim of a serious illness or injury.

“The primary focus of CALS curriculum is to train medical teams in rural areas to anticipate, recognize and treat life-threatening emergencies,” said Dr. Steven Davis. “Because of the dedication of the entire staff here at Tri-County I am absolutely confident that our team is prepared to respond to any number of medical emergencies that may arise.”

The first CALS program was developed in Minnesota in 1996 as a result of collaboration among emergency medicine and family physicians, rural practitioners and academic specialists, and nurses, nurse practitioners, PA’s, paramedics and others. The CALS program has gone on to be adopted in much of the United States, in parts of Canada and throughout the world.

State Trauma Advisory Councils of both Minnesota and Wisconsin have approved CALS as one of the training programs that can be used to qualify hospitals for specified levels of trauma designation. CALS has been selected by the US State Department as the preferred source of medical training for our US Embassies around the world.

For more information, contact Deb Zacharias, ER Nursing Supervisor, at (218) 632-8767.


Tri-County Health Care is a private, not-for-profit health care system located in Wadena, MN. Offering a complete spectrum of care services from minimally invasive surgery and cancer care, to leading edge diagnostic imaging capabilities, obstetrics, and rehabilitation services, Tri-County operates a 25-bed hospital and medical clinic in the city of Wadena. It also operates six satellite clinics and three physical therapy clinics throughout Todd, Wadena, and Ottertail Counties. Satellite clinic locations include Henning, Bertha, Ottertail, Sebeka, Verndale, and Baxter.



Keeping Rural Trauma Care Strong

Keeping Rural Trauma Care Strong

by Chad Cooper | Posted: Friday, October 14, 2016 5:00 am

A heart attack strikes. A motor vehicle accident causes serious, life-threatening injuries. A child’s airway becomes blocked.

We depend on hospitals to offer life-saving care every day. In a rural area where distance to the nearest hospital is typically much greater than in a metro area, getting advanced life support care in a timely manner is more critical than ever.

At Riverwood Healthcare Center, our emergency department staff trains intensively and regularly to deliver comprehensive advanced life support. In 2008, Riverwood Healthcare Center became the third hospital in Minnesota to receive the prestigious certification of excellence in emergency care – the CALS Hospital designation from the Comprehensive Advanced Life Support Program. In mid-September at our annual gala event in Aitkin, two representatives of the CALS program presented  Riverwood with a plaque of recertification as a CALS Hospital.

CALS is a national program designed to provide lifesaving emergency medical education for rural health care providers. Developed in Minnesota in 1996 as a result of collaboration among emergency medicine physicians, family physicians, rural practitioners, academic specialists, nurses, nurse practitioners, physician assistants and paramedics, CALS is now one of the premier education programs for rural healthcare providers.  Riverwood’s emergency department medical director, Dr. James Harris, a CALS instructor, played a leadership role in the development of the CALS program.

Each year, Riverwood offers CALS training for its own healthcare providers and nurses, as well as area hospitals and emergency medical technicians, with about 30 participating in each class. The CALS classes offer an opportunity to learn and practice life-saving skills for the care of critically ill or injured patients with a wide range of emergencies. Course content includes trauma, cardiac, stroke, pediatrics, obstetrics, neonatal, airway compromise and sepsis.

Participants report that taking the CALS course enhances their skills, confidence and teamwork abilities, leaving them better prepared to treat critically ill or injured patients. CALS recertification for healthcare professionals is required every four years. Between courses, CALS offers health care providers the ability to refresh their skills and update their emergency medical knowledge.

Riverwood’s emergency department trauma team is made up of one emergency care  physician and two to three registered nurses, an x-ray technician, a lab technician and a certified registered nurse anesthetist – all available 24/7. CALS and other ongoing training ensures that all who are staffing our emergency room are well qualified and prepared to respond to critically ill or injured patients, including those suffering from heart attack or stroke.

Riverwood has a Level 1 Heart Attack Hospital Program, a stroke-ready designation, and participates in the Minnesota  Department of Health statewide trauma program with a Level III Trauma designation. In 2006, Riverwood became the first rural hospital in Minnesota to be approved for a trauma care designation.

Since 2004, we have partnered with the Minneapolis Heart Institute and Abbott Northwestern Hospital in Minneapolis on a treatment protocol for heart attack patients. Within 30 minutes of arrival at Riverwood, our emergency staff is specially trained to quickly assess and identify the needs of cardiac patients and transfer those in need of angioplasty surgery to Abbott Northwestern via medical airlift service.

The stroke-ready designation means that our hospital is equipped to evaluate, stabilize and provide emergency care to patients with acute stroke symptoms. We always have a stroke team available who can administer a key clot-dissolving drug called tPA.

