trauma management

1. Pembimbing: dr. Yogi Prabowo, SpOT(K), Sp. EM
dr. Ario Baskoro
dr. Natanael Parningotan Agung
dr. Gasha Aryapratama
dr. Herdy Adriano
dr. Adlina Karisyah
TRAUMA CENTER

2. INTRODUCTION
• Trauma centres play an essential role in the trauma system providing
acute care to the most seriously injured, system leadership, and
education and research programs.
• The trauma centre is a medical centre where resources are dedicated
and/or prioritized to ensure the acutely injured patient can receive full
and timely resuscitation, assessment and definitive care on a 24-hour
basis.
● Adult Trauma Centres are classified numerically (Levels I – V) and two
levels of
● Pediatric Trauma Centre (P-I, P-II) have also been defined.
Resources For Optimal care of The Injured Patient. Commitee On Trauma American College of Surgeons. 2014

3. To develop, implement and provide oversight of a
comprehensive trauma care system that:
• Prevents injuries.
• Saves lives.
• Improves the care and outcomes of trauma patients.
MISSION

4. • Trauma: Severe injury or injuries requiring rapid evaluation and
transport to specific hospitals with trauma care
capabilities.“Worst of the worst”.
• Trauma system: Organized approach to treating patients with
acute injuries.
• Trauma registry: Repository of data on patients who receive
hospital care for certain types of injuries.
DEFINITION

5. CAUSE OF INJURY CATEGORIES
• Cut/Pierce
• Drowning/Submersion*
• Fall
• Fire/Burn
• Fire/Flame
• Hot object/substance
• Firearm
• Machinery
• Motor Vehicle Traffic
• Pedal Cyclist, Other
• Pedestrian, Other
• Transport, Other
• Natural/Environmental
• Bites and Stings
• Overexertion
• Poisoning*
• Struck By, against
• Suffocation*

6. TRAUMA SYSTEM
6

7. TRAUMA CENTER SCOPE
7
Emergency Preparedness
• Multiple trauma centers
expressed doubt whether
they could handle a mass
casualty event
• New funding could provide
necessary training and
capability to more adequately
prepare for a mass casualty
situation
Staff Training and
Education
• Potential new funding could
allow more centers to
pursue residency programs
• Funding could also allow for
staffing of new dedicated
performance improvement
systems
Recruitment and
Retention Initiatives
• With trauma specialists
becoming more expensive
and difficult to retain,
additional funding would
allow centers to improve
incentives for high-quality
personnel

8. LEVEL I
8
Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system.
A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through
rehabilitation.
Elements of Level I Trauma Centers Include:
• 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic
surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and
maxillofacial, pediatric and critical care.
• Referral resource for communities in nearby regions.
• Provides leadership in prevention, public education to surrounding communities.
• Provides continuing education of the trauma team members.
• Incorporates a comprehensive quality assessment program.
• Operates an organized 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

9. LEVEL II
9
A Level II Trauma Center is able to initiate definitive care for all injured patients.
Elements of Level II Trauma Centers Include:
• 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of
orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care.
• Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be
referred to a Level I Trauma Center.
• Provides trauma prevention and continuing education programs for staff.
• Incorporates a comprehensive quality assessment program.

10. LEVEL III
10
A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation,
surgery, intensive care and stabilization of injured patients and emergency operations.
Elements of Level III Trauma Centers Include:
• 24-hour immediate coverage by emergency medicine physicians and the prompt availability of
general surgeons and anesthesiologists.
• 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.
• Offers continued education of the nursing and allied health personnel or the trauma team.
• Involved with prevention efforts and must have an active outreach program for its referring
communities.

11. LEVEL IV
11
A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS)
prior to transfer of patients to a higher level trauma center. It provides evaluation, stabilization, and
diagnostic capabilities for injured patients.
Elements of Level IV Trauma Centers 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 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 Center.
• Incorporates a comprehensive quality assessment program.
• Involved with prevention efforts and must have an active outreach program for its referring
communities.

12. LEVEL V
12
A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and
prepares patients for transfer to higher levels of care.
Elements of Level V Trauma Centers Include:
• Basic emergency department facilities to implement ATLS protocols.
• Available trauma nurse(s) and physicians available upon patient arrival.
• After-hours activation protocols if facility is not open 24-hours a day.
• May provide surgery and critical-care services if available.
• Has developed transfer agreements for patients requiring more comprehensive care at a Level I
through III Trauma Centers.

13. In a Level I Pediatric Trauma Center:
• At least 2 surgeons who are board certified or eligible in pediatric surgery
• At least 1 board certified or eligible orthopedic surgeon with pediatric fellowship training and
one additional board certified or eligible orthopedic surgeon with demonstrated interests and
skills in pediatric trauma care
• At least 1 board certified or eligible neurosurgeon with pediatric fellowship training and one
additional board certified or eligible neurosurgeon with demonstrated interests and skills in
pediatric trauma care
• At least 2 physicians who are board certified or eligible in pediatric critical care medicine or
in pediatric surgery and surgical critical care.
• At least 2 physicians who are board certified or eligible in pediatric emergency medicine
Pediatric intensive care unit and pediatric section of emergency department must be staffed
by individuals credentialed by the hospital to provide pediatric trauma care in their respective
area
PEDIATRIC TRAUMA CENTER
13

14. In a Level II Pediatric Trauma Center
• At least 1 board certified or eligible pediatric surgeon
• At least 1 board certified or eligible orthopedic surgeon with demonstrated
interests and skills in pediatric trauma care
• At least 1 board certified or eligible neurosurgeon with demonstrated
interests and skills in pediatric trauma care
• Pediatric intensive care unit and the pediatric section of the emergency
department must be staffed by individuals credentialed by the hospital to
provide pediatric care in their respective areas
PEDIATRIC TRAUMA CENTER
14

15. COMPONENTS
Trauma center consists of:
• Emergency Departement
• Ambulansce
• Laboratorium
• Radiology
• OT
• Intensive Care Unit (ICU)
• Rehabilitation
• Pharmacyst
• Inte
15

16. TRAUMA CENTER IN INDONESIA
Facilities :
• Minimum type D Hospital.
• Available for Emergency Departement/ Unit.
• Available for Operation Theathre.
• Surgeon.
• Esensial Specialist doctors: Rehabilitation, ortophaedy, Lung, Internist, and
cardiologist
• Established team for work related injury consist of adminisration. Surgeon,
GP/EM Doctor and Nurses
• Available for Pharmacyst/ drugs depo.
16

17. HUMAN RESOURCES
Doctor :
• Qualified with work related
injuries training sertificate.
• Qualified with Advanced
Cardiac Life Support (ACLS) –
Advanced Trauma Life Support
(ATLS)
• Legaly Registered and owned
practical permission liscence
Nurse/Paramedic :
• Qualified with work related
injuries training sertificate.
• Qualified with Basic Trauma
Life Support (BTLS).
• Legaly Registered and owned
practical permission liscence
• )
17

18. THANK YOU
18