Paramedic Care:Principles & Practice

Volume 5Trauma Emergencies

Death by PowerPoint

Chapter 1 Trauma and Trauma Systems

Topics Trauma Trauma as a Disease The Trauma Care System Trauma Center Designation Your Role as a Paramedic

Trauma

Trauma Physical injury caused by external force Leading killer of persons under 44 in

US 150,000 deaths annually

Most expensive medical problem

Trauma Two major categories:

Penetrating Blunt

< 10 % are serious

Trauma Serious vs. Not Serious

The use of trauma triage criteria will aid you in making this determination.

Trauma as a Disease

Trauma as a Disease Highway Safety Act of 1966

Led to development of EMS Trauma was categorized as a disease

Trauma can often be prevented The public health model

Surveillance, risk analysis, intervention development, implementation, and evaluation

Surveillance The collection of data Epidemiology

Epidemiology

Risk Analysis Examines the various factors that impact the

development, course, and consequences of a disease.

Haddon Matrix A three-by-three matrix that describes nine

elements

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Intervention Development

Programs to reduce both the incidence and the seriousness of trauma

Examples Safer highway design Autos with better braking systems, crumple zones,

and passive restraint systems Programs that encourage drivers to use their

seatbelts, to not drink and drive, and to drive defensively

Implementation Act of placing an intervention into practice Includes:

Enforcing traffic laws Reducing speed limits in hazardous areas Rebuilding highways to be safer Building safer autos Encouraging changes in driver behavior Safety education Continuing to improve our EMS system

Evaluation Accomplished by repeating the processes of

surveillance To identify the benefit or ineffectiveness of an

intervention or program We must continue to search out risk factors,

develop and implement interventions, and evaluate our systems’ performance

The Trauma Care System

http://www.doh.state.fl.us/demo/trauma/guidebook.htm

The Trauma Care System

Integration of EMS Hospital care

Reduces Cost Time to surgery Mortality

Proper Care Immediate surgical intervention to repair

hemorrhage sites

Trauma Center Designation

Trauma Center Designation

The trauma system is predicated on the principle that serious trauma is a surgical disease. < 10 % Life threatening Surgical care for trauma patients can drastically

reduce trauma mortality and morbidity.

Trauma Center Designation

Level I Level II Level III

Trauma Center Designation

Level I Regional Trauma Center All types of surgical and medical subspecialty Research and teaching commitment

Level II Area Trauma Center Majority of surgical and medical subspecialties

available 24/7 Level III

Community Trauma Center Specialized ED with the majority of surgical and

medical subspecialties available 24/7 (on call)

Trauma Center Designation

In some remote areas, there is provision for an additional level of trauma patient destination. Level IV

Seriously injured trauma patients may be taken for stabilization and care before transport.

The design of a trauma system should be flexible in order to meet the needs of the region it serves.

Trauma Center Designation

Specialty Centers Neurocenters Burn Centers Pediatric Trauma Hyperbaric Medicine Microsurgery

Your Role as a Paramedic

CUPS

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Your Role as a Paramedic

Trauma Triage Criteria START Nearest appropriate facility

Mechanism of Injury Analysis (MOI) Processes and forces that cause trauma Consider inertial forces

Index of Suspicion (IOS) Anticipation of injury to a body region, organ, or

structure based on MOI

Your Role as a Paramedic

The Golden Period BEST survivability

from incident to surgery is 1 hour

Platinum 10 Minutes Scene time limited to

10 minutes Air Transport

Speed vs. need Type of patients

transported

Your Role as a Paramedic

The Decision to Transport The trauma triage criteria When applying trauma triage criteria, it is best to

err on the side of precaution.

Your Role as a Paramedic

Injury Prevention Bicycle safety programs Firearm safety Boat safety Child safety seat classes

and checking Data and Trauma

Registry Data retrieval system for

trauma patient information

Your Role as a Paramedic

Quality Improvement QI or QM Examine the system performance Evaluate calls Accurate and complete documentation