AMERICAN TRAUMA SOCIETY APRIL 2014

ATS INFORM INDUSTRY NEWS FROM AROUND THE TRAUMA ENVIRONMENT

Upcoming ATS Events April 16-17: ATS Pennsylvania Division Annual Trauma Conference -

Hershey, PA May 1-31: National Trauma Awareness Month June 5-6: ATS Trauma Registry Course – Washington, DC June 5-6: ATS Board of Directors Mid-Year Meeting - Falls Church, VA

In This Issue

Page 1 ATS News

Page 2 Injury Prevention News

Page 5 Industry News

Page 9 Trauma Research

Page 7 TSN Corner

SERVING AS AN ADVOCATE FOR THE TRAUMA CARE SYSTEM, TRAUMA

PREVENTION PROGRAMS, AND THE VICTIMS OF TRAUMA AND THEIR

FAMILIES THROUGHOUT THE UNITED STATES FOR OVER 45 YEARS

From ATS Executive Director Ian Weston - “An Active Spring Ahead for the ATS”

Spring is always a new and exciting time of year, especially for the ATS. This year, we mark this new season with tons of new opportunities for our members and for the trauma community.

Next month, ATS will join other trauma organizations to promote injury prevention and trauma awareness during National Trauma Awareness Month. This year, in its 26th year, NTAM will highlight Sports Injuries for this year’s campaign, entitled “Play It Safe.” We hope you will join ATS and our longtime partner, the Society of Trauma Nurses in raising awareness during this important campaign.

Looking for some top-notch educational opportunities? Look no further than the ATS. Through the remainder of the year, the ATS has premier courses and continued education for Trauma Registrars, Trauma Program Managers and coming soon, a course for the Injury Prevention Specialist. Make sure to check the ATS calendar for upcoming opportunities and locations.

The ATS offers so many ways for you to get involved and make a difference. Join one of our ATS committees, attend an educational session, become a mentor, network with other trauma professionals. These are just a few of the ways you can take advantage of your ATS network. Get started today!

I am most excited for the upcoming redesign of our new ATS website! Big changes are coming this June/July when we transition to a website that will serve our members well. Our site is being design with you in mind – giving you direct access to important information, connecting you with your peers and streamlining access to ATS products, resources and education.

We look forward to continuing to serve you, our members. Please do not hesitate to contact our office if we can assist you.

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AMERICAN TRAUMA SOCIETY - INFORM APRIL 2014

Did you Know? The number of people killed in distraction-affected crashes decreased slightly from 3,360 in 2011 to

3,328 in 2012. An estimated 421,000 people were injured in motor vehicle crashes involving a

distracted driver, this was a 9% increase from the estimated 387,000 people injured in 2011.

10% of all drivers under the age of 20 involved in

fatal crashes were reported as distracted at the time of the crash. This age group has the largest proportion of

drivers who were distracted.

Drivers in their 20s make up 27% of the distracted drivers in fatal crashes.

Engaging in visual-manual subtasks (reaching for a phone, dialing, or texting) associated with the use of

hand-held phones and other portable devices increased the risk of getting into a crash by three times.

Five seconds is the average time your eyes are off the road while texting. When traveling at 55mph, that's

enough time to cover the length of a football field blindfolded.

New York Division of ATS Elects New President

The New York State Division of the ATS recently held their annual Board of Directors meeting where, Linda Schwab, RN, was elected as the Division’s new President. Linda is a recognized leader in the field of trauma care, administration, and education. As Trauma Program Manager, Ms. Schwab works with regional and statewide committees to implement research-based improvements in trauma care and public health policy. She received both her Bachelor’s and Master of Science degrees from D ‘Youville College in Buffalo NY. She has over 30 years of clinical experience in the field of trauma and burn care. Linda continues to serve as lecturer, instructor, and coordinator for many trauma and burn care courses, and presentations throughout New York State and Southern Ontario. Through her research activities, clinical publications, active involvement with the community, and leadership role in several professional organizations, she has had an important impact on the quality of trauma care at ECMC and throughout New York State. Linda sits on the New York State Trauma Advisory Committee. The ATS is thrilled to welcome Linda to this new roll and appreciate her hard work, leadership and continued service to the ATS.

