9. System valuables
Efficacy
of care
Safety
of care
System control
Cost
of care
Severity
of injury
Co-morbid
conditions
System performance
Patient outcome
survival
Quality
Ease of recover
Committee on trauma American college of surgeons},2006
10. Trauma care
The age of
basic science
Understanding of
the physiology of
shock and the
importance
Capabilities for
diagnosing
internal injuries
Supportive
care
Technology
advance
The field of
quality and safety
Capabilities for
pre-hospital care
Hemodynamic
stability
Development of
trauma center
Resuscitation
endpoint
Creation of ATLS
Critical
management
algorithms
Reducing
medical error
Krongdai U.FoNMU2013
11. Component of
a Modern trauma system
• The entire patient pathway from point of
injury and pre-hospital care management,
through ED resuscitation and specialist
emergency surgical intervention, to
reconstruction of injuries and rehabilitation,
before reintegration into society.
Lendrum and Lockey, 2013
12. Inclusive trauma systems
Pre-hospital
care
Trauma
centers
Emergency
preparedness
Accurate triage and
bypass protocols
Immediate transfer
protocols for major
trauma patients
Incident planning
Save life and allow
safe transport
Rehabilitation
services and
facilities
Integrated incident
planning for other
incident types
Rapid transfer
to the most
appropriate facility
Monitor the
standard of care
and trauma
registries
Enhancing
healthcare
response to mass
casualty incidents
Krongdai U.FoNMU2013
22. Trauma Nurse Coordinator
• Works in close
collaboration with trauma
director
• Providing care to injured
patient
• Process educational,
clinical, research,
administrative, & outreach
activities
• Supervised registrar,
secretary, trauma nurse
clinician
Trauma Case Manager
• Daily ward round
• Collaborating between
medical teams &
multiple care givers
• Documentation
• Building a rapport
• Reassure patients
• Feedback problems to
trauma coordinator &
director
• Conduct patient education
• Data collection
26. Severity scales to characterize
the nature and extent of injury
are important adjuncts
to trauma care systems.
H. R. Champion
27. TRISS;
Trauma Score-Injury Severity Score
• TRISS determines the probability of survival
(Ps) of trauma patient from the ISS and RTS
using the following formulae:
Ps =
1
(1+e-b)
28. b = b0+b1(RTS)+b2(ISS)+b3(ageIndex)
AgeIndex = 0 if the patient is below 54 years
= 1 if 55 years and over
If the patient is less than 15, the blunt coefficients
are used regardless of mechanism.
b0
b1
b2
b3
Blunt
-0.4499
0.8085
-0.0835
-1.7430
Penetrating
-2.5355
0.9934
-0.0651
-1.1360
30. Injury Severity Score (ISS)
• summarize the severity of the condition of
multiply injured patients.
• The ISS is the sum of squares of the highest
AIS grades in each of the 3 most severely
injured body regions.
ISS = a2 + b2 + c2
31. Abbreviated Injury Scale (AIS)
• classifies the injury into 1of 6 categories,
each with an associated severity score:
1=minor , 2=moderate, 3=serious,
4=severe, 5=critical, and 6=fatal.
• has been shown to relate to risk of death
in each body region.
32. Example: ISS calculation
Region
Head & Neck
Face
Chest
Abdomen
Extremity
External
Injury
Description
Cerebral Contusion
No Injury
Flail Chest
Minor Contusion of
Liver
Complex Rupture
Spleen
Fractured femur
No Injury
AIS
3
0
4
2
5
3
0
Square
Top Three
9
16
25
38. DO YOU HAVE?
• Strong organizational skills, interpersonal
skills, and communication skills.
• Leadership skills.
• The ability to be self-directed and function
autonomously.
• The ability to work collaboratively in a selfdirected work team environment.
Krongdai U.FoNMU2013
39. DO YOU HAVE?
• Baccalaureate degree in nursing.
• Certified of Clinical expertise in trauma care.
• Minimum of 5 years of trauma clinical
experience in either the ED/ER or Critical
Care.
Krongdai U.FoNMU2013
