VA Sierra Pacific Network (VISN 21)

Maria VanHart provides care to a Veteran at the North Las Vegas Medical Center

NORTH LAS VEGAS, Nev.- When faced with trauma in a hospital emergency department, nurses have a myriad of tools and resources available to tackle whatever challenges come their way. But when faced with a situation as the only lifesaver at the scene of a horrific accident in a remote location, dealing with 10 patients, lack of necessary equipment, a language barrier, and sweltering heat, even the most experienced nurse can be challenged. That was the scenario that a VA Southern Nevada Healthcare System nurse faced recently.

On the afternoon of June 20, an SUV traveling a lonely stretch of highway between Las Vegas and St. George, Utah, experienced a sudden tire blow-out, overturning and flipping off the road. The event threw several passengers from the vehicle and trapped others inside.
Maria VanHart, a VASNHS emergency department nurse was heading home to Utah after her shift at the North Las Vegas Medical Center. Nearly 30 minutes into her commute, she happened upon the single-vehicle accident. While a few onlookers had stopped to assist the victims, none of them were trained to manage the scene.

VanHart assessed the situation, and then quickly acted. “I did what I was trained to do,” she said. “I didn’t panic. I just immediately did what needed to be done.”

One of VanHart’ s first challenges was communicating with the victims. She learned that the family had travelled to the United States from Syria for a wedding. Of the 10 passengers, only a 10-year-old boy, was able to speak English. “He was walking around with some minor bumps and bruises, but overall looked OK,” said VanHart. He would serve as translator for all her patient care questions. “The first thing I told him was ‘I need you to show me everyone who was in the vehicle.’”

The driver of the vehicle was the father, who had suffered only minor bruises. An older teenage girl holding a baby were walking around the scene, both seemingly unscathed. The boy’s immediate concern was for his brother, a 14-year-old who was trapped inside the overturned vehicle. “. He was not breathing. and (based on his condition) I knew immediately that he was dead.”
 
Realizing that there was nothing that she could do for the deceased was a difficult decision for VanHart. “This is the first time that I’ve ever been in a situation where I was the person who had to say ‘there’s nothing more we can do for him. We’ve gotta move on to people who we can save.’ It was the first time I was the highest-ranking medical person on-scene who had to pronounce someone dead.”

VanHart quickly turned her attention to others who needed immediate care. The mother of the family, who was thrown from the vehicle during the accident, and was laying 10 feet behind the wreckage. VanHart concluded that she had suffered a severe pelvic injury and had potential internal bleeding.

At the front of the vehicle were two more victims on the ground: a boy in his late teens who had a broken leg and an infant girl who didn’t initially appear to have any injuries. While bystanders told VanHart that the infant was fine, she wanted to examine her just in case. “When I did my assessment on her, I could see some facial bruising agonal breathing, and one of her pupils was blown, so I knew she had a head injury. She may have been having some seizure activity because her eyes were fluttering. She and the mother needed to be flown to a hospital immediately.”

As the only medically-trained responder, VanHart continued to do her best to maintain control of the scene. After a short period of time, the Moapa Police Department arrived on site. “The scene was very active,” said Officer Alex Cruz. “Between attempting to stop traffic, rendering first aid and requesting additional units, it was hectic to say the least. Maria was running around and appeared to be calm and know what she was doing. At first, I thought that she may have been a volunteer paramedic because she was wearing scrubs, but then I noticed that there were no ambulances or emergency vehicles other than the police cars. She was directing people on what to do while rendering aid herself. It was like an orchestra conductor.”
Based on the severity of the victim’s injuries, VanHart asked Cruz to request immediate evacuation. “I trusted her expertise and ended calling three helicopters and four ambulances due to her triaging the scene,” he said. “You could tell that she knew what she was doing and there was no time to question her capabilities.”

Another challenge facing the responders was more difficult to navigate. When paramedics removed the clothing from the woman who VanHart believed suffered internal injuries, her husband became enraged. “I know that as a Muslim, he believed it was inappropriate for men to see his wife without clothing,” VanHart said. “He was still in shock and needed someone to understand him, so I did my best to do that.”

After years of working with doctors of various nationalities, VanHart has picked up phrases in many languages. “One of the things that I learned from working with doctors from the Middle East was a common greeting, ‘As-salamu alaykum’ which means ‘peace be upon you’,” she said. “So, I sat with the husband and I told him that, and he seemed to calm down. He responded ‘wa ʿalaykumu s-salam,’ which means ‘peace be upon you, too.’”

After the helicopters were loaded with patients and VanHart had briefed the receiving medical teams at University Medical Center in Las Vegas, she finally took a step back and realized what had happened. She had been on the scene for two hours, in 105-degree heat, and was exhausted. “When the adrenaline goes away, there’s a crash. It’s an emotional and physical crash. I was dehydrated and physically shaky afterwards. I sat down, drank some water, and called my friends for reassurance.”

One of the first calls she made was to her trauma training instructor, VASNHS Nurse Practitioner Aileen Thompson. “She called me and asked, ‘did I do the right things?’ recalled Thompson. “I told her ‘yes, you did exactly the right things. You maintained a chaotic scene, kept people calm in a very tragic situation, rapidly assessed and triaged, maintained airways and vitals.’ That’s a huge responsibility to take command of that scene and tell police officers ‘I need two helicopters,’ but she made the right decisions, and potentially saved two lives.”
As VanHart’s instructor as well as her friend, Thompson says that VanHart is uniquely equipped to handle situations just like the accident. “As a nurse, she is intelligent and is a phenomenal leader. I trust her without question. As a person, she is so kind and caring. She loves these people. She does the right thing, even if it’s not popular. She is not afraid to ruffle feathers to make sure that the patient gets what they need. I can’t think of anyone more qualified to take care of those people.”

For anyone who speaks with VanHart, two personality traits become immediately apparent. The first is her dedication to serving and helping others. The second is relentlessness in pursuit of the best method to accomplish the first. “I get bored easily,” she said. “I’m always trying to learn new skills.”

VanHart first became a firefighter and advanced EMT while living in Indiana. Upon moving to Las Vegas, she worked for the “flying ICU,” then became a trauma-trained nurse and emergency medical system registered nurse. In addition to her job at the North Las Vegas VA Medical Center, where she has worked for over three years, she also works in a critical access care hospital in Kane County, Utah.

“As a Marine Veteran myself, I am very glad that she (VanHart) chose to work at the VA,” said Cruz. “It was 105  degrees that day; we were all running around, and she stayed calm under pressure. When I saw her lanyard from the VA Hospital, I felt relieved. I’m very honored that we had the ability to work together.  

VanHart is a breast cancer survivor, a woman who lost most of her family to illness at a young age, and is married to the former head of UMC hospital’s trauma nursing department. Healthcare has always played a big role in her life. Because of these connections, VanHart has a unique philosophy when it comes to assessing her work.

“At the end of the day there are two things that let me know if I have done my job that day. One is ‘what was my patient-to-hug ratio?’ And the other one is ‘had my mother been the last person I had cared for, would I have done anything differently?’ Everyone out there is someone’s parent or child, and they all deserve to be cared for as if they were my own.”