MEDICAL CENTER

1. MEDICAL CENTER MANPOWER AND EQUIPMENT NEEDED AT PERMANENT CIRCUITS DINO ALTMANN, MD Rede D’Or Hospital São Luiz BRAZIL

2. MEDICAL CENTER – PERMANENT CIRCUIT Sceneintervention • Helmet, balaclavaand HANS removal • Cervical collar • Primarysurvey / Resuscitation A – airway B – breathing C – circulation D - disability • Driver extrication (E - exposure)

3. MEDICAL CENTER – PERMANENT CIRCUIT Medical center • ReassessABCD’s • E – Exposure • Secondarysurvey • Fractureimmobilization • Surgicalintervention (ifindicated) Chest tube insertion Central venousline Cricothyroidotomy Hemostasis • Stabilizationandpreparation for transfer

4. MEDICAL CENTER – PERMANENT CIRCUIT Medical center • Emergencyroom • Criticalburntreatment • Intensivecareunit • Examinationrooms • Observationrooms • Ophtalmologyroom • Radiology & Lab • Helipad

5. MEDICAL CENTER – PERMANENT CIRCUIT Trauma team Chief Medical Officer DeputyChief Medical Officer Medical Center Manager Doctor Track Supervisor Doctor Specialtyteams Specialtyteams ReceivingHospitals Medical InterventionCars Extricationteams Ambulances Pit laneteams Medical center Trauma Surgery ER Nurses Anesthesiology Neurosurgery ThoracicSurgery OrthopedicSurgery Radiology PlasticSurgery/Burns General Practitioner/Cardiology

6. Medical Center Plan – ER carearea MEDICAL CENTER – PERMANENT CIRCUIT BATHROOM AND STAFF LOCKER ROOM BATHROOM AND STAFF LOCKER ROOM RISING DOOR STAFF COMMON ROOM INTENSIVE CARE UNIT EXAMINATION AND OBSERVATION ROOMS OXYGEN STORAGE PHARMACY & STORAGE ROOM ANTI-DOPING CONTROL X-RAY, ULTRA-SOUND AND LAB COVERED AMBULANCE ACCESS SERIOUS BURN TREATMENT OPHTALMOLOGY ROOM RECEPTION EMRGENCY ROOM CHIEF MEDICAL OFFICER RACE CONTROL RISING DOOR

7. MEDICAL CENTER – PERMANENT CIRCUIT Ambulace entrance

8. MEDICAL CENTER – PERMANENT CIRCUIT ER entrance

9. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

10. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

11. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

12. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

13. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

14. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

15. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

16. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

17. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

18. MEDICAL CENTER – PERMANENT CIRCUIT ER equipment

19. MEDICAL CENTER – PERMANENT CIRCUIT ER drug kits DOPAMINE KIT NOREPINEPHRINE KIT NITROPRUSSIDE KIT DOBUTAMINE KIT NITROGLYCERIN KIT

20. MEDICAL CENTER – PERMANENT CIRCUIT ER specific kits SUCTION KIT CENTRAL VENOUS LINE URINARY DRAINAGE

21. MEDICAL CENTER – PERMANENT CIRCUIT Emergencyroom – teamdisposition 1 AIRWAY MANAGER Assess, assistventilationandintubate 2 6 AIRWAY ASSISTANT TEAM LEADER Oxygenandsuctionset-up Assessteamresponsabilities Suctionneeds ReassessABCD’s E – exposure Secondarysurvey Set priorities 3 EMERGENCY NURSE Perform procedures central venousline chest tubes cricothyroidotomy hemostasis Monitoring Check pulse andbloodpressure AssessIV’s Pushmeds Placedefibrillationpads 5 DATA MANAGER ChestcompressionorAuto-Pulse Results Chart 4 EMERGENCY NURSE ASSISTANT Record interventions Getpatienthistory - AMPLE Deployequipment Prepare meds Rundefibrillator

22. MEDICAL CENTER – PERMANENT CIRCUIT ER Trauma teamatwork

23. MEDICAL CENTER – PERMANENT CIRCUIT Patientprepared for transfer

24. MEDICAL CENTER – PERMANENT CIRCUIT Helicoptertransfer

25. Medical Center Plan – Ambulatorycarearea MEDICAL CENTER – PERMANENT CIRCUIT BATHROOM AND STAFF LOCKER ROOM BATHROOM AND STAFF LOCKER ROOM RISING DOOR STAFF COMMON ROOM INTENSIVE CARE UNIT EXAMINATION AND OBSERVATION ROOMS OXYGEN STORAGE PHARMACY & STORAGE ROOM ANTI-DOPING CONTROL X-RAY, ULTRA-SOUND AND LAB COVERED AMBULANCE ACCESS SERIOUS BURN TREATMENT OPHTALMOLOGY ROOM RECEPTION EMRGENCY ROOM CHIEF MEDICAL OFFICER RACE CONTROL RISING DOOR

26. MEDICAL CENTER – PERMANENT CIRCUIT Ambulatorycareareareception

27. MEDICAL CENTER – PERMANENT CIRCUIT Ambulatorycarearea

28. MEDICAL CENTER – PERMANENT CIRCUIT Thankyou