1. KGMU Trauma 2

2. Levels of trauma centre*
The different levels (i.e. Level 1-5) refer to the kinds of resources available in a trauma centre and the number of patients admitted yearly.
*(American college of surgeons and COT)

3. Level 5
A Level 5 Trauma Centre provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.
Elements of Level 5 Trauma Centres Include:
Basic emergency department facilities to implement ATLS protocols 
Available trauma nurse(s) and physicians available upon patient arrival.
Has developed transfer agreements for patients requiring more comprehensive care at a Level I to III Trauma Centres.  

4. Level 4
A Level 4 Trauma Centre has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma centre. 
It provides evaluation, stabilization, and diagnostic capabilities for injured patients.

5. Elements of Level 4 Trauma Centres Include:
Basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage.  
Available trauma nurse(s) and physicians available upon patient arrival.
May provide minor surgery and critical-care services if available.  
Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Centre. 
Incorporates a comprehensive quality assessment program
Involved with prevention efforts and must have an active outreach program for its referring communities. 

6. Level 3
A Level 3 Trauma Centre has demonstrated an ability to provide prompt assessment, resuscitation, Gen surgery, intensive care and stabilization of injured patients.

7. Elements of Level 3 Trauma Centres Include:
24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anaesthesiologists. 
Incorporates a comprehensive quality assessment program
Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center. 
Provides back-up care for rural and community hospitals.
Involved with prevention efforts and must have an active outreach program for its referring communities. 

8. Level 2
A Level 2 Trauma Centre is able to initiate definitive care for all injured patients.
Elements of Level 2 Trauma Centres Include:
24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopaedic surgery, neurosurgery, anaesthesiology, radiology and critical care. 
Tertiary care needs such as cardiac surgery, haemodialysis and micro vascular surgery may be referred to a Level I Trauma Centre. 
Provides trauma prevention and to continuing education programs for staff. 
Incorporates a comprehensive quality assessment program.

9. Level 1
Level 1 Trauma Centre is a comprehensive regional resource that is a tertiary care facility central to the trauma system.
A Level 1 Trauma Centre is capable of providing total care for every aspect of injury – from prevention through rehabilitation. .

10. Elements of Level 1 Trauma Centres Include:
24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopaedic surgery, neurosurgery, anaesthesiology, radiology, plastic surgery, oral and maxillofacial, paediatric and critical care. 
Referral resource.
Leadership in prevention, public education to surrounding communities.

11. Continuing education of the trauma team members.
Comprehensive quality assessment program.
Teaching and research effort to help direct new innovations in trauma care.
Program for substance abuse screening and patient intervention.
Meets minimum requirement for annual volume of severely injured patients

12. Primary survey ABCDEs of trauma care A Airway and c-spine protection
B Breathing and ventilation
C Circulation with hemorrhage control
D Disability/Neurologic status
E Exposure/Environmental control

13. Airway Assessment and Intervention
Airway should be assessed for patency
Assume c-spine injury in patients with multisystem trauma
Supplemental oxygen
Suction
Chin lift/jaw thrust
Oral/nasal airways
Definitive airways
RSI for agitated patients with c-spine immobilization
ETI for comatose patients (GCS<8)

14. Breathing Assessment and Intervention
Inspect, palpate, and auscultate
Deviated trachea, crepitus, flail chest, sucking chest wound, absence of breath sounds
CXR to evaluate lung fields
Ventilate with 100% oxygen
Needle decompression if tension pneumothorax suspected
Chest tubes for pneumothorax / hemothorax
Occlusive dressing to sucking chest wound
If intubated, evaluate ETT position

15. Circulation Assessment and Intervention
Rapid assessment of hemodynamic status
Level of consciousness, Skin color, Pulses in four extremities and Blood pressure and pulse pressure. Cardiac monitor
Apply pressure to sites of external hemorrhage
Establish IV access
Cardiac tamponade- decompression if indicated
Volume and Blood resuscitation

16. Disability Abbreviated neurological exam Level of consciousness
Pupil size and reactivity
Motor function
GCS (Glasgow Coma Score)

17. Exposure Complete disrobing of patient Logroll to inspect back
Rectal temperature
Warm blankets/external warming device to prevent hypothermia

18. Trauma 1 and Trauma 2 Trauma 1 New emergency And Trauma centre

19. Phase wise facilities at Trauma 2
(From 1st Jan 2016 to 31st may 2016)
Level 3-4 facility
40 beds
3 ventilators
Phase 2
(From 1st June to 30th Sep2016)
Level 3 facility
100 beds
6 ventilators

20. Treatment of all kind of trauma patients, including general surgery , orthopaedic surgery, oral surgery, plastic surgery, critical care.
All patients of head injury will be entertained but patients having GCS <10 or requiring active neurosurgical management (operation) will be transferred to KGMU Trauma 1.
All pathological investigations and ultrasound will be available round the clock.
CT Scan & X-ray machines to be installed soon.

21. Phase 3
(From 1st Oct 2016 to 31st march 2017)
Level 2 facility
218 beds
28 ventilators
Phase 4
(From 1st April 2017 onwards)
Level 1 facility, With teaching and research and to start Super speciality courses

22. The activist is not the man who says the river is dirty
The activist is not the man who says the river is dirty. The activist is the man who cleans up the river.
(Ross Perot)

23. Sapne unhi ke sach hote hain, jinke sapno mai jaan hoti hai hai.
Sirf pankh hone se kuchh nahi hota, hausalon se udaan hoti hai.

24. Thankyou