Visit the New York State Division of the ATS at:

www.NYATS.org

April is Distracted Driving Awareness Month

Poisonings, mostly from drug overdoses, are the leading cause of accidental death among working-age adults in the United States, a new report shows. In half of those cases, the overdose resulted from prescription-drug abuse, according to the U.S. National Safety Council. For younger people, motor vehicle crashes caused the most injury deaths, with distractions caused by cellphones contributing

significantly to those crashes. Meanwhile, falls caused the most fatal injuries among people older than 65. Overall, injury deaths increased 3.2 percent in 2012 from the year before, driven by increases in accidental deaths at home and in cars, according to the report.

Experts say in 1993 the trend began to emerge of people in their 30s and 40s dying of unintentional poisoning, largely due to drug abuse. That trend has only strengthened, with poisoning now the major cause of unintentional fatal injuries among working-age adults aged 25 to 64. In 18 states and Washington, D.C., poisoning is the leading cause of accidental death. Drugs both legal and illicit accounted for nearly 91 percent of poisoning deaths reported in 2010, the report found, with alcohol poisoning accounting for an additional 6 percent. About half of those poisoning deaths are caused by overdoses of prescription drugs. Young people, meanwhile, are dying in crashes that appear to be related to cellphones and other distractions -- not alcohol or drugs, the report found.

Injury Prevention News Overdoes, Cellphone-Lined Car Crashes Among Top Causes of Fatal Injury in U.S. Health Day – March 13, 2014

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AMERICAN TRAUMA SOCIETY - INFORM APRIL 2014

Americans' excessive alcohol use contributes to thousands of deaths each year, and the majority who die are working-age adults, according to a new government report. More than two-thirds of these deaths and 80 percent of years of life lost come from the ranks of adults aged 20 to 64, according to the Michigan Department of Community Health. The state-specific report, released Thursday by the U.S. Centers for Disease Control and Prevention (CDC), found that, in the 11 states studied, alcohol caused a median of 1,650 deaths each year between 2006 and 2010. This equated to a median of 43,000 potential years of life lost, the researchers said. The study used death-certificate and alcohol-consumption data from 11 states -- California, Florida, Michigan, Nebraska, New Mexico, North Carolina, North Dakota, South Dakota, Utah, Virginia and Wisconsin, according to the CDC's March 14th Morbidity and Mortality Weekly Report. New Mexico had the highest death rate from excessive drinking of the 11 states studied -- about 51 alcohol-related deaths per 100,000 residents. Utah had the lowest, with 22.4 alcohol-related deaths per 100,000. The most total alcohol-related deaths occurred among whites. Blacks, American Indians and Alaska natives, however, tended to have higher death rates linked to excessive drinking than other groups, the researchers found.

“With the Thrills Come Extreme

Risks”

Most Alcohol-Linked Deaths Occur Among Working-Age Adults: CDC Health Day – March 13, 2014

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Ever since the advent of the "X Games" in the mid-1990s, Americans have embraced so-called extreme sports such as mountain biking, skateboarding and snowboarding. But experts are warning that the fun can quickly turn to tragedy when amateurs try to mimic stunts they've seen on television. A new analysis finds that extreme sports have been linked to more than 4 million injuries since 2000, and now cause more than 40,000 head and neck injuries annually. According to a study from the Western Michigan University School of Medicine these sports combined were linked to more than 4 million injuries occurring over the 11-year period. About one in every 10 of those injuries were to the head or neck. Head injuries accounted for the vast majority of that group (87 percent) when compared with neck injuries (17 percent). About 2.5 percent of both head and neck injuries were classified as "severe," meaning they involved a fracturing of either the skull or bones of the neck. Overall, the sport associated with the greatest number of head and neck trauma

‘Extreme Sports’ Linked to 40,000 Head and Neck Injuries Per Year Health Day – March 14, 2014

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incidents was skateboarding, which produced more than 129,000 such injuries during the study. The Research team point out that the number of Americans who skateboard has risen by nearly 50 percent, to more than 14 million, since 1999.

