Landstuhl Regional Medical Center
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Transcript of Landstuhl Regional Medical Center
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Trauma: early assessmentCharles Perrotta, M.D.
With thanks to Mike McBride, M.D. who provided many of the slides
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Landstuhl Regional Medical Center
• Treats all patients evacuated from both combat theaters
• The only ACS trauma center outside the US• 65,000 patients evacuated from U.S.
CENTCOM (from 45 coalition nations)• 12,000 combat casualties (2004-2010)• Responsible for treatment of 245,000 U.S.
military personnel and families within Europe
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Landstuhl Regional Medical Center
• Fully accredited (JCAHO, ACS, etc)• Staffing: 2,837 including 1,161 Army, 309 Air
Force, 304 Navy, 12 Marines, 1,279 civilians and 4 VA civilians
• 149 inpatient beds• 218 beds in its Medical Transient Detachment
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USAR mobilizations
• Oct –Dec 2003 at LRMC• Mar- May 2006 at LRMC• Mar- May 2008 at Vilseck : working with
families and with the WTU (Warrior Transition Unit)
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Redeployment Rounds
• Priority #1: OIF/OEF patients with blast injuries.
• Priority #2: OIF/OEF patients with non-blast injuries.
• Goal: Every patient receives a triage assessment and psychological first aid.
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Assessment
• Introduction “I’m a psychiatrist working with your medical team. Every patient gets ‘top to bottom care.’”
• Pain assessment– 1) pain level using the pain scale 1-10.– 2) “At what level do you call the nurse for help?”– 3) Catching the pain early can reduce the amount
of pain medication required.
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Soldiers need to take charge of their medical care by knowing all
they need to know about their injury and treatment.
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Soldiers need to learn how ask for help;“The more comfortable you are the
sooner you will heal.”
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Comfort Measures
• Room temperature• Hydration• Nutrition• Sunlight• Privacy
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“Tell me about your injury”
• Knowledge of medical information• The trauma story.
– Filling in the missing pieces.– Post trauma symptom assessment.– PTSD education
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Post Trauma Assessment
• Quantity and quality of:– IED attacks– Small arms fire– Mortar attacks– Suicide bombers– Exposure to dead bodies – Returning fire
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PTSD Education
• Normalize the response to trauma as universal, using the metaphor of tissue injury.
• Healing of the mind requires a mastery of the event.
• Dreams, flashbacks, emotional flooding are normal psychological reactions to trauma.
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Identifying Survivors Guilt
• A common reaction to trauma especially if others have been killed or wounded.
• The belief they have let their unit down.• Treatment approach includes getting the facts
of the incident, reviewing their role and response, arranging communication with unit downrange.
• After Action Report model
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Preparation for Transfer
• A common anxiety is when they will fly and where they will be transferred to.
• Reinforce soldier’s ability to communicate needs (pain, comfort, anxiety, etc.)
• Follow up e-mail or phone call to CONUS for those patients demonstrating Acute Stress Disorder symptoms.
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Special thanks to Mike McBride, M.D. (USAR and Milwaukee VA)
Landstuhl Regional Medical Center
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