Trauma

1. Trauma Nursing –Connecting the Dots
Prof.T.Samuel Ravi Kumar
Former Trauma Center Coordinator
CMC Vellore

2. Trauma Room
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4. Preamble
 Trauma Nurse plays a pivotal role in assuring qualitative trauma care services at the Trauma
Center
 The continuum of clinical care provided to trauma patients extends from the time of injury through
to long-term recovery and final outcomes.
 Towards comprehensive Trauma Care, Trauma Team to be equally trained
 Nurses bring a unique expertise to meet the complex physical and psychosocial needs of trauma
patients and their families to influence outcomes across this entire continuum
Ensure optimal, equitable, and accessible care for all persons sustaining trauma
Focus on Zero preventable death
Contain costs while enhancing efficiency
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5. OBJECTIVES
To achieve
1. Reduction in the Trauma Mortality
2. Empowered Certified Trauma Nurses in all the Emergency
departments in India
3. Trauma Nurse Coordinator at District level ,all hospitals
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6.  Trauma Nursing Management
 Concept
 Clinical
 Administration
 Master Grid
 Role Clarification
 Career pathway 6
FOCUS
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7. Trauma Nursing as A DISCIPLINE
 Overview of Trauma in India
 Trauma Nursing Global models
 Trauma Care Challenges in India – Gap Analysis
 Trauma Nursing – Multidimensional approach
 Trauma Training
 Trauma Care Service-
• Nurse led Trauma Care
• Trauma Nurse Coordinator/Consultant
• Trauma Educator
◎ Trauma Quality Assurance & Research
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8. Overview of Trauma in India
The rate of accidental deaths (per lakh of
population) has slightly increased in 2019
as compared to 2018.
National Crime record Bureau India 2019
Over 29,000 Road Accidents Recorded In
Maharashtra In 2021; Fatalities Up By 4 Per Cent
Outlook India. Dec 13, 2022
Mumbai's road mishap deaths rise 11% in 1 year,
Maharashtra's maximum in 5 years
Times of India June 21, 2022
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9. Focus Trauma Nursing
Trauma
1. Prevention – Trauma Nurse Educator
2. Research
3. Training - Simulation , Certification
4. Trauma Care – Trauma Nurse
5. Trauma Quality Assurance
6. Mass Casualty / Disaster Management
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10. Overview of Trauma Nursing in India
◎ ( Gap Perspective)
 Emergency Nurse with multiple role, task.
 Limited empowerment
 Rotation within the hospital as per need which limits specialized training in the
field of Trauma & Critical care Nursing
 Training the skill set for privileging to practice
 Limited training and specialization opportunities across the country
 Limited specialization at higher level of learning
 i.e. Master’s in Emergency , Trauma & Disaster Nursing
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11. Overview of Trauma in India – Filling the Gap
Nurse led Trauma care program (Capacity for timely trauma service)
Trauma Care rendered at
Sub Centres – Immediate Emergency care & refer
Primary Health Centres Immediate Emergency care & refer
Community Health Centres Triage & Emergency care
District Hospitals Triage , Resuscitation & Emergency Care
Medical Colleges and Research Institutions
 Comprehensive Trauma Care & Trauma Nurse Practitioner
Trauma Nursing Framework – India TNF-I
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12. Trauma Nursing Global models
 Trauma Nursing as an specialty approach
 Trauma Nurse Practitioner "feasible, safe, effective in their roles and provide
quality health services.“
 Trauma Nurse Quality Managers
 Trauma Nursing rounds in clinical setting
 Trauma-care process through a trauma nurse-initiated discharge planning
program patient-family follow up.
Trauma Nursing Framework – India TNF-I
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13. Towards ZERO preventable deaths
 Non Preventable death -
 when injuries are not survivable and not currently curable or reversible
 Possible preventable death -
 when injuries are severe, but currently curable or reversible under
optimal circumstances
 Preventable death –
 Rate is the proportion of deaths judged to be preventable if optimal trauma care has been
delivered
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14. Trauma Care Infrastructure
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15. Trauma Nursing Role
 Trauma Nurse
 Trauma Nurse Educator (Clinical)
 Trauma Nurse Manager
 Trauma Quality Manager
 Trauma Nurse Researcher
 Trauma Nurse Coordinator (MCM)
 Academic Faculty
 Role in International Agencies such as W H O, towards trauma quality care
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16. Boundary
A boundary is a clear place where you
begin and the other person ends.
Professional boundaries are complex
because they involve personal values,
culture and ethics.
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17. Trauma Quality Assurance Core Measures
◎ Core Measures focus efforts which utilize data to improve the
healthcare delivery process
○ Process measures
◉ System operations/Not clinical in nature
◉ Qualitative filters (e.g. Satisfaction survey)
◉ Institutional filters (e.g. Time to CT)
○ Outcome measures
◉ Clinical/Patient focused
◉ Quantitative/benchmarks (e.g. VTE rates)
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18. Process Measures - Required
 Surgeon response to ED – highest level trauma plus all other required responses
 Trauma team activation criteria
 Response of specialists to time-sensitive procedures
 Over and under triage
 Admissions to non-surgical service
 Transfers out
 Times trauma center is on diversion
 ED physicians covering other hospital units – response times to ED
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19. Process Measures – Required
 Response times of CT/MRI when on-call
 Transfers to higher level of care within the institution
 Organ donation rate
 Registry abstraction – 80% within 2 months
 Multidisciplinary Trauma Committee Decisions
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20. System Process Core Measures
 Protocol compliance
 ED dwell time for trauma activation
 In-house emergent/urgent intubations
 Delay in OR availability
 OR staff response & PACU staff if on-call
 Radiology misread rate
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21. Clinical Practice Guidelines
 Evidenced based practice guidelines reduce variance in care
 Road map for clinical decisions
 Effect outcomes
 Trauma Centers must
 Track compliance
 Monitor effect on outcomes
 Trauma quality indicators: internationally approved core factors for trauma
management quality evaluation
Coccolini, F., Kluger, Y., Moore, E.E. et al. Trauma quality indicators: internationally approved core
factors for trauma management quality evaluation. World J Emerg Surg 16, 6 (2021).
https://doi.org/10.1186/s13017-021-00350-7
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22. The Trauma Registry
 The Trauma Registry is the foundation for the trauma program
 Provides data to support:
 Research
 Finance
 Special projects
 All aspects of the trauma program
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23. Trauma Nursing Role
 Trauma Nurse
 Trauma Nurse Educator (Clinical)
 Trauma Nurse Manager
 Trauma Quality Manager
 Trauma Nurse Researcher
 Trauma Nurse Coordinator (MCM)
 Academic Faculty
 Role in International Agencies such as W H O, towards trauma quality care
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24. Trauma Nursing -India
1. Trauma Nursing Journal – Knowledge update
2. Trauma Nursing Association
3. Specialized training in Trauma & Mass Casualty
Management
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25. Timeline
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DEC
NOV
OCT
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
With the Input of the Experts the time line is to be finalized for further proceedings

26. Thank You 26
CONCLUSION