When two Mount Hope gang members were shot in January, one of the first things San Diego Police gang Lt. Keith Lucas did was text Cornelius Bowser. Bowser’s a 51-year-old former West Coast Crip-turned-community activist. From Bowser, the word of the shooting spread through “the streets” – his version of a phone tree that connects OGs, or reformed “original gangsters,” across rival territories. Through their contacts, he might be able to get a name, an address or a phone number that could get him into the victim’s hospital room. Bowser leads the volunteer-based Community Assistance Support Team, or CAST. In April, the group persuaded the police to share real-time information on gang shootings and stabbings so they could deploy quickly into streets, alleyways and hospital rooms to talk gang members down from retaliating. Bowser said diffusing the situation early on is the best way to prevent gang violence. “When you talk about an individual that gets shot and he’s in the hospital, of course he can be thinking about getting vengeance, but’s he’s also thinking about how he could have lost his life. He’s also thinking about some of the changes that he maybe needs to make in his life,” Bowser said. “So if we’re able to get in there and make a human connection with them and win their trust, we can actually change their mind about what they were thinking about doing.”

Ending Gang Retaliation With Text Messages Voice of San Diego, March 17, 2014

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AMERICAN TRAUMA SOCIETY - INFORM APRIL 2014

The rate of serious head injuries among professional mixed martial arts competitors is potentially twice that of professional football players, according to U.S. researchers. With the sport growing in popularity, especially among youth, new rules may be needed to protect kids and professionals alike from repeated

traumatic brain injuries, a new study concludes. The popularity of mixed martial arts, which combines techniques and skills from a variety of fight disciplines including judo, karate and kickboxing, has exploded around the globe in recent years. Professional mixed martial arts matches are now legal in all states but New York. Yet players' risk of head injury hadn't been well studied, according to the University of Toronto. The highly physical nature of the contact sport - which some critics consider dangerous or violent - got the researchers wondering just how high a risk players run of getting knocked out repeatedly. In a review of 844 professional mixed martial arts matches, sponsored by the Ultimate Fighting Championship, researchers found that players suffered a knockout in 12.7 percent of matches, and that a technical knockout took place in about 19 percent, meaning that nearly one-third of matches ended as a result of some type of head trauma. These numbers mean that out of every 100 matches in which a mixed martial arts athlete could be knocked out, known as an athlete exposure, the injury would occur 6.4 times. The comparable concussion rates for boxing and kickboxing are, respectively, 4.9 and 1.9 per 100 exposures, authors noted.

Free Safety Program Available on

“Responding to Gunfire”

Sadly, firefighters and other emergency responders are now more frequently fired upon in the course of their duties. They are also being called upon to respond to scenes with on-going ballistic threats such as active shooter events. In response, the Firefighters Support Foundation's (FSF) newest training program, Response to Gunfire--Tactics when Shot at or Working at Ballistic Scenes, is now available. This program addresses the types of gunfire events that first responders may find themselves at, what their actions should be to protect themselves, and what to do while waiting for SWAT to arrive on-scene. Also covered is integrating with an armed law enforcement escort team so as to attend to downed victims. The program consists of a 40-minute video presentation and an accompanying 48-slide PowerPoint. The presenter is the commander of a very active state police SWAT team who has responded to hundreds of events where fire service and EMS personnel had to work in concert with law enforcement. He has trained hundreds of firefighters and other first responders to integrate with armed law enforcement escort teams. The program is free to all members of public safety and emergency management agencies. Simply click HERE for the video and HERE for the PowerPoint.

Head Injury Risk is High in Mixed Martial Arts Reuters – April 2, 2014

Poisonings from electronic cigarettes and their nicotine liquid have increased dramatically, the CDC reported. Calls to poison control centers for e-cigarette exposures rose from one per month when monitoring started in September 2010 to 215 per month as of February 2014. E-cigarettes now account for nearly 42 percent of all cigarette-related calls, the CDC reported in the April 4th issue of Morbidity and Mortality Weekly Report. More than half of the calls related to the nicotine-vaporizing devices reported negative health effects, a higher proportion than with calls related to conventional cigarettes. The most common adverse health effects cited during those calls were vomiting, nausea, and eye irritation, but also included one suicide death from intravenous injection of nicotine liquid. Use by kids has been a concern, as one analysis of e-cigarette refill liquids noted that nicotine content levels high enough to be fatal to children were common.

E-Cig Poisoning on the Rise MedPage Today – April 5, 2014

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AMERICAN TRAUMA SOCIETY - INFORM APRIL 2014

AHRQ has released a new study that evaluates the reporting of external cause of injury codes (E codes) on injury-related discharges in the Healthcare Cost and Utilization Project (HCUP)

databases. The study, titled HCUP External Cause of Injury (E Code) Evaluation Report, is part of an HCUP Method Series, which features methodological information on topics dealing with HCUP databases and software tools. Injuries are a major cause of mortality, morbidity and disability. E codes are intended to provide data for injury research and evaluation of injury prevention strategies. Injury-related discharges were identified in the HCUP databases using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The percentage of injuries with injury-related E codes was determined for each of the following HCUP databases: State Inpatient Databases, Nationwide Inpatient Sample, State Emergency Department Databases, and Nationwide Emergency Department Sample.

