Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC
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Transcript of Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC
Level 3 Trauma Center- Why?
• Beneficial to the injured patient • Statewide Trauma System • The Golden Hour
- Rural VS. Urban Trauma• Local Hospital Benefits
Why Level 3?• Improved patient outcomes• Prevent patients from dying of simple injuries• Patients receive quality care close to home• Decrease burden on busy level 1 centers • Most rural trauma is MVC related – Auto Insurance coverage is decent– Supports financial stability of local hospital • Helps defray cost
• Enhances community awareness and perception of local hospital
Commitments and Resources
• Hospital and Surgeons• ER physicians/Nurses • Internists • Anesthesia/Radiology
• Operating Room• ICU• Ancillary Services • EMT Services • TPM
EMT Services
• Effective program vital • Paradigm Shift • Trust • Transfers – Ground VS. Air
• Trauma Alerts• PHTLS• TNCC • EMS Appreciation Dinner
Statewide Trauma System
• Support from Level 1 Centers ESSENTIAL– UK and UL– Resources and Guidance – Lead hospitals for system
Trauma Registry
• Clinical data management system– State Registry – UK/UL
• Training for registration• Time Consuming
PIPSPerformance Improvement and Patient Safety
• “The concept of monitoring, evaluating, and improving the performance of a trauma program”
• Multidisciplinary Peer Review Committee• Major focus of COT
General Surgeons
• Foundation of Trauma Service– Unwavering Commitment
• Board Certification • ATLS Certification • Response time- 30 minutes • Co-Director ICU • Directs Care of ICU Trauma Patients
Orthopedic Surgeons
• Absolute Requirement • Majority of OR Cases • ATLS Helpful• Liaison to Trauma Program • Involved in PIPS
• Began program NOV. 2009 • COT- Consultative Visit April 2012 • COT- Verification Visit May 2013• RTTDC – – DEC 2009 – UKMC
Trauma PatientsYear #Patients Admits Transfers Deaths2009 34 ---- ----- ----(Nov-Dec)
2010 308 67% 31% 2%
2011 304 61% 38% 1%
2012 216 59% 39% 1.5%(Jan-Aug)
Mechanism of Injury
Year Blunt Falls Penetrating 2009 82% (14%) 9%
2010 86% (17%) 12%
2011 89% (18%) 9%
2012 91% (28%) 7%
PIPS
• Meets monthly • Multidisciplinary Peer review • Chart Reviews- 3Levels – TPM- All Transfers; Medical Admits (PI)– TMD – Committee
• All PEDs • All Transfers • All Deaths • Miscellaneous
Transfer Agreements • Essential • University of Kentucky• University of Louisville• Kosairs (?)• Predefined Neuro diversion plan
Education • Nursing
– TNCC• Trauma Nurse Core Curriculum • 75% Certified • 4 year term
– Trauma Competency Training • New procedures & equipment (FAST)• PEDS Trauma
– Trauma Symposiums• Physicians
– ATLS – Trauma Symposiums – CME
Lessons Learned 1. Collaborative Effort
• Surgeons • ER physicians• Hospital • EMS• Level 1 Centers
2. Treat Locally VS. Transfer• “Golden Hour”• Do NOT delay departure
3. Activation of Trauma Team by EMS• Shared protocols • Learning experience• Paradigm Shift
Trauma Patient AlgorithmResus
Stable
Admit Locally
Discharge Home Transfer
Transfer
Unstable
Surgery
Transfer Admit Locally
Transfer
Community Outreach
• Fall Prevention• “KIDS” Safety Day – EMS, Police Dept., KSP, UKMC, YMCA, Dept.
Transportation – 300 Kids – Free Bike Helmets