Amanda Wilde (Host): Summer is often a time of fun, freedom, and travel, but for emergency departments it's something else entirely. Trauma season. With increased outdoor activity comes a surge in injuries and emergencies putting frontline healthcare professionals to the test. Today on the Sinai Health and Hope Podcast, we're joined by someone who knows this reality better than most, Riki Kaelin. Riki is an emergency department nurse at Sinai Chicago, one of the busiest trauma centers in the city. With years of experience handling life and death situations on a daily basis, Riki is here to share what it's really like on the front lines of trauma care and how his team handles the pressure.

And we'll talk about what we can all do to help prevent avoidable injuries this summer. Riki, welcome to the show.

Riki Kaelin, RN, BSN, EMT-P: Thanks for having me. Good morning.

Host: Riki, you work at a level one trauma center in a major city, but I'm wondering if you can walk us through what a typical day looks like for you in the trauma ED, if such a thing as typical exists.

Riki Kaelin, RN, BSN, EMT-P: I would saythat every day is different. We definitely have our days kind of try to lay them out, when we get there, we get report from the offgoing shift. And, some days that looks different. Some days when you walk in at seven o'clock in the morning, there's not a whole lot going on.

The ER can be pretty empty. On other days, which seems no rhyme or reason to, it can be extremely busy with every room packed, people waiting in the waiting room. Summertime is often more busy than usual. Usually starts our trauma season, which we like to call it, which usually runs from late spring all the way through the fall. Winter months can be slower with more traumatic visits, but ultimately even the summer, early, even the wintertime can be very sporadic, busy, kind of don't know what to expect.

Host: I imagine summer you're going to see a lot of the kinds of injuries you only see in the summer that have to do with the outdoor activities that we do in the summer.

Riki Kaelin, RN, BSN, EMT-P: For sure. There are definitely injuries, visits that we see during that time, when you have more people out and about. So, we try to plan and be aware of those coming through the emergency room more than we do in the wintertime.

Host: Sinai Chicago is known as one of the busiest trauma centers in the city. What makes working there different from other emergency departments?

Riki Kaelin, RN, BSN, EMT-P: So I've never worked anywhere else other than Sinai. I actually started my nursing career here when I graduated nursing school. I was fortunate enough to do like a residency and come straight on through the emergency room. My current full-time job and experience prior to that, I felt kind of made me ready for the emergency department. But I will tell you that in talking to people that I work with that have worked at other facilities, that have experience working in other trauma centers, one of the biggest things I think we face here at Sinai is that we don't have as many resources as maybe some of the larger institutions have. Whether that be staffing or equipment or resources out in the community. So trying to educate people on some of the dangers, for instance, that may exist out in the community during those summer months where trauma can be significantly more abundant than the winter time can be a little bit more difficult. So I think it just makes the nurses that work in the ER significantly more resourceful than most.

Host: What are some of the most common trauma cases you see in the summer months? Are there any patterns that stand out year after year?

Riki Kaelin, RN, BSN, EMT-P: Oh, for sure. And I know that a lot of people may think because of Chicago's reputation that it may be something towards violence. But to be honest with you, one of the biggest things that we see are motor vehicle accidents or related motor vehicle accidents, like pedestrian struck by an auto. I think that's where the majority of our trauma comes from.

Host: And you see more of that in the summertime.

Riki Kaelin, RN, BSN, EMT-P: Oh, for sure. Once there's more people out, I think that you just run an inherent higher risk of those accidents happening, more people driving, more people, you know, out enjoying the summer weather. When those two things combine, I think that you definitely have a recipe for increased incidents for sure.

Host: How do you and your team mentally and physically prepare for these high intensity situations, especially when the pace just doesn't let up.

Riki Kaelin, RN, BSN, EMT-P: Coffee. Lots of coffee.

Host: Fueled by coffee.

Riki Kaelin, RN, BSN, EMT-P: In all seriousness, I think that there is a type of resiliency that you develop working in the emergency room. It gets so busy all the time, that you work on managing your time, you work on managing your workload, and it's not something that comes easy for sure.

 It's very intimidating for newer nurses who come through the emergency room and see the pace that we're moving at or the workload that we have to face. But, I think it's just learning from those nurses that were experienced before me and learning their techniques and the way to deal with the higher volume was paramount.

So like coping mechanisms and being resilient to some of the higher stress situations that we may encounter, I think is super critical to being able to function and not only function in the day, but throughout your career as an ER nurse.

Host: So there's got to be a way also to do some self-care to balance that out when you're not at work.

Riki Kaelin, RN, BSN, EMT-P: I preach a lot about overall health, physical fitness, eating well, getting as much sleep as you can. When you're working nights, it's not easy. So, you know, I think that trying to make up those deficiencies in other areas, like staying physically active and making sure you're eating as well as possible. Those little things add up over time and help kind of just decrease the amount of stress that we face.

