trauma in nether land

8/8/2019 Trauma in Nether Land

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Organization of Trauma Care in the Netherlands

Christian van der Werken

Paris, May 30st, 2008


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GNP Euro p.c.

x 1000COUNTRY

France

Netherlands

Austria

Germany

Switzerland

United Kingdom

United States

22,8

23,3

23,5

22,0

34,9

23,9

27,8

Healthcare Spen-

dings Euro p.c.

1460

1400

1330

1720

2480

1080

3805

Physicians

p. 1000 c.

3,37

3,15

3,38

3,37

3,61

2,30

2,56

Life

expectancy

80,6

79,1

79,2

78,9

80,6

78,7

78,0

Differences between countries


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The Netherlands in the 1980s

Lack of organized trauma care

No centralized care for the multiple injured patient

Dutch Trauma Society stipulated repeatedly the need for action

Simultaneously major incidents attracted the political arenato improve the organization of trauma care


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Basic Concepts Reorganization Trauma Care

Regionalization and concentration of trauma care

(Inclusive trauma system)

Ambulance services

Inception of geographically dispersed Trauma Centers

Backup helicopter service for a nationwide network ofmobile medical teams

National Trauma registry

Education ATLS (Advanced Trauma Life Support)

PHTLS (Pre Hospital Trauma Life Support)

MIMMS (Major Incident Medical Management Support)


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Geography and Demography

Over 100 hospitals

All have an Emergency Service taking care for injured patients

Virtually all have ATLS trained doctors and nurses Physical distance is never a problem

Ambulance time is < 15 minutes and is everywhere reached

Except: - West - Frisian islands

- Urban conglomerations (traffic congestion)


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Prehospital Care

Principally provided by ambulance personnel

Crew:

Specifically trained driver

PHTLS trained paramedic (90 % is ICU or anesthesiology trained)

Resuscitation of severe trauma and cardiac arrest:

Hard neck collar

Spine board Coniotomy

Chest needle decompression

Intubation (without muscle relax.)

Defibrillation

No permission to perform full anesthesia

Generally accepted national standard protocols


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Emergency Response System

Early on 80 (!) different ambulance care providers

Now 26 regions with

- Central control room (dispatch or CPA)

- Full ambulance service

- Training and evaluation responsibility

Contact by European emergency number: 112

Coordination by CPA

Legal obligation to reach the victim within 15 minutes after first call


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Ambulance

SPREAD OVER THE COUNTRY:

202 ambulance stands


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Ambulance Service

Responsibility qualification based

(nurse is sole responsible for all the actions taken) Registration through Individual Health Professions Act (BIG)

Professional has to be authorized to perform medical actions

Functionally independent Overall responsibility lays with the medical officer of the

ambulance service


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On site care

Basic emergency care by paramedics

Evolving knowledge shows the efficacy of SCOOP AND RUN

In complicated cases or need for prolonged anesthesia, support

can be called in from a designated Mobile Medical Team

10 MMTs by car / special minibus


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On site care

Basic emergency care by paramedics

Evolving knowledge shows the efficacy of SCOOP AND RUN

In complicated cases or need for prolonged anesthesia, supportcan be called in from a designated Mobile Medical Team

10 MMTs by car / special minibus

4 MMTs by helicopter


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Mobile Medical Team

Four hospitals are providing a helicopter backup facility

Trained medical specialist (anesthesiologist or trauma surgeon)

Paramedic with special training

Until the beginning of 2006 flying time was between 7 am and 7 pm


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Mobile Medical Team

Four hospitals are providing a helicopter backup facility

Trained medical specialist (anesthesiologist or trauma surgeon)

Paramedic with special training

Until the beginning of 2006 flying time was between 7 am and 7 pm

Recently one night helicopter service was started as pilot study


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Mobile Medical Team doctor training

Anesthesiology training (for surgeons)

Surgical training (for anesthesiologists)

ICET training Media training

ATLS

ACLS

APLS

Toxicology training

Crew resource management

Flight safety training Line check JAR-OPS

Helicopter training


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Trauma Centers

Since 1999 designation of 10 (later11) Trauma Centers

8 University hospitals

3 General teaching hospitals with neurosurgical facilities

Adequate care for every trauma patient in the most suitable hospital Centralization of the care for the polytrauma patient for the best care

Decision made by the ambulance or MMT crew

Protocols and direction on which patients belong in which facility

are in place and are working well


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Exclusive Trauma System

patients

ISS > 16 p.


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Dutch Trauma Centres


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Dutch Trauma Centers


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Burn care in The Netherlands

Three major Burn Centers (Rotterdam, Beverwijk and Groningen)

Patients

Burn body surface area of > 20 %

(children > 15 %)

Burn in special areas

Combined trauma and burn

No relation with a university hospital

*

*

*


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Hospital Care in The Netherlands

High standard of care

Well trained specialists (ATLS generally accepted)

Advanced

TraumaLife

Support

Categorized care- Trauma Centers (10%): highest level of care: polytrauma

- Large general hospitals (30%) without neurosurgery:

major trauma

- Restricted capacity for trauma care (60%): isolated injuries

Care is well distributed over these facilities


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In Hospital Care in The Netherlands

Alert before patient arrives by the CPA

Internet transfer patients data and parameters

Emergency room:

Surgeon is in charge

Team approach: surgeon (ATLS+), anesthesiologist (ATLS+),neurologist, radiologist supported with trained emergency carenurses

Team on site when patient arrives

Additional services available on demand


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In Hospital Care in The Netherlands

Alert before patient arrives through the CPA

Internet transfer data

Emergency room:

Surgeon is in charge

Team approach: surgeon (ATLS+), anesthesiologist (ATLS+),neurologist, radiologist supported with trained emergency carenurses

Team on site when patient arrives

Additional services available on demand

Crucial is the ongoing lack of ICU beds for trauma


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Trauma Care in The Netherlands

Mainly provided by general surgeons

80 % of skeletal trauma is treated by (trained) general surgeons

20 % and most spine injuries are treated by orthopedic surgeons

Training of general surgeons:

Designated trauma rotation in last year of training

Two years fellowship after registration as a general surgeon


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Trauma Care in The Netherlands

Mainly provided by general surgeons

80% of skeletal trauma is treated by (trained) general surgeons

20 % and most of spine trauma is in the hands of orthopedicsurgeons

Training of general surgeons:

Designated trauma rotation in last year of training Two years fellowship after registration as a general surgeon

Care funding through statewide obligatory insurance/social security

Trauma Centers are funded through a special program

(0,5 million Euro per year) for organizational en logistic functions

Helicopter Centers have additional funds for their service


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2500 - 4000 polytrauma patients (ISS > 16) / year

20 % helicopter MMT intervention

11Traumacenters 180 - 300 polytrauma patients per center / year

20 % in hospital mortality

Polytrauma Care in The Netherlands


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Wishes for the future

- Increase helicopter MMT services 4 6

- All helicopter MMTeams 24 x 7 operational

- Increase national ICU capacity

Halve the number of trauma centers


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547.000 square kilometers

64.5 million inhabitants


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Response time to victim

trauma in nether land

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