New HCUP Methods Report Evaluates Reporting of E Codes

Based on data from 653 U.S. hospitals, the 2014 user comparative database report provides initial results that hospitals can use to compare their patient safety culture to other U.S. hospitals. In addition, the 2014 report presents results showing change over time for 359 hospitals that submitted data more than once. The report consists of a narrative description of the findings and four appendixes, presenting data by hospital characteristics and respondent characteristics for the database hospitals overall and separately for the 359 trending hospitals.

Select to download print version (Part 1, PDF File, 2.4 MB; Parts 2 and 3, PDF File, 3.5 MB).

Hospital Survey on Patient Safety Culture

Optimal Resources for Children’s Surgical Care in the United States American College of Surgeons – March 2014

The American College of Surgeons has issued new standards aimed at ensuring surgical facilities achieve optimal outcomes in young patients by meeting the medical, emotional and social needs of children and infants. The standards categorize facilities by level of resources, similar to the classification of trauma centers: • Level I facilities are at the highest level of

preparedness. They're equipped to perform complex and non-complex procedures on children of all ages, are staffed around the clock with credentialed pediatric surgeons, anesthesiologists, radiologist and ER docs, and have Level IV NICUs.

• Level II facilities are capable of providing advanced care for children of all ages, including those with comorbid conditions, typically in a single surgical specialty. A certified pediatric surgeon, anesthesiologist and radiologist must be on staff, with other pediatric specialists available for consultation. Facilities must have a Level III or higher NICU and be able to stabilize and transfer critically ill children to a hospital with higher-level resources.

• Level III facilities have the resources to perform common, low-risk procedures in otherwise healthy children older than 1 year. A general surgeon, anesthesiologist and emergency physician with pediatric experience must be on staff. These facilities must have a Level I or higher NICU and be able to stabilize and transfer critically ill children to a hospital with higher-level resources.

Additionally, all facilities hosting pediatric patients must have at least 1 pediatric surgical nurse on staff, must develop a pediatric rapid response team that's available at all hours and have an in-house physician certified in Pediatric Advanced Life Support. They must also be equipped for the resuscitation of pediatric patients in all clinical care areas.

Trauma Industry News

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The overuse of antibiotics in U.S. hospitals is putting patients at risk and helping to fuel the creation of deadly superbugs, according to a government report released Tuesday. Prescribing practices vary widely, with doctors in some hospitals providing three times as many antibiotics for patients as physicians in other facilities treating similar types of patients, concluded the report, produced by the Centers for Disease Control and Prevention. The CDC analyzed prescribing practices at 323 hospitals in 2010 and 11,282 patients at 183 hospitals in 2011. About 36% of patients studied were given the powerful antibiotic vancomycin without testing or for too long, the report found. Other

CDC: Antibiotic Overuse Can Be Lethal Wall Street Journal, March 4, 2014

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antibiotics are similarly overused, it said, with nearly 40 percent of patients being treated for urinary-tract infections with these drugs, the report said. Overprescribing antibiotics is making many of these drugs less effective because superbugs resistant to them are developing so fast. The practice also can sicken patients, by making them vulnerable to other types of infections such as Clostridium difficile, a bacterial infection.

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When a major New York roadway is shut down for two years starting on April 12, it will bring road closures, gridlock and other traffic related problems to the region. Nonetheless, EMS dispatchers will be ready. The Jersey City EMS dispatch center uses color-coded maps to track and to anticipate emergency calls. The program, which looks at historical call data to predict future needs, is called MARVLIS, or Mobile Area Routing Vehicle Location Information System. Based on its

Jersey City EMS Uses Data to Predict Next Emergency CBS New York – March 24, 2014

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predictions, ambulances are pre-positioned in different neighborhoods. This particular system looks at a 2-hour block based on time of day, day of week and season and dispatchers find that people kind of do the same things at

