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When is the major trauma patient most at risk from preventable morbidity/mortality?

When is the major trauma patient most at risk from preventable morbidity/mortality?. The role of the trauma team is to provide organization out of chaos and coordinate treatment 55-91% 1,2 of preventable deaths occur at reception

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When is the major trauma patient most at risk from preventable morbidity/mortality?

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  1. When is the major trauma patient most at risk from preventable morbidity/mortality? • The role of the trauma team is to provide organization out of chaos and coordinate treatment • 55-91%1,2 of preventable deaths occur at reception • Most of the reported errors during reception relate to resuscitation • McDermott F. • Shackford SR, Hollingworth-Fridlund P, Cooper G F et al. The effect of regionalization of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma 1986;26:812020. Reducing Errors in Adult Trauma Resuscitation

  2. ATLS and trauma resuscitation • Significant deterioration in knowledge and skills within months of ATLS training1,2 • 53% overall protocol compliance when measured prospectively3 1 Ali J, Cohen R, Adam R et al. Attrition of cognitive and trauma management skills after the advanced trauma life support (ATLS) course. J Trauma 1996;40:860-6. 2 Blumfield A, Ben Abraham R, Stein M et al. Cognitive decline after Advanced Trauma Life Support courses. J Trauma 1998;44; 513-`16. 3 Spanjersberg WR, Bergs EA, Mushkudiani N et al. Protocol compliance and time management in blunt trauma resuscitation. Emerg Med 2009; 26;23-27. Reducing Errors in Adult Trauma Resuscitation

  3. Reducing Errors in Adult Trauma Resuscitation

  4. 1,171 patients recruited • 163,516 data points related to error • No significant difference between HCG, CG and SG for ISS, APACHE, LOS, mortality • 75% male, 37.1 years • 88.7% blunt trauma • 5.2% mortality • Mean ISS 13 (matched in Registry) • 44% of patients ISS>16 • 23% of patients ISS>26 Reducing Errors in Adult Trauma Resuscitation

  5. Algorithm deviation – ‘error rate’ Reducing Errors in Adult Trauma Resuscitation

  6. Error rates per errorable flag per patient Reducing Errors in Adult Trauma Resuscitation

  7. M Fitzgerald , P Cameron , C Mackenzie et al,Trauma Resuscitation Errors and Computer Assisted Decision Support Arch Surg 2010 In Press Among 1171 patients: Significant Reduction in error rate/ patient from the Baseline Control Group to the Study Group (2.53 to 2.13, p=0.004) and between the Control Group to the Study Group (2.30 to 2.13, p=0.042). Real time decision support by experienced trauma teams improved protocol compliance reduced errors and morbidity. A critical decision was required every 72 seconds Error free resuscitations were increased from 16- 21.8% (p=0.049) during the first 30 min. Morbidity from shock management (p< 0.025), blood use (p< 0.0001) and aspiration pneumonia (p=0.046) were decreased. Reducing Errors in Adult Trauma Resuscitation

  8. 8. Existing Hospital Databases 1. Compliance Templates 4. Video File TRR Video Audit Tool 5. Screen Capture File 7. Audit File 6. Patient Data File 2. Algorithm File 9. Audit Summary 3. Reference Data File 10. Audit Results Database …building an integrated TR&R audit tool… Reducing Errors in Adult Trauma Resuscitation

  9. RESUSCITATION DECISION SUPPORT ISREADY AND ABLE! • Decision –Support TR & R System for RESUSCITATION ready for U.S. Multi-Centered Clinical Trial powered to show reduced mortality. • Biomedical Manufacturer needed to miniaturize hardware/software add voice to visual prompts and ruggedize for Field Use. • Additional Blast and other military relevant injury management algorithms should be added in collaboration with military partner. • Software commands written in all major languages (English, Mandarin, German, French, Spanish etc) and ready for licensing. • Inexpensive way to provide effective real-time Decision support……..THINK AED ! Reducing Errors in Adult Trauma Resuscitation

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