1. Rural Trauma Team Development Course© (RTTDC)
A Brief Overview
Slide #1 – Title Slide
This is a picture from a real scene in rural Alaska.

2. The Purpose of RTTDC
To train rural hospital and clinic personnel in a team approach to the initial assessment and resuscitation of the injured patient
To rapidly initiate transfer to definitive care when appropriate
Slide #2 – The Purpose of RTTDC

3. RTTDC Objectives To improve care of the rural trauma patient by:
Establishing a trauma team using the personnel and resources available at a facility
Developing a team approach to trauma resuscitation, stabilization and prompt transfer
Identifying key factors in organizing and preparing the resuscitation area and equipment
Slide #3 – RTTDC Objectives

4. Who teaches RTTDCs?
RTTDCs are taught by personnel from an area’s level I, II or III trauma center
Builds the working relationship between a trauma center and its referring facilities
Allows personnel at the area trauma center to see first-hand the resources available at the referring facility
Slide #4 – Who teaches RTTDC?

5. Who is the RTTDC audience?
Anyone who is available and able to play a role on a facility’s trauma team, including….
Physicians
Nurse Practitioners
Physician Assistants
Nurses
Pre-hospital providers
ED, radiology, respiratory and laboratory technologists
Administrative personnel
Slide #5 – Who is the RTTDC audience?

6. Rural Trauma Team Composition
Teams have a core of at least three members
Suggested roles depend on available personnel
Team leader (Physician, NP or PA)
Team member #1 (Nurse)
Team member #2 (Nurse, technician, prehospital provider, other)
Teams may have more than three members
Extended team members
are personnel available to
support the core team
Slide #6 – Rural Trauma Team Composition

7. Course Site Requirements
Room large enough to seat audience for lectures
Additional room(s) for Team Performance Scenarios
Ideally held in rural facility’s ED
AV equipment (LCD, screen, speakers)
Microphone for instructors
Laptop computer
Important to make a trial of the course slides on the actual laptop that will be used at the course
Slide #7 – Course site requirements
If the Team Performance Scenarios are held in one room, it must be large enough that conversations at other stations are not a distraction.
If it is not possible to conduct the scenarios in the team’s ED, the room or rooms should follow that setup as closely as possible. ED setup is part of the information gathered in the pre-course arrangements.
The RTTDC course slides have embedded videos, so speakers are necessary in order for the participants to hear the audio tracks.

8. Equipment requirements
Minimal equipment needed
Intubation heads, adult and pediatric
Endotracheal tubes and laryngoscopes
Broselow® tape
Chest tube and needle for chest decompression
Scenarios can use manikins, or patient models if available
Slide #8 – Equipment requirements
Most trauma centers will already have the type of simulators useful in an RTTDC.
The picture on the slide is a pediatric patient model with simulated injuries (moulage).

9. RTTDC Format 8 ½ hour course
Can be taught in modules also
Interactive lectures and patient scenarios
Teams sit and work together throughout course
Course worksheets
Completed by teams during course
Help to identify and note individual team member responsibilities
Slide #9 – RTTDC Format
The RTTDC course text has a worksheet for the primary assessment chapters (airway, breathing, circulation, disability, exposure and environment) and for the transfer to definitive care chapter. The worksheets have sections for participants to complete regarding facility preparation, individual responsibilities and opportunities for improvement.

10. RTTDC Format: Lectures
ABCDE of trauma
Airway
Breathing
Circulation
Disability
Exposure and environment
Transfer to definitive care
Pediatric trauma
Slide #10 – RTTDC Format: Lectures
This slide and the next list the lectures presented in the first part of the course.
A patient scenario is introduced at the start of the lectures, and new information on the patient is given at each step of the primary assessment and transfer to definitive care lectures.

11. RTTDC Format: Lectures
Special considerations in trauma
Pregnancy
Burns
Geriatric
PIPS (performance improvement and patient safety)
Communications
General overview of subject in video lecture
Role-playing scenarios on video
Slide #11 – RTTDC Format: Lectures

12. RTTDC Format: Scenarios
Team Performance Scenarios
Teams rotate through three patient scenarios
With prior approval, may substitute real cases for course scenarios
Staged as closely to team’s ED as possible
Information on facility resources gathered pre-course
Helps identify areas to change
Critiquing by instructors
Self-critiquing by teams
Slide #12 – RTTDC Format: Scenarios
The teams spend the majority of the afternoon rotating through three scenario stations. With approval from the ACS Trauma Programs office, the faculty and the facility may use a real case, or create one that would specifically address areas that the facility has indentified as needing improvement.

13. RTTDC Policies ACS provides 8.25 CMEs for physicians
Non-physicians can claim credits from other organizations
Can have up to 30 participants
Course can be held for teams from multiple facilities
Courses must be approved by Chair of RTTDC committee and ACS staff
Slide #13 – RTTDC Policies

14. RTTDC Costs RTTDC 3rd edition text Other possible costs
$50.00 each, plus shipping
Other possible costs
Travel for course faculty
Venue rental
AV equipment rental
Lunch and breaks
Miscellaneous small expenses (phone, copying, postage, etc.)
Slide #14 – RTTDC Costs
RTTDC texts are ordered from the ACS Trauma Programs office.

15. How To Request An RTTDC
Rural facility identifies a facilitator to work with course coordinator
Facilitator makes on-site arrangements and helps organize participants into teams
Facilitator contacts course coordinator at area trauma center
Course coordinator sends pre-course questionnaire to gather information about facility resources and needs
Slide #15 – How to Request an RTTDC

16. Does RTTDC Make a Difference?
An ongoing study in West Virginia has found that RTTDC significantly reduces delays in the transfer process of rural trauma patients.
Slide #16 – Does RTTDC Make a Difference?
“Does the Rural Trauma Team Development Course Shorten the Interval from Trauma Patient Arrival to Decision to Transfer?”
Journal of Trauma, February Volume 70 - Issue 2 - pp
Kappel, David A. MD, FACS; Rossi, Daniel C. DO, PGY-V; Polack, Edward P. MD, MA, FACS; Avtgis, Theodore A. PhD; Martin, Matthew M. PhD

17. Summary
Teaches rural trauma teams to quickly assess patients for injuries requiring prompt transfer
Using faculty from the area trauma center builds working relationships
Tailored to a facility’s resources and needs
Shown to improve time to decide to transfer
Designed to be simple and economical to present
Slide #17 – Summary

18. For Further Information
The RTTDC program is administered by the American College of Surgeons Trauma Programs office. For more information or for other assistance with RTTDC, please call (312) or to
Slide #18 – For Further Information
July 2011