Public Comment Invited on Model EMS Clinical Guidelines Project

The National Association of State EMS Officials (NASEMSO) Model EMS Clinical Guidelines project team has unveiled the initial draft of the Model EMS Clinical Guidelines and is requesting public comments by April 30, 2014, before finalizing the document. The project, launched in the September 2012 with funding support provided by the National Highway Transportation Safety Administration (NHTSA) Office of EMS and the Health Resources and Services Administration (HRSA), will be finalized in September 2014. Two of the three phases--the selection of guideline titles and the determination of essential components of a guideline--were completed following a public comment period one year ago. These guidelines are intended to be a patient-centric resource for EMS medical directors and EMS systems of care. Because of the variety in scopes of practice for the different levels of EMS practitioners, the guidelines have been drafted without reference to the level of practitioner. The project team, which is comprised of members of the NASEMSO Medical Directors Council, representatives from seven EMS medical director stakeholder organizations (American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), American College of Osteopathic Emergency Physicians (ACOEP), American Academy of Emergency Medicine (AAEM), American Academy of Pediatrics, Committee on Pediatric Emergency Medicine (AAP-COPEM), American College of Surgeons, Committee on Trauma (ACS-COT) and Air Medical Physician Association (AMPA) and subject matter experts, has entered the final phase of this effort with the release of the draft guidelines. The guidelines will be offered as an optional model for state, regional and local EMS systems to adopt.

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Cutting back antibiotics use by 30 percent would reduce the number of infections with C. difficile by 26 percent, the report estimated. About 250,000 hospitalized patients a year develop C. difficile infections, which can lead to sepsis and death. The findings suggest that while many hospitals recently have moved to crack down on antibiotic overuse, more should be done, the CDC said.

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those different time periods. As a result, Jersey City has been able to reduce response times by 33 percent – by more than 3 minutes. Before implementing this system, they were at the national average of about 9 minutes.

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Boston Bombing Survivor Back on the Dance Floor

with New Leg CBS News – March 20, 2014

Despite losing part of her left leg in the Boston Marathon bombing last year, a professional dancer is back on stage. Adrianne Haslet-Davis, 33, from Boston, performed for first time since being injured on Wednesday at the 2014 TED Conference in Vancouver, British Columbia. Wearing a white, sparkling short dress, Haslet-Davis showed off her new high-tech prosthetic leg as she twirled across the floor with dance partner Christian Lightner. "I'm thrilled to have danced again," Haslet-Davis said statement released after her performance. "I was always determined to dance again, and I knew that I had to, that I would, and here I am," she

said. Haslet-Davis and her husband, Air Force Maj. Adam Davis, are among the more than 260 people who were injured at the finish line of the 2013 Boston Marathon. Hugh Herr, director of biomechatronics at the Massachusetts Institute of Technology, said at the online conference he started designing the bionic leg specifically for dancing after visiting Haslet-Davis in the hospital. Herr, himself a double amputee, said he wanted the dancer to be able to get back to what she loved doing. Herr said he spent hours in the lab studying dance to see what movements and forces were needed to create the prosthetic for Haslet-Davis. Haslet-Davis said she hopes to dance publicly again soon on "Dancing with the Stars."

TSN Corner

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When a patient lands in the ER with a life-threatening injury, perhaps requiring surgery and an in-patient stay, the medical team treats the crisis at hand, repairs the damage, stops the bleeding, resets the bones. But with a hospital discharge can come a cascade of new concerns, emotional as well as physical. When can I work again? Will I ever walk? Sending trauma victims home without follow-up could come with a long-term cost. Monitoring is tricky with a population already overwhelmed with appointments and medications and, quite likely, pain. A team of trauma

After Trauma, New Technologies May Target

Who Needs Help Medical Xpress – March 27, 2014 Researchers have developed what

they describe as a "fundamentally new" treatment approach for paralysis: epidural stimulation. In a new report, they describe how 4 men with chronic complete motor paralysis were able to recover some voluntary movement after receiving epidural stimulation from an implanted unit. The ability of these patients to move voluntarily improved over time with daily stimulation and training. The study seems to indicate that electrical stimulation can reprogram damaged nerves in the spinal cord so they regain the ability to receive stimuli. The study included 4 men, average age 26.9 years, with a spinal cord injury incurred at least 2 years before the study. Their injuries ranged in neurologic level from C7 to T5. None were able to stand or walk independently or voluntarily move their lower extremities despite standard-of-care rehabilitation and additional intense locomotor training. Researchers implanted a stimulator into the abdomen of each patient. The stimulator was originally developed for use in pain but was refined for use as an epidural spinal cord stimulator. The investigators also implanted a 16-electrode array over vertebrae T11 to T12, where the locomotor sensors are located. Each patient had an individually programmed device that they simply placed over the abdomen to initiate stimulation. There was a separate program for the left and for the right leg. With stimulation and with auditory and visual cues, the patients could execute intentional movements of the legs.