In the event of a critical illness or injury, remember that time is critical in obtaining emergency medical care.  Stress the importance of calling 9-1-1 immediately with all your family members, including children. The paramedics who arrive on scene can take immediate actions to stabilize patients for transport to the hospital.

Riverwood is committed to delivering excellent emergency care for patients in our rural service area. Providing our staff with comprehensive education through the CALS program helps build their advanced life support skills and keeps local trauma care strong.

Chad Cooper is the chief executive officer for Riverwood Healthcare Center, overseeing a 25-bed hospital in Aitkin and three clinics in Aitkin, Garrison and McGregor.

CALS Returned to Cap Haitien, Haiti — August 2016

Haiti Medical Education Project continues to partner with the CALS (Comprehensive Advanced Life Support) Global Program and partners in Haiti to train physicians and nurses in emergency medical training. Twenty-one (21) new CALS Providers and 6 new CALS Instructors were trained in Cap Haitien, Haiti August 15-19, 2016.

The CALS Essentials course teaches the CALS universal team approach to managing life-threatening injury and illness. CALS E providers learn to work together in a systematic way during cardiac, trauma, pediatric, obstetric and adult medical emergencies.

CALS Essentials (CALS-e) was designed for physicians and nurses in places like Haiti that have limited resources.

Full report

Rutgers researchers debunk ‘five-second rule’: Eating food off the floor isn’t safe

Rutgers Biomedical and Health Sciences News, 09/10/2016

Sometimes bacteria can transfer in less than a second.
Rutgers researchers have disproven the widely accepted notion that it’s okay to scoop up food and eat it within a “safe” five–second window. Donald Schaffner, professor and extension specialist in food science, found that moisture, type of surface and contact time all contribute to cross–contamination. In some instances, the transfer begins in less than one second. Their findings appeared online in the journal Applied and Environmental Microbiology. The researchers tested four surfaces – stainless steel, ceramic tile, wood and carpet – and four different foods (watermelon, bread, bread and butter, and gummy candy). They also looked at four different contact times – less than one second, five, 30 and 300 seconds. They used two media – tryptic soy broth or peptone buffer – to grow Enterobacter aerogenes, a nonpathogenic “cousin” of Salmonella naturally occurring in the human digestive system. Transfer scenarios were evaluated for each surface type, food type, contact time and bacterial prep; surfaces were inoculated with bacteria and allowed to completely dry before food samples were dropped and left to remain for specified periods. All totaled 128 scenarios were replicated 20 times each, yielding 2,560 measurements. Post–transfer surface and food samples were analyzed for contamination. Not surprisingly, watermelon had the most contamination, gummy candy the least. “Transfer of bacteria from surfaces to food appears to be affected most by moisture,” Schaffner said. “Bacteria don’t have legs, they move with the moisture, and the wetter the food, the higher the risk of transfer. Also, longer food contact times usually result in the transfer of more bacteria from each surface to food.” Perhaps unexpectedly, carpet has very low transfer rates compared with those of tile and stainless steel, whereas transfer from wood is more variable. So while the researchers demonstrate that the five–second rule is “real” in the sense that longer contact time results in more bacterial transfer, it also shows other factors, including the nature of the food and the surface it falls on, are of equal or greater importance. “The five–second rule is a significant oversimplification of what actually happens when bacteria transfer from a surface to food,” Schaffner said. “Bacteria can contaminate instantaneously.”

Should Nurse Licenses Hold Across States?

Should Nurse Licenses Hold Across States?

Advocates say such a new approach to licensure is critical in an evolving health care world, but nurse unions disagree.

July 13, 2016

Marty Stempniak


Motorists can cross state borders from California to Connecticut and the drivers’ licenses they got back home remain valid. But in most cases, a nurse can’t practice her profession in different states without multiple licenses.

A group of advocates wants that to change. Arizona just signed legislation to enter the Nurse Licensure Compact, joining Florida, Idaho, Oklahoma, South Dakota, Tennessee, Virginia and Wyoming. A nurse in Arizona can travel to any state that’s part of the arrangement to practice medicine, without obtaining further licenses.

With the growing importance of telemedicine, as well as the need for nurses in underserved areas, momentum for a license that transcends borders seems to be building, says Jim Puente, director of the compact with the National Council of State Boards of Nursing. “If you’re a nurse who is practicing telephonically with patients in the western part of the U.S. and that is your client base, you need to hold a license in every one of those states. That’s an onerous task, not to mention expensive,” Puente says. “We believe a nurse is a nurse from state to state, and that a multi-state license will eliminate the redundancy.”

A simpler compact was first implemented in 2000, eventually swelling to 25 states. However, growth stagnated in 2010, Puente says, because the original excluded background checks. With their inclusion this time around, Puente hopes to quickly reach, and surpass, the original 25. The old compact will stay in effect, meanwhile, until either the end of 2018, or when the new one reaches 26 states.

