TRU-Lab The Development of a Simulator Lab for Evaluating Technology to Support Pediatric Trauma Resuscitation Ivan Marsic (PI), Marilyn Tremaine (Co-PI) & Joe Wilder (Co-PI) (CAIP, Rutgers U) Jacek Gwizdka (Co-PI) & Aleksandra Sarcevic + Michael Lesk (SCILS, Rutgers U) Randy Burd (PI), Jeff Hammond (Co-PI) (UMDNJ)

Jacek Gwizdka2 Trauma bay – typical resuscitation event: personnel + equipment

Jacek Gwizdka3 Trauma Resuscitation Medical goal: stabilize the patient, safe the patient’s life Environment Characteristics: –fast pace –rapidly changing patient status –team members come and go –medical team roles assigned for each shift  but roles may change Information exchange –verbal information exchange among team members high noise level – many people speak at the same time Information access –access to patient information EMS report; patient health record –access to information from medical instruments e.g. heart rate monitor, oxygen level; blood pressure Information capture –information captured on paper by a dedicated nurse-scribe –typically used for re-cap after the event (but also as for legal purposes)

Jacek Gwizdka4 ATLS – Advanced Trauma Life Support A. Airway with cervical spine protection –the most common cause of death is failure to secure airways B. Breathing / ventilation / oxygenation C. Circulation - stop the bleeding! D. Disability (neurological status) E. Expose / Environment / body temperature Iterate: primary survey (30sec!!!); secondary survey; etc.

Jacek Gwizdka5 Issues Medical errors Lack of efficiency Possible causes: –miscommunication verbally communicated information is “lost” –inaccurate or incomplete information no access to patient health history inaccurate record of accident

Jacek Gwizdka6 Objectives and Main hypothesis Objectives –Eliminate medical errors –Improve efficiency Integrated information capture and display system used during resuscitation will reduce communication errors and improve the efficiency of emergency pediatric trauma

Jacek Gwizdka7 Main Project Phases 1.Identify and model communication patterns and data requirements semi-structured interviews of medical team members and observation of actual and simulated adult and pediatric trauma resuscitations methodology: Cognitive Work Analysis 2.Develop information capture and display system improve information exchange and decision support during pediatric trauma resuscitation 3.Evaluate system impact on reducing communication errors and improving the efficacy of pediatric trauma resuscitation evaluate using human patient simulators

Jacek Gwizdka8 Research Issues What aspects of trauma therapy are we aiming to improve? What are the appropriate metrics? –number of medical errors? –efficiency – time? time for primary survey, overall time? –effectiveness? –are they due to communication errors? due to lack of information? Can “it” be improved by introducing information technology? If so, by how much? –improvements in therapy (e.g. no errors, cure for multiple organ failure) could decrease trauma mortality by 13% –pre-injury behavioral changes could decrease mortality by > 50% R. Stewart et. al. (2003). Seven Hundred Fifty-Three Consecutive Deaths in a Level I Trauma Center: The Argument for Injury Prevention. The Journal of TRAUMA Injury, Infection, and Critical Care

Jacek Gwizdka9 Project Status NSF – applied – answer expected Aug,06 NIH – will be applying end of May In the meantime, we are moving ahead… –Literature review –We are learning methodologies (CWA) –We are learning about trauma procedures (ATLS) –Starting observations (pending IRB...) simulated trauma sessions real trauma events (video-taped) –IRB … received response today… Rutgers U IRB UMDNJ IRB

Jacek Gwizdka10 Thank You Q & A