Long-Paralyzed Patients Move Legs With

Epidural Stimulation Medscape – April 8, 2014

Ohio TSN Program Honored as Crain’s Health Care Hero The TSN Program at Metro Health in Northern Ohio was recently awarded the Crain's Healthcare Hero’s Volunteer Organization of the Year 2014. Now in its seventh year, Crain's Health Care Heroes program put the spotlight on those working each day to improve the lives and health of those in Ohio. Sarah Hendrickson, the TSN-Coordinator from MetroHealth, and the team of TSN volunteers will be accepting the award in May.

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professionals began with a simple study to test compliance, sending automated text messages to patients recruited from a Level I Trauma Center to evaluate PTSD symptoms. They texted once a day for 15 days, asking participants to text back, answering basic questions evaluating their mental health. Follow-up surveys were done after one month and again after three months. Results of this feasibility pilot study are forthcoming in the journal General Hospital Psychiatry. Feedback from the surveys indicated that many people would have liked more engagement, such as a return text response, a notice reminding them when they were getting to their last daily text and even an option to continue.

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AMERICAN TRAUMA SOCIETY - INFORM APRIL 2014

Public health emergencies, such as the 2001 anthrax attacks and the 2009 H1N1 influenza pandemic, raise concerns about the nation's vulnerability to threats from CBRN agents and new or reemerging infectious diseases, such as pandemic influenza. HHS is the federal agency primarily responsible for identifying medical countermeasures needed to address the potential health effects from exposure to CBRN agents and emerging infectious diseases. HHS conducted a review to assess how to better address these concerns. Its August 2010 review concluded that the advanced development and manufacture of CBRN medical countermeasures needed greater support. The review recommended that HHS develop centers to provide such support, in part by using flexible manufacturing technologies, such as disposable equipment, to aid in the development and rapid manufacture of products. The Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 requires the Government Accountability Office (GAO) to examine HHS's flexible manufacturing initiatives and the activities these initiatives will support. This report addresses (1) how much funding HHS has awarded for flexible manufacturing activities for medical countermeasures, and (2) the extent to which these activities will support the development and production of CBRN medical countermeasures. Read GAO-14-329, National Preparedness: HHS Has Funded Flexible Manufacturing Activities for Medical Countermeasures, but It Is Too Soon

GAO Study Highlights Manufacturing Component of Medical Countermeasures

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Cedars-Sinai has partnered with the U.S. military to design the "operating room of the future" that will enable emergency medical teams to respond more quickly and effectively to patients with life-threatening injuries. Under the project, called "OR 360," research teams have reconfigured the operating

Cedars-Sinai Partners with the U.S. Military to Design “Operating Room of the Future” News Medical – March 26, 2014

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room with movable walls and equipment for more flexible use, identified ways to eliminate disruptions during surgery, and developed an iPhone app that provides diagnostic information about blood pressure and other vital signs before patients arrive in the emergency room. The initiative, drawing on practices from surgery, psychology, aviation and other disciplines, focuses on addressing potential breakdowns in the coordination of trauma care during the so-called "golden hour," when prompt medical attention can mean the difference between life and death. Physicians from Cedars-Sinai and military hospitals on two continents, along with researchers from several universities, have analyzed the complex processes of trauma care - from the moment a doctor's pager is triggered to the time a patient arrives in a trauma bay to the patient's transfer to an intensive care unit. The aim of this research has been to find ways to simplify the time-pressured nature of trauma care, including improving communication and teamwork among medical staff, making better use of technology and re-engineering the operating room so that bulky equipment pivots effortlessly around surgical teams rather than cluttering work spaces. OR 360 has been funded by $3.8 million in grants from the U.S. Department of Defense. Cedars-Sinai has collaborated with personnel at military medical centers in the United States and Europe.

