intro to trauma

3. Topics
 Trauma
 Trauma as a Disease
 The Trauma Care System
 Trauma Center Designation
 Your Role as a Paramedic

4. Trauma

5. Trauma
 Physical injury caused by external force
 Leading killer of persons under 44 in US
 150,000 deaths annually
 Most expensive medical problem

6. Trauma
 Two major categories:
 Penetrating
 Blunt
 < 10 % are serious

7. Trauma
 Serious vs. Not Serious
 The use of trauma triage criteria will aid you in making this
determination.

8. Trauma as a Disease

9. 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

10. Surveillance
 The collection of data
 Epidemiology

11. Epidemiology

12. 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

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

14. Intervention Development
 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

15. 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

16. 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

18. The Trauma Care System

19.  http://www.doh.state.fl.us/demo/trauma/guidebook.
htm

20. The Trauma Care System
 Integration of
 EMS
 Hospital care
 Reduces
 Cost
 Time to surgery
 Mortality
 Proper Care
 Immediate surgical intervention to repair hemorrhage sites

21. Trauma Center Designation

22. Trauma Center Designation
 The trauma system is predicated on the principle that
serious trauma is a surgical disease.
 < 10 % Life threatening
 Surgical care for trauma patients can drastically reduce
trauma mortality and morbidity.

23. Trauma Center Designation
 Level I
 Level II
 Level III

24. 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)

25. 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.

26. Trauma Center
Designation
 Specialty Centers
 Neurocenters
 Burn Centers
 Pediatric Trauma
 Hyperbaric Medicine
 Microsurgery

27. Your Role as a Paramedic

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

29. 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

30. 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

31. Your Role as a Paramedic
 The Decision to Transport
 The trauma triage criteria
 When applying trauma triage criteria, it is best to err on the
side of precaution.

32. 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

33. Your Role as a Paramedic
 Quality Improvement
 QI or QM
 Examine the system performance
 Evaluate calls
 Accurate and complete documentation