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Trauma Systems, Centres and Teams
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Trauma units must provide a trauma team that consists of: A trauma team leaderSurgical expertise that is able to provide damage control surgery in a 24/7 emergency theatreAccess to critical careImmediate computed tomography service which can report scans within one hourProtocols for transferring patients to and from an MTCA rehabilitation service If a TU is the primary receiver of a trauma patient, they should be able to identify patients who are beyond their capability to treat and have systems in place to ensure the safe and rapid transfer of these patients to an MTC. For less seriously injured patients, a TU will normally be able to provide care under the most appropriate specialty. Some TUs provide specialist services for specific injuries which are available for all patients in the network who require them. Patients may be transferred from an MTC to a TU for such specialist care or for continuing medical management and rehabilitation, once they have received their initial care at the MTC.
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Which finding most urgently needs to be conveyed to the trauma team?Bilateral pleural effusionsEndotracheal tube tip positionLeft apical capRight lung consolidationRight pneumothorax
Trauma principles
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
In most circumstances, the trauma team is alerted and mobilised early to allow for preparation prior to the patient's arrival. A team leader, usually the most senior figure, should be identified and team roles allocated; these should normally include: Team leaderAirway assessment: The attending anaesthetistPrimary survey: Any team member ideally with advanced trauma life support (ATLS) trainingCannulation: Any team memberScribe: Any team member, to document trauma assessmentOthers: To aid with imaging requests/transfer
Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills
Published in Prehospital Emergency Care, 2023
Madhuri B. Nagaraj, Jessica E. Lowe, Alexander L. Marinica, Brandon B. Morshedi, S. Marshal Isaacs, Brian L. Miller, Andrew D. Chou, Michael W. Cripps, Ryan P. Dumas
EMS handoffs are integral to patient care. Previous literature has identified that an improved handoff structure can lead to better workflow and preparedness in multiple settings and promotes the use of a standardized approach or tool (21,22). However, the correlation between the EMS handoff and trauma team communication skills has not been previously studied. Using TVR, we were able to perform a detailed analysis of almost 100 trauma resuscitations and found that higher MIST completeness scores correlated with teams who scored in the top-quartile on the T-NOTECHS scale. This supports our hypothesis that the completeness of the information provided during a handoff correlates with the communication skills of the trauma team during a resuscitation. Thus, an area of focus for the improvement of trauma team resuscitation skills is to develop communication between trauma teams and EMS providers in order to ensure the thoroughness of information transfer.
Prehospital trauma care evolution, practice and controversies: need for a review
Published in International Journal of Injury Control and Safety Promotion, 2020
Each of the decades thereafter saw advances in technology to be used on site, within the Ambulance, at the Emergency Room, in the diagnostic laboratories, in Imaging Modalities (CT, USG, MRI), in the intensive care unit, in the operating room and in rehabilitation. While such evolution has helped our understanding, in many centres each area operates in silos without interacting with each other. We now see ‘boxed in’ specialties that deal with areas such as 1. bystander care, 2. EMS ambulance service (Run by different agencies), 3. emergency room/casualty services, 4. intensive care services, 5. in-hospital trauma team services to provide in-hospital care, 6. rehabilitation services and 7. community and social services for long-term disability rehabilitation. Lack of a unified accountability disperses responsibility for system failures and perpetuates divisions between public safety and medical-based emergency and trauma care professionals (Committee on the future of Emergency care in the U. S. health system, 2007).
Impact of a prehospital discrimination between trauma patients with or without early acute coagulopathy of trauma and the need for damage control resuscitation: rationale and design of a multicenter randomized phase II trial
Published in Acta Chirurgica Belgica, 2019
Martin Tonglet, Vincenzo D’Orio, Didier Moens, François-Xavier Lens, Jérémy Alves, Maximilien Thoma, Bernard Kreps, Pierre Youatou Towo, Romain Betz, Justine Piazza, Julien Szecel, Gerard Decoster B., Michèle Guillaume, Eddy Husson, Anne Françoise Donneau, Jean Louis Poplavsky, Jean Marc Minon, Alexandre Ghuysen
Early identification of trauma patients suffering from active bleeding and/or from EACT remains challenging in clinical practice. The TICCS is an easy-to-calculate clinical score developed for identification of trauma patients in need for DCR and suffering from EACT. Its ability to predict those critical conditions has been previously evaluated but, so far, its potential impact on patients’ care remains uncertain. The several components of DCR are widely debated in the literature but there is logical consensus that every one of those aspects has to be applied as early as possible. Massive transfusion protocols (MTPs) or exsanguination protocols (EPs) proved in several studies to be efficient partly by shortening the delay of transfusion [8,9,25]. The existence of an immediately available experienced trauma team at patient’s arrival proved to be efficient partly by shortening the delay of decision and the delay of surgical control of the bleeding [8]. Studies also demonstrated that prolonged prehospital, on-scene, time has a strong negative impact on patients’ outcome [26]. This suggests that a very early flagging of trauma patients in need for DCR would be beneficial but this need to be proved. Our study overcomes this medical need by proposing an original but crucial question: do we improve our quality of care by an earlier diagnosis? Does a prehospital discrimination between trauma patients with or without a potential need for DCR has a positive impact?