Some have expressed concern about the move toward multi-state licensure. Local governments are hesitant to lose revenue from licensing fees, while nurse unions worry about inconsistent state licensure regulations. They’re also afraid that if they go on strike in one state, nurses from another state could be brought in to replace them.

But other nurse groups support breaking down state boundaries. The American Organization of Nursing Executives first voiced its approval for the idea in 2002, and continues to support it, says Jo Ann Webb, vice president for federal relations and policy. Professions such as physicians, psychologists and dietitians are taking notice, and considering similar compacts.

“There is a nursing shortage, and you complicate that with the fact that somebody wants to go to work, and yet they have to go through all this rigmarole,” Webb says. “Figuring there are a lot of jobs available, they might take something in retail, as opposed to nursing, if it’s too complicated and expensive.”

Leaders in states with pending legislation are eager to join, too. Governors in Missouri and New Hampshire were poised to sign newly passed legislation in June, making those the ninth and 10th states to join the compact. Minnesota is also contemplating hopping aboard, and health systems such as the Mayo Clinic are lobbying state officials there for approval.

The Rochester, Minn., organization needs nurses with flexibility to help staff its emergency Mayo 1 helicopter, and the system operates intensive care units through video and telephone capabilities in such states as Iowa, Wisconsin and Georgia, says Sharon Prinsen, R.N., nurse administrator. Such innovative approaches to staffing are necessary for success in health care’s changing landscape, she believes.

“It really opens the door for technology and new models of care to address meeting patients wherever they are versus having to come forward to a traditional facility to be cared for,” Prinsen says.

The border reciprocity agreement allows nurses who work in the neighboring states of Iowa, South Dakota, North Dakota and Wisconsin to practice nursing in Minnesota without a Minnesota license, provided they register with the Minnesota Board of Nursing. But the Minnesota Nurses Association has expressed strong opposition to the idea. The group argues that passing the pact could weaken the state’s oversight of the practice of nursing, and result in inconsistent standards, loss of licensing revenues to Minnesota, and threatens to nurses’ rights to organize.

“For these reasons, the Minnesota Nurses Association steadfastly opposes the compact,” the group wrote in a statement last year. “We do, however, remain committed to seeking regulatory alternatives that do not put patient and nurses in harm’s way, or put states in jeopardy of financial risk and potential loss of rule-making authority and oversight accountability.”

Nurse groups are opposing legislation in Rhode Island, and state officials have considered repealing the state’s participation in the previous compact. Misconceptions and false information abound, according to Maria Ducharme, R.N., senior vice president for patient care services and chief nursing officer at the 247-bed Miriam Hospital in Providence, R.I. Nursing exams are similar from state to state, she says, and so are the duties performed by RNs.

That’s why she and others at the Lifespan hospital have been advocating for the law change. The compact, she says, would help to remedy certain challenges. For instance, when hospitals are slammed in winter months with dozens of patients suffering from the flu, respiratory ailments and injuries caused by falls on slippery outdoor surfaces, they could put out a call to nurses from nearby states to help. In some instances, Miriam’s daily admissions can swell by 100 in as little as 24 hours.

Ducharme also points out that some rural regions are struggling to find specialists in fields like peri-operative nursing or labor and delivery.

“We need to be using our resources nationally in the best way we know how,” says Ducharme, who is also president of the Organization of Nurse Leaders for Rhode Island, Massachusetts, New Hampshire and Connecticut. “We’re doing a disservice to patient care in some respects, especially as it relates to nurses who are educated and experienced in a specialty.”

Point/Counterpoint — Five Reasons For/Against the Compact:


  • Eliminates redundancy, duplicative regulatory processes and unnecessary fees for nurses.
  • Improves access to licensed nurses during a disaster, or other times of great need for nursing services.
  • Benefits military spouses who often relocate every two years.
  • Requires state boards of nursing, by statute, to participate in the national nurse license database, which shares license and discipline info among compact states.
  • Removes multi-state privileges from nurses who are under discipline in compact states, thereby protecting remote states when a home state licensee is disciplined for a violation of the nurse practice act.

Source: National Council of State Boards of Nursing, 2015


  • Supersedes the rights and interests of states and citizens, and enacting it requires states to cede administrative authority, removing its ability to oversee, evaluate and change.
  • Compromises the state’s responsibility for establishing a requirement for initial and continued competency of nonresident nurses.
  • Risks considerable financial loss to states, due to compact requirements for annual maintenance fees and the elimination of licensure and re-registration fees from nonresident nurses.
  • Weakens existing public policy, state laws and rules, including union activity, and nurses’ rights to organize.
  • Leaves unanswered questions related to licensure, data confidentiality and nurse discipline.

Source: Minnesota Nurses Association, 2015