Steven R. Vallance, MD, PhD, FACSTrauma 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

Local Hospital

• Administrative “Buy In”• $$$$• Ancillary Support Services • Financial Rewards

SURGEONS

• General Surgery – Trauma Medical Director

• Orthopedic Surgery

Trauma Program Manager (TPM)

• Experience • Charlotte Oneal

Anesthesia

• IN- House NOT required• CRNA’s Permissible • Liaison to trauma program

Radiology

• In house or by Teleradiology • CAT Scan 24/7– CT tech on call

ER Physicians/Nurses

• Coordinated- Collegial Collaboration • ATLS- Physicians• TNCC- Nurses

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

Medicine/Hospitalist Service

• Must be available • Consults and Admits

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

Operating Room• Readily Available 24/7• Support of OR Staff

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

The Journey

• Began program NOV. 2009 • COT- Consultative Visit April 2012 • COT- Verification Visit May 2013• RTTDC – – DEC 2009 – UKMC

PROTOCOLS

Trauma Flow Sheet

Trauma Alert Criteria

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

Education

• EMT’s – TNCC – PHTLS – Appreciation Dinner • Guest Speaker

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

Summary

• Arduous and prolonged journey • General Surgery and Orthopedic Surgery

commitment• Hospital “Buy In”• TPM Essential• Statewide Trauma System • PIPS