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Breaking New Ground in Trauma Education
- 1. Breaking new ground in Trauma Education Dr Amit Maini MBBS BSc FACEM Alfred Hospital, Melbourne Dr Andy Buck MBBS BMedSc FACEM No Fixed Abode
- 2. Why is Trauma Education Important?
- 3. • Trauma is a major health problem world-wide, and it’s on the up • Responsible for 10% of global deaths, and by 2020, MVA will be 3rd leading cause of death in the world • All trauma is managed in the Emergency Department first • ACEM defines it as core, and high and expert level knowledge is expected Trauma is COMMON!
- 4. • Heterogenous - no two traumas are the same • Multisystem injuries - time critical decisions, and skills can affect outcomes • Many confounders - extremes of age, pregnancy, obesity, intoxication • Conflicting priorities in management • Managing the room - co-ordinating the “team” - human factors • In our system - most ED’s don’t manage major trauma, but we all need to know how Trauma is HARD!
- 5. Trauma is EXPENSIVE! • Affects all ages, in Australia, peak incidence in 15-24y age group • Large economic burden attached to this: • hospital treatment • productive life years lost to morbidity & mortality • social / psychological cost - families, staff
- 6. But does education affect clinical outcomes? • Aim of education – to improve quality of care • Outcomes are the key, but are difficult to measure: • Heterogeneity of trauma • Poor methods for assessment of morbidity • Difficulty measuring intervention that affects only one aspect of patient care
- 7. Trauma Education – the old way Textbooks Working at a trauma centre One short course
- 8. Trauma Education Needs Survey * * Trauma Education Needs Survey via www.edexam.com.au and www.edtcc.com November 2012 Less than 50% who attended an alternative trauma course feel adequately prepared to confidently manage trauma patients.
- 9. • Old article but validates utility of face to face short course format • Lectures, small group sessions, skill stations and scenarios – seen to be effective • Demonstrated improved compliance with guidelines • Hard to demonstrate effect on clinical outcomes • Studies show combination of online learning & face to face teaching better than either alone Face to face courses
- 10. Would you consider doing a trauma course other than EMST / ATLS if it was designed to meet your trauma education / experience needs?* * Trauma Education Needs Survey via www.edexam.com.au and www.edtcc.com November 2012
- 11. Trauma Education – the new way
- 12. www.etmcourse.com Course manual in iBook format with video, audio & digital images Accessible & up to date Blog Podcast3 Day Course Face to face Interactive Relevant ED Focused
Editor's Notes
- CommonTrauma a major health problem world wide.And all trauma is managed in the Emergency Department First. ACEM defines it as core, and high and expert level knowledge is expected.Hard!HeterogenousMultisystem injuries where time critical decisions, and skills can affect outcomesMany confounders - extremes of age, pregnancy, obesity, intoxicationConflicting priorities in managementManaging the room - co-ordinating the “team” - human factorsIn our system - most ED’s don’t manage major trauma, but we all need to know how. CostlyIt’s a disease that afflicts all ages, but, here in Australia, peak incidence in 15-24y age group.There is a large economic burden attached to thishospital treatmentMany productive life years lost to morbidity & mortalitySocial / psychological cost - families, staffOutcomesTo improve the quality of care delivered after going through the educational process.Outcomes are the key, but are difficult to measure.Heterogeneity of traumaPoor methods for assessment of morbidityDifficulty measuring intervention that affects only one aspect of patient care
- CommonTrauma a major health problem world wide, and it’s on the up.According to WHO, responsible for 10% of global deaths, and by 2020, MVA will be 3rd leading cause of death in the world.And all trauma is managed in the Emergency Department First. ACEM defines it as core, and high and expert level knowledge is expected.
- Hard!HeterogenousMultisystem injuries where time critical decisions, and skills can affect outcomesMany confounders - extremes of age, pregnancy, obesity, intoxicationConflicting priorities in managementManaging the room - co-ordinating the “team” - human factors.In our system - most ED’s don’t manage major trauma, but we all need to know how.
- CostlyIt’s a disease that afflicts all ages, but, here in Australia, peak incidence in 15-24y age group.There is a large economic burden attached to thishospital treatmentMany productive life years lost to morbidity & mortalitySocial / psychological cost - families, staff
- OutcomesAnd perhaps the most important thing – you would hope that it has some affect on outcomes, because that’s the point!To improve the quality of care delivered after going through the educational process.Outcomes are the key, but are difficult to measure.Heterogeneity of traumaPoor methods for assessment of morbidityDifficulty measuring intervention that affects only one aspect of patient care
- Traditionally, in the past, there are 3 main avenues for learning how to manage traumaTextbooksHalf of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half–so the most important thing to learn is how to learn on your own.David Sackett, often referred to as the “father of evidence-based medicine,”Much has been said about the utility of the textbooks, but pre-internet, that’s all there was!JournalsRestricted accessA lot of it is quite surgically focused and nor relevant to our practice in the emergency department,Short CoursesEMST / ATLS - James Styner (1980)Held over 2-5 days, intensive. Use generic ABC system. Concentrate on initial assessment - subsequent management missed.Often considered the “ Gold Standard” - though not sure how this can be measured. They have stood the test of time, and provided a well accepted method of managing trauma patients, but this was developed before emergency medicine really took off as a specialty, and In many ways, we have surpassed it, in terms of what we do. Despite the widespread acceptance of these courses, concerns have been raised at the ability of students to retain the knowledge and skills, especially if they are not utilizing these skills often. Work in a Trauma CentreHow many of you work in a major trauma receiving hospital?Most of us don’t work in trauma centres, or have only spent limited rotations there as part of our training. A lot of folks rotating through miss out - In my own hospital, I have come across trainees who have not put a chest tube in for the whole 6 months they are there, and have to battle it out with other trainees for learning opportunities. Indeed myself and Andy have both seen final year advanced trainees who have not been taught how to put a chest tube in for managing traumatic pneumothorax.
- Old article but validates the utility of the face to face short course formatCombination of lectures, small group sessions, skill stations and scenarios – seen to be effectiveDemonstrated improved compliance with guidelinesHard to demonstrate effect on clinical outcomes
- Why is it needed?