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Your doctor may soon need to test how "activated" you are. "Patient activation" is a measure of how engaged patients will be in their own care. Patients who are highly activated have better outcomes and incur lower costs, studies show, even though as many as 40 percent of Americans lack the skills, knowledge and confidence to become model patients. They fail to take their medications, skip preventive screenings and end up back in the hospital soon after discharge. Activation is especially important for patients leaving a hospital after surgery or trying to manage diabetes, high blood pressure or other chronic conditions. More hospitals, health plans and employers are scoring patients on how engaged they will be in their

How Doctors Rate Patients Wall Street Journal – March 31, 2014

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Trauma Research News

Levels of total tau protein in blood shortly after a head injury were not only diagnostic for clinically definite concussion, but were significantly predictive of persistent symptoms, researchers said. In a study of 288 Swedish pro hockey players, including 28 who experienced concussions, median total tau (t-tau) in blood samples taken 1 hour after injury in the concussed players was 10 pg/mL (range 2-102), compared with 4.5 pg/mL (range 0.06-22.7) in preseason samples taken from 47 other players (P<0.001), according to Sahlgrenska University in Mölndal, Sweden. The area under the receiver-operating characteristic curve (AU-ROC) for elevated t-tau at 1 hour post injury (versus the average measured in a group of players after a noncompetitive "friendly" game) to diagnose concussion was 0.80 (95% CI 0.75-0.94), the researchers reported online in JAMA Neurology.

Blood Test Diagnoses Concussion, Gauges Severity MedPage Today – March 14, 2014

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Cervical Spine Clearance Protocols in Level 1 Trauma Centers in the United States Medscape – March 2014

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The overall prevalence of cervical spine injury in the adult trauma population is estimated to be 3.7 percent. Forty-three percent of cervical spine injuries are considered clinically unstable. Although the majority of these injuries are diagnosed, approximately 0.2 percent of these injuries that result in spinal cord injury are not initially diagnosed. Because the goal of cervical spine clearance is to have no missed injuries, it is paramount to develop accurate guidelines and protocols to "clear the cervical spine." The Eastern Association for the Surgery of Trauma (EAST) has published and updated evidence-based guidelines on cervical spine clearance since 1998. As guidelines evolve, it is important for trauma centers to update their own institution's protocols to reflect the most

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up-to-date literature. However, the extent to which level 1 trauma centers have adopted these guidelines or have developed their own based on the review of the available data is unknown. This study evaluates the use of evidence-based protocols or checklists. The study demonstrates that written cervical spine clearance protocols exist in 57 percent of level 1 trauma centers in the United States, and only 60 percent of the participating centers have protocols that incorporate the most recent evidence-based recommendations provided by the 2009 EAST guidelines.

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care using an assessment called the Patient Activation Measure, or PAM. Scores make it easier to customize information, coaching and other interventions. The

aim is for patients, rather than feel overwhelmed by instructions, to become confident that they can change their own behavior. PAM was developed by the University of Oregon's Health Policy Research Group.

Rating Patients Continued….

Mild Head Injuries Linked to Risk of Death Years Later Reuters – March 28, 2014

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Adults hospitalized with mild head injuries have almost double the risk of dying in the next 15 years compared to similar people with no history of head injury, according to a new UK study. It's not clear whether lifestyle before and after a head injury is to

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Head Injuries Continued….

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University of Cincinnati research is offering hospitals and trauma centers a unique, accurate and scientific approach to making decisions about transporting critical-care patients by air or by ambulance. A presentation this week at the annual meeting of the Association of American Geographers (AAG) in Tampa, Fla., highlights research which uses analysis by Geographic Information Systems (GIS) technology to provide information on whether patient transport would be more successful by ambulance or medical helicopter in terms of cost

Research Offers Scientific Approach to Make Transporting Decisions of Critical Care Patients News Medical – April 8, 2014

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as well as patient care. Early results indicate GIS technology is both accurate and successful in providing estimated transport times to trauma centers. The study analyzes patient transport data from the Maryland Medevac Helicopter Program, focusing on travel time equal to or less than 60 minutes, the so-called "golden hour" of getting critical-care patients to treatment. In applying the GIS technology to factor ambulance versus medical helicopter response times, the researchers examined more than

Antihypertensive Medical Linked to Increased Patient Fall Injuries JAMA Internal Medicine – April 8, 2014

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Patients taking antihypertensive medication experienced a higher rate of serious fall injuries, especially if they had a previous fall injury, according to a study in JAMA Internal Medicine. Using the Medicare Current Beneficiary Survey, researchers analyzed data from approximately 4,900 non-hospitalized adults with hypertension older than 70 years old. Patients were divided into three categories, with 14.1 percent not receiving any hypertensive medication, 54.6 percent in a moderate-intensity hypertensive group and 31.3 percent in a high-intensity hypertensive group. Nine percent of the participants experienced a serious fall injury — hip or major fractures, traumatic brain injury, joint dislocation or mortality — and 16.9 percent died. Patients in the moderate-intensity group and the high-intensity group were more likely to experience a serious fall injury. Researchers suggest potential harms and benefits should be compared when deciding whether to administer antihypertensive medications to older adults.

