Emergency Trauma Care

A New Modular Trauma Care Course

C. James Holliman, M.D., F.A.C.E.P.Program Manager, Afghanistan Health Care Sector Reconstruction ProjectCenter for Disaster and Humanitarian Assistance MedicineUniformed Services UniversityBethesda, Maryland, U.S.A.

Goals of the Emergency Trauma Care (E.T.C.) Course

ƒ Provide medical personnel with a standardized systematic approach to caring for trauma victims

ƒ Encompass the care needed for major and for minor trauma

ƒ Simplify and standardize the information presented by instructors

ƒ Allow some flexibility in course content

Core Lectures in the E.T.C. Course

ƒ Introduction, Initial Assessment

ƒ Airway management / ventilation

ƒ Shockƒ Intravenous fluids & linesƒ Chest traumaƒ Abdominal traumaƒ Pelvic traumaƒ Genitourinary traumaƒ Cervical traumaƒ Head traumaƒ Facial traumaƒ Extremity traumaƒ Trauma personnel duties

ƒ Prehospital trauma management

ƒ Mammal bites, rabies, tetanus

ƒ Flame & scald burnsƒ Electrical injuriesƒ Hypothermia & frostbiteƒ Near - drowningƒ Snakebitesƒ Gunshot woundsƒ Wound care & repairƒ Pediatric traumaƒ Trauma in pregnancyƒ Interhospital transfers

Specific Skills Covered in the E.T.C. Courseƒ Primary & secondary patient assessmentƒ Airway opening maneuvers & ventilationƒ Orotracheal & nasotracheal intubationƒ Peripheral & central intravenous line

placementƒ Intraosseous line placementƒ Spine & limb immobilization techniquesƒ Radiographic identification of injuriesƒ Surgical procedures : cricothyroidotomy,

venous cutdown, pericardiocentesis, thoracentesis, thoracostomy tube, peritoneal lavage, local anesthesia, wound repair

ƒ Reduction of common joint dislocations

Target Audiences for the E.T.C. Course

ƒ Physicians practicing in rural hospital emergency departments

ƒ Junior emergency medicine, surgery, & family practice residents

ƒ Military general medical officersƒ Physician assistants & nurse

practitionersƒ Physicians from other countries which

are just starting to develop emergency medicine

ƒ Medical students

Choice of Formats for the E.T.C. Courseƒ Minimum : 3 days

–24 hours of lectures, 1 hour written test

ƒ Preferable : 4 days–24 hours of lectures, 4 hours practical skills sessions, 1 hour written test & 1 hour practical skills test

ƒ Add-on options :–Additional practical skills or simulated patient assessment sessions–Cadaver or animal surgical laboratory

Advantages of the E.T.C. Course Compared to the A.T.L.S. Course

ƒ Broader range of trauma topics coveredƒ Care beyond that of initial resuscitation &

referral is coveredƒ Lecture slides contain core information to be

learned rather than just outlines or topic headings

ƒ Greater applicability to countries without organized trauma referral systems, or in situations where there is limited availability of trauma surgeons

ƒ Flexibility to adjust course content to local needs

ƒ Less expensive if animal surgical lab not included

ƒ Does not require surgeons for instructors

Field Testing of the E.T.C. Course

ƒ All core lectures already presented as emergency medicine Grand Rounds

ƒ Entire course presented in Taegu, Korea, April 1995 to 60 Korean physicians & nurses ; all passed written test in Korean

ƒ 5 day course first in Slovenia Feb. 1997ƒ Presented several times in Slovenia and

Turkeyƒ Presented in Croatia in 2004ƒ A standard course in Romania since 2003ƒ Presented in the U.A.E. with goat lab in

2003

New Additions to the E.T.C. Course Utilized since 1997

ƒ Afternoon hands-on sessions on use of ultrasound in trauma

ƒ Small group sessions on radiograph interpretation

ƒ Lecture & discussion on trauma team member roles and duties

ƒ More case simulation small group discussion sessions

ƒ Entire course materials rewritten and reformatted in 2002

Written Test Options for the E.T.C. Course

ƒ 50 question true / falseƒ 100 question multiple choiceƒ Open versus closed book (using

the slide printout course manual)–Open book may be appropriate if participants' English skills are not great

ƒ Simulated cases (as in ATLS)ƒ Present a mini-lecture

Equipment Needed for the Practical Skills Sessions of the E.T.C. Courseƒ Backboards with straps, cervical collarsƒ Extremity splintsƒ IV catheters and needlesƒ Suture kits (clamps, needle holders, scissors,

scalpels, prep & drape materials, sutures)ƒ Chest tubes & waterseal hookupsƒ Airways, bag-valve-masks, laryngoscopes, stylets,

endotracheal tubesƒ X-ray films for teaching & testing sessionsƒ Optional moulage kits for simulated injuries for the

testing sessionsƒ Mannequins (for IV's, intraosseous, etc.)

Goals for Use of the E.T.C. Course in Other Countries

ƒ Introduce standardized quality trauma care to areas lacking this service

ƒ Develop cadres of local instructors to provide ongoing training in trauma care

ƒ Adjust the course content to reflect local trauma care needs & capabilities

ƒ Provide a relatively inexpensive means to have a large positive effect on public health by training trauma care providers