Host: What advice would you give to someone who's thinking about going into trauma nursing, especially in high volume hospitals like Sinai?

Riki Kaelin, RN, BSN, EMT-P: I think there's probably two things that you need to focus on the most. Number one is start somewhere where you can build a good foundation of nursing care. I know it's not super popular, but like a me, a medical or surgical floor or telemetry where you're learning your basic foundations of nursing, such as your assessment skills and your time management. And then to my previous point, helping develop some like coping mechanisms that can build resiliency. Some of the things that we see are extremely stressful. You know, they can tug at your heartstrings, they can hit close to home, and we deal with those situations sometimes multiple times a day. So if you don't have a good way of coping with some of that emotional trauma that kind of gets put back on us; I think you, you diminish the duration of your career and your mental fitness is just as important as your physical fitness. So, I think those two things primarily, if you can fundamentally lock those down, you'll make it as an ER nurse. Just takes a little bit of time.

Host: Sounds like something you have to build up in yourself and maybe talk with people doing the job like yourself, so you really get that idea how it will be for you. What are some basic safety tips or preventive steps you wish people knew about, especially in the summer months? I just think often of fireworks and grilling, but there's car safety, as you mentioned, biking. What are some basic safety tips, that you wish people knew more about?

Riki Kaelin, RN, BSN, EMT-P: So I think those basic things are super important. Wearing a helmet, if you're riding a bike, I mean, bicycle injuries from June through September, unbelievable how many people don't wear helmets. Seat belts during vehicle accidents. That is probably the number one thing that you can do to prevent major injuries in like a collision. But, to that point for all different types of unintentional trauma that we see throughout the ER, I think like situational awareness is probably one of the biggest things that I could hammer home to someone that is, you know, really thinking about how to stay safe throughout. I mean the summertime, but anytime throughout life, when you are out and about and there are significantly more people out having a good time, lots more cars on the road, just being aware of your surroundings and where you're at, you know, being on busy streets versus side streets.

So like, just kind of being aware of some of the dangers that are out there and some of the primary reasons, like why some people get injured throughout those busier months.

Host: I'm sure there are many moments and stories from your time in trauma emergency that have really stuck with you. I wonder if you could share one that reminds you why you do this work.

Riki Kaelin, RN, BSN, EMT-P: I can think of one thing that made me realize that doing emergency care was something that I was that you know, it sounds like a cliche, but I was like, meant to do. I was a brand new nurse and I had maybe been working at Sinai for about six months, and it was a very, very sad, tragic story.

And I, I always would like to think of a feel good story that somebody came out and was better off than when they before they met me. And it's hard to think of, of one specific reason, but I will tell you that some of the harder things and the difficult things to deal with, like delivering some terrible news to people. One of the first things I had to do was deliver news to a family who had lost family members. I was going with a physician to the family room to tell them that their family members didn't make it. And during that interaction I was able to provide additional information beyond what the doctor was able to tell them from like a pathophysiological standpoint. More like what are the next steps and, how do you go about the next steps in a process like that? And I think I realized that I really have a knack for that compassion because I think compassion is like a mindset, not an emotion. And there are a lot of people that have trouble separating emotion from your job, and it's hard to do that. But I think I developed that skill and if I could pass that along to anyone, if I could teach someone how to do that, I think it's probably one of the most beneficial things that I've learned how to do is just be compassionate at people's worst time and help them through a process that frankly, not very many people have an easy time dealing with.

Host: That's why you are able to keep doing it. You said compassion is more of a mindset, and I think by staying in that place, it allows you to be able to deal with trauma compassionately without it destroying you.

Riki Kaelin, RN, BSN, EMT-P: Yeah, I think that's paramount. We as a team, see a lot of stressful and a lot of very emotionally charged incidents. So trying to be able to separate that, it goes along with having good coping mechanisms and being resilient to kind of some of that, that emotional trauma that we see.

Just knowing that you're there to try to be strong for people, like I said, at their worst is, it's something that I think I could have ever done for people, but somehow stumbled into this career, with the ability to do, and I, I hope I do it well and I hope it offers some guidance and comfort to families, throughout my career. If it helps, I hope it, just makes things a little easier.

Host: Riki, thank you so much for sharing this meaningful work that you do and how you do it at a level one trauma center. It's quite demanding and stressful, but obviously also rewarding.

Riki Kaelin, RN, BSN, EMT-P: Well, I really appreciate you having me on, and thank you.

Host: That was trauma Emergency Department Nurse Riki Kaelin. For more information, go to sinaichicago.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Amanda Wilde. Thanks for listening to Sinai Chicago Health and Hope.