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

Chapter 1 Trauma and Trauma Systems Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Topics Trauma Trauma as a Disease The Trauma Care System Trauma Center Designation Your Role as a Paramedic Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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

Trauma Trauma is a physical injury or wound caused by external force or violence. Leading killer of persons under 44 in the United States. 150,000 deaths annually Most expensive medical problem in terms of lost wages, initial care, rehabilitation, and lifelong maintenance. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Trauma Trauma is typically divided into two major categories: Penetrating Injury caused by an object breaking the skin and entering the body Blunt Injury caused by the collision of an object with the body in which the object does not enter the body Serious/life-threatening problems occur in less than 10% of all trauma patients. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Trauma During your assessment it is essential that you determine the difference between a trauma patient with serious, life-threatening conditions and one who is less seriously injured. The use of trauma triage criteria will aid you in making this determination. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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

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

Surveillance The collection of data to identify the existence, significance, and characteristics of a disease or disease process Epidemiology Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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

Risk Analysis 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 Pre-event elements Event elements Post-event elements Characteristics of the host The agent The environment Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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

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

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

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

The Trauma Care System Integration of Reduces Proper Care EMS Hospital care Reduces Cost Time to surgery Mortality Proper Care Immediate surgical intervention to repair hemorrhage sites Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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

Trauma Center Designation The trauma system is predicated on the principle that serious trauma is a surgical disease. Life-threatening injuries account for less than 10 percent of all trauma patients. Surgical care for trauma patients can drastically reduce trauma mortality and morbidity. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Trauma Center Designation The current model for a trauma system includes three levels of trauma center Level I Level II Level III Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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) Refer to the American College of Surgeons “Gold Book” for exact designations and criteria. Level III – The ACS requires that surgical specialists be available to be called in within one hour from trauma team activation. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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

Trauma Center Designation Specialty Centers Neurocenters Burn Centers Pediatric Trauma Hyperbaric Medicine Microsurgery Neurocenters – Spinal surgeon Burn Centers – Plastic surgery available 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 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 Shock and head injury Frequent reassessment and trending 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 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 © Bell Helicopter Textron, Inc. 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 The Decision to Transport The trauma triage criteria are designed to help you with transport decisions. These criteria are designed for the “over-triage” of trauma patients. When applying trauma triage criteria, it is best to err on the side of precaution. 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 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 © Austin County, Texas EMS 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 Click here to view a video on trauma. 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 Quality Improvement QI or QM Examine the system performance and attempt to improve and provide better patient care Evaluate calls to determine if standard of care was met Accurate and complete documentation Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Summary Trauma Trauma as a Disease The Trauma Care System Trauma Center Designation Your Role as a Paramedic Prevalence and significance of trauma. Components of trauma system. Characteristics of community, area, and regional trauma centers. Trauma triage criteria. Golden hour of care. Value of air medical service in trauma patient care. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