Salem Hospital shares behind-the-scenes look at emergency care

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Last January, Ariel Buik found herself a patient at the same hospital she worked in.

Buik was sandwiched between two friends on a sled that raced down an icy hill on Kuebler Boulevard. She saw the sign coming, but couldn’t do anything to stop the collision. They slammed into the pole at over 50 miles an hour, hard enough to rip it out of the ground.

Buik, an emergency room technician at Salem Health, knew as she lay on the ground that something was deeply wrong in her body. She could feel her crushed pelvis. Her abdomen felt like it was churning with hot lava.

Those details elicited some soft gasps from the gathered audience at Salem Health’s State of Health Care event, held at the Salem Convention Center Tuesday morning. Open to the media for the first time this year, the annual event highlights a portion of the hospital’s work in the community to local stakeholders, city leadership and local health care and service providers. 

This year’s focus was trauma care, giving a peek behind the curtain into what the hospital said is the busiest emergency department between Los Angeles and Canada, seeing over 115,000 patient visits each year. Presenters shared their experiences saving and losing lives, and how growing and aging Salem population trends have impacted the way they work.

Buik spent 17 days in the hospital followed by nearly 50 days living in inpatient physical therapy. She’s gotten to know trauma care from both sides as both a patient and a provider. Her friends on the sled had more minor injuries.

She said in an interview after the event that even though she’d been empathetic to patients before, her experience at the hospital brought a perspective shift. 

“It was a different feeling knowing how painful it actually is,” she said. “It’s something that never leaves your body.”

She’s now careful about the little things, like keeping her nails short to avoid scratching patients, and the big things, like thorough searches for hard-to-see injuries. She said the emergency responders hadn’t noticed she was in hemorrhagic shock from internal injuries, and she would have bled out without the careful eye of emergency room doctors.

More and more people are finding themselves in the care of those doctors each year. One of the reasons for the increasing demand, said presenter Mandi Dix, director of emergency and psychiatric services, is that it’s the only large hospital in a region that serves over half a million people from Newport to Santiam.

The emergency department sees an average of 320 patients per day. Department visits are up 31% over the last five years, she said, and surpassed pre-Covid levels this year. Patients are more severely ill too.

“Waits are often longer than patients would like,” Dix said. 

Salem Health has expanded its operations in recent years, adding a new hospital tower with 150 beds in 2022, which presenters said have since filled up. The lack of alternative hospitals in Salem has posed an issue for patients with Regence Blue Cross Blue Shield insurance, who can’t get in-network non-emergency care after the hospital and insurer failed to negotiate a new contract earlier this year.

There isn’t another hospital in Salem, in part because the state has not yet found that a facility is needed through its evaluation process. Hospitals are also facing financial issues around the state. Earlier this week, U.S. Rep. Janelle Bynum shared her concerns with constituents in Silverton about a lack of options for local Regence patients. 

Dix said that, in the last two years, they’ve been able to reduce the time patients stay by an hour earlier on average, nearly meeting national discharge time goals despite an increase of 28 patients a day over that same time period.

The increase in patients, according to Dr. Elizabeth Windell, the medical director of trauma services, can be attributed to Salem’s population growth, and aging population.

“We are actually one of the fastest-growing places in the country. And with that, we’re going to have an influx of people,” Windell said. 

Presenter Sarah Daniels, a nurse and the hospital’s trauma program manager, said their department sees everything from workplace injuries to drownings to shootings, which have nearly tripled in Marion County over the last decade according to a recent study. They also see unique traumatic injuries from hunting, farming, boating and logging given Salem’s proximity to rural areas and outdoor recreation.

“This can be something as mild as a cut, sprain or bruise, or they can be more severe or serious or life threatening such as traumatic brain injury, spinal cord injury or internal bleeding,” Daniels said of emergency department patients.

Ground-level falls are the most common type of injury they see, Daniels said, which can be attributed to Salem’s aging population. Seniors who fall can be seriously harmed with a broken hip or head injury. Motor vehicle accidents are the leading cause of injury and death for younger people, including pedestrians and cyclists being hit on the road.

In 2024, one-third of the motor vehicle-related fatalities in Salem were pedestrians, Daniels said. 

Windell shared some of the equipment they use for trauma care at Salem Hospital. She said that because of their tools on hand, only 3% of their patients need to be transferred to another trauma center for specialty care. That’s often Oregon Health and Science University which can treat things like a complex burn victim or reattach an amputated limb.

Salem Health has new CT scanners, replaced in 2022, to better determine injuries, and a bright red button in each room allowing doctors to call for a medical flight at a moment’s notice if a transfer is needed. With surgical equipment on hand, an emergency room can turn into a makeshift operating room for patients who can’t be moved into the dedicated one-floor elevator up to surgery.

They also have a pediatric cart on hand, with a fold out chart that doctors lay next to the child. Their height on the chart corresponds with a drawer with the proper sizes of chest tubes and other supplies.

“You don’t want to be trying to scramble through the compartment to find this little guy if a pediatric patient comes in,” Windell said, holding up a child-sized chest tube.

Among Salem Health’s most vital equipment is whole blood. Salem Health is one of two hospitals in the state that has it on hand, Windell said. Most hospitals carry separated blood components: red blood cells, white blood cells, platelets and plasma.

“Studies have shown that it will improve your 24-hour mortality, and it also decreases the need for other blood products,” she said.

The most blood Windell has ever transferred into one patient, who survived, was 133 units. The adult human body holds about 10 units of blood, according to the Red Cross.

Windell also described the hospital’s preparation for mass casualty incidents, such as a mass shooting or earthquake which have not occured recently. She said they’ve seen multiple casualties and serious injuries come in at once though, including when a semi-truck driver fell asleep at the wheel and killed 7 people and injured several others in May 2023.

“Sometimes my work is extremely emotionally draining, but it’s also extremely rewarding. Nothing makes me happier than when I can say ‘Your family member is alive and they’re going to make it,’” Windell said.

Another emphasis of the event was the community both inside and outside the hospital. Windell shared the hospital’s efforts to teach kids in local schools about bike safety and distribute hundreds of helmets, and to offer stop the bleed classes to teach the public how to help save someone by packing a wound and tying a tourniquet before the ambulance arrives.

Salem Health has 19 surgeons on its trauma team, 37 emergency physicians, and dozens more specialists available to respond to incidents.

“It takes a village,” Windell said.

Contact reporter Abbey McDonald: [email protected] or 503-575-1251.

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