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MEDICAL SCHOOL FMUSP

MEDICAL SCHOOL FMUSP. HOSPITAL HCFMUSP. Instituto Ortopedia e Traumatologia HCFMUSP. PUBLIC MEDICAL SCHOOL PUBLIC RESOURCES REGIONAL STATE OF SÃO PAULO PRIVATE RESOURCES DONATIONS. CONSIDERED BEST MEDICAL SCHOOL BEST MEDICAL RESEARCH CENTER BRAZIL. PUBLIC HOSPITAL

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MEDICAL SCHOOL FMUSP

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  1. MEDICAL SCHOOL FMUSP HOSPITAL HCFMUSP

  2. Instituto Ortopedia e Traumatologia HCFMUSP

  3. PUBLIC MEDICAL SCHOOL PUBLIC RESOURCES REGIONAL STATE OF SÃO PAULO PRIVATE RESOURCES DONATIONS CONSIDERED BEST MEDICAL SCHOOL BEST MEDICAL RESEARCH CENTER BRAZIL

  4. PUBLIC HOSPITAL RESOURCES STATE OF SÃO PAULO FEDERAL HEALTH UNIC SYSTEM (SUS) 80% PATIENTS PRIVATE RESOURCES HEALTH INSURANCE 20% PATIENTS

  5. HCFMUSP 2010 EMERGENCY REFERENCE CENTER HIGH COMPLEXITY 50 816 PATIENS 15 011 TRAUMATIC INJURIES (30%) • ORTHOPAEDIC UNIT • SCI CENTER • patients • 1789 falls (26,9%) • crash (19,3% )

  6. Traumatic injuries • 6648 patients TRAFFIC FALLS WORK INJURIES OTHERS

  7. FALLS

  8. TRAFFIC INJURIES • 1.284 (19.3%) CAR MOTORCYCLE RUNOVER BICYCLE

  9. Traffic injuries 1.284 patients • Car – 393 • 1.07 / day / 7.5 / week • Motorcycle - 572 • 1.56 / day / 11/week • Run over - 253 • 0.7 / day / 4.9 / week • Bicycle – 66 • 1.3/ week 3.5 / day 24.7 / week 107/ month

  10. BRAZILIAN TRAFFIC INJURIES EPIDEMY

  11. Associated Factors with Motorcycle Crashes São Paulo – Brazil 2013 Júlia Maria D’Andréa Greve Marcelo Rosa Resende Heráclito Barbosa da Silva Celso O Bernini Vilma Leyton

  12. Road deaths per 100 000 population in the USA and EU

  13. PROSPECTIVE STUDY • Data collection • 02/19/2013 to 05/12/2013 • 42 shifts - 24 hours (alternate days) • Road • Traffic engineer • SC investigator • Vehicle • Crash investigator • Victim • Health professional team Human Factors Road Factor Vehicle Factor Factor inter-relation

  14. OPERATIONAL FLOW CET Road Data Database HCFMUSP Victim Data Coord. HC Fireman Base (P..H.C.) Crash Crash investig. Accident Data

  15. Results 326 victims – Hospital 169 accidents - CET 141 accidents - Crash investigator

  16. Motorcycle driver Identification 20% 30 anos Idade média Collegegraduation 58% 92% men High School 62% Monthincome U$250-750

  17. Motorcycle driver 55% Anotheraccidents Anotherhospitalization 18% 77% PersonalTransportation 23% Delivery service

  18. Diagnóstic Light injuries 17% 48% Lowermember fracture 23% Uppermember fracture Other injuries 12% 9% Multiple injuries 5% BTI 1% Pelvicinjury

  19. OUTCOMES 56% Transfer 10% ER Discharge 2% Hospitalization Death 18%

  20. RESULTS

  21. DrivingLicense 100% men 23% 75% Lessthan 32 years • No License

  22. Drivinglicense 33% Lessthan 4 years 31% Defensivedrivingcourse • Withdrivinglicense 77%

  23. Safety Equipments 90,2% Helmet 17,8% Jacket, helmet and boots

  24. Alcohol and Drug Oral fluid / Urin / Blood / Breath Test 21,3% Alcohol and/ ordrugs in onebyologicalsample 14,2% 7,1% drugs (cocainemostused) alcohol

  25. ScientificAnalysisVehicle and Road

  26. Resultsquestion “are you guilty” ?

  27. GUILTY EQUAL MOTORCYCYCLE DRIVER AND CAR DRIVERI

  28. GuiltyAnalysis BEHAVIORAL FACTORS MAIN FACTOR LACK OF PREPARRATION OF THE BOTH DRIVERS HEAVY TRAFFIC METROPOLIS

  29. High velocity 13% accidents 71% 29% Car Motorcycle

  30. Condições do acidente 94%dryroad 67%duringday light 25%passengers 18%on Friday

  31. Typeofcollision 48%lateral 29%rear and front 23%transversal

  32. Fator viário 18% roadproblems • Mainproblems • Inadequatedcrossroadsinalization • Oil • Sand • Hole Buracos • Irregularities

  33. Fator veicular 8% vehicleproblems 11% tyres 07% brakes Motorcycle250 cc Less than 6 years

  34. Conclusões • HUMAN FACTORS • DrivingLicenseConcession • Alcohol and drugas • Behaviourinadequatedmotorcycle(88%) e car driver (84%) • Motorcycle as transportorwork • Lackofriskperception - education

  35. Conclusões • VehicleFactor • Lackofconservation – brake and tyres • Road Factor • