2 The Purpose of RTTDCTo train rural hospital and clinic personnel in a team approach to the initial assessment and resuscitation of the injured patientTo rapidly initiate transfer to definitive care when appropriateSlide #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 facilityDeveloping a team approach to trauma resuscitation, stabilization and prompt transferIdentifying key factors in organizing and preparing the resuscitation area and equipmentSlide #3 – RTTDC Objectives
4 Who teaches RTTDCs?RTTDCs are taught by personnel from an area’s level I, II or III trauma centerBuilds the working relationship between a trauma center and its referring facilitiesAllows personnel at the area trauma center to see first-hand the resources available at the referring facilitySlide #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….PhysiciansNurse PractitionersPhysician AssistantsNursesPre-hospital providersED, radiology, respiratory and laboratory technologistsAdministrative personnelSlide #5 – Who is the RTTDC audience?
6 Rural Trauma Team Composition Teams have a core of at least three membersSuggested roles depend on available personnelTeam leader (Physician, NP or PA)Team member #1 (Nurse)Team member #2 (Nurse, technician, prehospital provider, other)Teams may have more than three membersExtended team membersare personnel available tosupport the core teamSlide #6 – Rural Trauma Team Composition
7 Course Site Requirements Room large enough to seat audience for lecturesAdditional room(s) for Team Performance ScenariosIdeally held in rural facility’s EDAV equipment (LCD, screen, speakers)Microphone for instructorsLaptop computerImportant to make a trial of the course slides on the actual laptop that will be used at the courseSlide #7 – Course site requirementsIf 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 neededIntubation heads, adult and pediatricEndotracheal tubes and laryngoscopesBroselow® tapeChest tube and needle for chest decompressionScenarios can use manikins, or patient models if availableSlide #8 – Equipment requirementsMost 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 alsoInteractive lectures and patient scenariosTeams sit and work together throughout courseCourse worksheetsCompleted by teams during courseHelp to identify and note individual team member responsibilitiesSlide #9 – RTTDC FormatThe 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 traumaAirwayBreathingCirculationDisabilityExposure and environmentTransfer to definitive carePediatric traumaSlide #10 – RTTDC Format: LecturesThis 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 traumaPregnancyBurnsGeriatricPIPS (performance improvement and patient safety)CommunicationsGeneral overview of subject in video lectureRole-playing scenarios on videoSlide #11 – RTTDC Format: Lectures
12 RTTDC Format: Scenarios Team Performance ScenariosTeams rotate through three patient scenariosWith prior approval, may substitute real cases for course scenariosStaged as closely to team’s ED as possibleInformation on facility resources gathered pre-courseHelps identify areas to changeCritiquing by instructorsSelf-critiquing by teamsSlide #12 – RTTDC Format: ScenariosThe 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 organizationsCan have up to 30 participantsCourse can be held for teams from multiple facilitiesCourses must be approved by Chair of RTTDC committee and ACS staffSlide #13 – RTTDC Policies
14 RTTDC Costs RTTDC 3rd edition text Other possible costs $50.00 each, plus shippingOther possible costsTravel for course facultyVenue rentalAV equipment rentalLunch and breaksMiscellaneous small expenses (phone, copying, postage, etc.)Slide #14 – RTTDC CostsRTTDC texts are ordered from the ACS Trauma Programs office.
15 How To Request An RTTDCRural facility identifies a facilitator to work with course coordinatorFacilitator makes on-site arrangements and helps organize participants into teamsFacilitator contacts course coordinator at area trauma centerCourse coordinator sends pre-course questionnaire to gather information about facility resources and needsSlide #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 - ppKappel, 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 SummaryTeaches rural trauma teams to quickly assess patients for injuries requiring prompt transferUsing faculty from the area trauma center builds working relationshipsTailored to a facility’s resources and needsShown to improve time to decide to transferDesigned to be simple and economical to presentSlide #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 toSlide #18 – For Further InformationJuly 2011