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blame for the increased risk, if the injury itself has lingering effects, or both, researchers from the Institute of Health and Wellbeing at the University of Glasgow, say. High rates of death in the year following a severe head injury have been well documented, researchers wrote in the Journal of Neurology, Neurosurgery and Psychiatry. But little is known about risk of death after mild head injuries and especially over the long term. To see how people with mild head injuries fare over the years, the researchers studied medical records for 2,428 adults admitted to hospitals in Glasgow with mild head trauma between February 1995 and February 1996. They also identified two comparison groups whose members were similar in age and background, but one group was

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made up of patients hospitalized for something other than a head injury. The other group contained community members who were not hospitalized and had no history of head injury. The researchers followed all the subjects for 15 years to compare their rates of death and injury. Overall, they found the group of head injury patients died at a rate of 2.45 percent per year, compared to the community group's rate of 1.34 percent per year. The group with non-head injuries had a mortality rate of 1.96 percent a year. The differences were more extreme among the younger subjects, with head injury patients who were under 55 at the beginning of the study at four times greater risk of dying than their peers in the community group.

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AMERICAN TRAUMA SOCIETY - INFORM APRIL 2014

Critical Care Continued….

New Discovery Gives Hope to Spinal Cord Injury Patients The Information Daily – April 1, 2014

Researchers have found a possible mechanism for re-growing damaged nerve fibres in the central nervous system (CNS). Currently this kind of damage is irreparable, leaving those who have suffered a spinal cord injury, stroke or brain trauma with serious impairments like loss of sensation and permanent paralysis. Published in Nature Communications, the research, from the Imperial College London's Department of Medicine, highlights the role of a protein called P300/CBP-associated factor (PCAF), which appears to be essential for the series of chemical and genetic events that allow nerves to regenerate. Regenerating nerve fibres is one of the best recovery solutions for those suffering from CNS damage. Researchers found that when they injected PCAF into mice with damage to their CNS, the amount of nerve fibres that grew back increased. This indicates that it may be possible to chemically control the regeneration of nerves in the CNS.

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Football Head Hits Correlate to Brain Changes Medscape – April 9, 2014

The more hits a football player's head takes during a season, the more changes show up on MRI of the player's brain, even in the absence of concussion, a new study shows. Researchers from Wake Forest Baptist Medical Center in Winston-Salem, North Carolina used data from helmet sensors to estimate the risks associated with all impacts to the head sustained by 24 young players during a season, then compared these risks to the white matter changes in the players' brain visible by diffusion tensor imaging. They found a very close correlation. In recent years, reports that many professional US football players have chronic traumatic encephalitis have raised concerns about the game. The worry has led to recent rule changes aimed at reducing the likelihood of head and neck injuries at all levels of the sport. However, few researchers have evaluated the effects of the game on young athletes, although millions of children and teenagers play football at ages when their brains are undergoing sensitive development. Then they placed Head Impact Telemetry System (HITS) sensors in the players' helmets and measured impacts over the course of games and practices for 1 complete season. They reasoned that hits can vary in their effects depending on whether the acceleration is linear or rotational and on other factors. They estimated the probability and seriousness of the harmful effects caused by the impacts they recorded, creating a measurement of "risk-weighted cumulative exposure" (RWE). Players who had the most hits were not necessarily the players who had the highest RWEs. At the end of the season, they scanned the players' brains again. They found statistically significant correlations between changes in players' white matter and their RWE.

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10 years of medical helicopter transports in a five county area surrounding Frederick County, Maryland, over 2000-2011. The data involved 2,200 medical cases. Based on the analyses of the medical cases in the study, the researchers found that 31 percent of the trauma cases transported by air could have also been transported by ambulance within the "golden hour" of trauma treatment, saving taxpayers thousands of dollars.