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Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC

Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC. Level 3 Trauma Center- Why?. Beneficial to the injured patient Statewide Trauma System The Golden Hour - Rural VS. Urban Trauma Local Hospital Benefits. Why Level 3?. Improved patient outcomes

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Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC

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  1. Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC

  2. Level 3 Trauma Center- Why? Beneficial to the injured patient Statewide Trauma System The Golden Hour - Rural VS. Urban Trauma Local Hospital Benefits

  3. Why Level 3? • Improved patient outcomes • Prevent patients from dying of simple injuries • Patients receive quality care close to home • Decrease burden on busy level 1 centers • Most rural trauma is MVC related • Auto Insurance coverage is decent • Supports financial stability of local hospital • Helps defray cost • Enhances community awareness and perception of local hospital

  4. Commitments and Resources • Hospital and Surgeons • ER physicians/Nurses • Internists • Anesthesia/Radiology • Operating Room • ICU • Ancillary Services • EMT Services • TPM

  5. Local Hospital • Administrative “Buy In” • $$$$ • Ancillary Support Services • Financial Rewards

  6. SURGEONS • General Surgery • Trauma Medical Director • Orthopedic Surgery

  7. Trauma Program Manager (TPM) • Experience • Charlotte Oneal

  8. Anesthesia • IN- House NOT required • CRNA’s Permissible • Liaison to trauma program

  9. Radiology • In house or by Teleradiology • CAT Scan 24/7 • CT tech on call

  10. ER Physicians/Nurses • Coordinated- Collegial Collaboration • ATLS- Physicians • TNCC- Nurses

  11. EMT Services • Effective program vital • Paradigm Shift • Trust • Transfers • Ground VS. Air • Trauma Alerts • PHTLS • TNCC • EMS Appreciation Dinner

  12. Statewide Trauma System • Support from Level 1 Centers ESSENTIAL • UK and UL • Resources and Guidance • Lead hospitals for system

  13. Medicine/Hospitalist Service • Must be available • Consults and Admits

  14. Trauma Registry • Clinical data management system • State Registry • UK/UL • Training for registration • Time Consuming

  15. PIPSPerformance Improvement and Patient Safety • “The concept of monitoring, evaluating, and improving the performance of a trauma program” • Multidisciplinary Peer Review Committee • Major focus of COT

  16. Operating Room • Readily Available 24/7 • Support of OR Staff

  17. General Surgeons • Foundation of Trauma Service • Unwavering Commitment • Board Certification • ATLS Certification • Response time- 30 minutes • Co-Director ICU • Directs Care of ICU Trauma Patients

  18. Orthopedic Surgeons • Absolute Requirement • Majority of OR Cases • ATLS Helpful • Liaison to Trauma Program • Involved in PIPS

  19. The Journey

  20. Began program NOV. 2009 • COT- Consultative Visit April 2012 • COT- Verification Visit May 2013 • RTTDC – • DEC 2009 • UKMC

  21. PROTOCOLS

  22. Trauma Flow Sheet

  23. Trauma Alert Criteria

  24. Trauma Patients Year #Patients Admits Transfers Deaths 2009 34 ---- ----- ---- (Nov-Dec) 2010 308 67% 31% 2% 2011 304 61% 38% 1% 2012 216 59% 39% 1.5% (Jan-Aug)

  25. Mechanism of Injury Year Blunt Falls Penetrating 2009 82% (14%) 9% 2010 86% (17%) 12% • 89% (18%) 9% 2012 91% (28%) 7%

  26. PIPS • Meets monthly • Multidisciplinary Peer review • Chart Reviews- 3Levels • TPM- All Transfers; Medical Admits (PI) • TMD • Committee • All PEDs • All Transfers • All Deaths • Miscellaneous

  27. Transfer Agreements • Essential • University of Kentucky • University of Louisville • Kosairs (?) • Predefined Neuro diversion plan

  28. Education • Nursing • TNCC • Trauma Nurse Core Curriculum • 75% Certified • 4 year term • Trauma Competency Training • New procedures & equipment (FAST) • PEDS Trauma • Trauma Symposiums • Physicians • ATLS • Trauma Symposiums • CME

  29. Education • EMT’s • TNCC • PHTLS • Appreciation Dinner • Guest Speaker

  30. Lessons Learned • Collaborative Effort • Surgeons • ER physicians • Hospital • EMS • Level 1 Centers • Treat Locally VS. Transfer • “Golden Hour” • Do NOT delay departure • Activation of Trauma Team by EMS • Shared protocols • Learning experience • Paradigm Shift

  31. Trauma Patient Algorithm

  32. Community Outreach • Fall Prevention • “KIDS” Safety Day • EMS, Police Dept., KSP, UKMC, YMCA, Dept. Transportation • 300 Kids • Free Bike Helmets

  33. Summary • Arduous and prolonged journey • General Surgery and Orthopedic Surgery commitment • Hospital “Buy In” • TPM Essential • Statewide Trauma System • PIPS

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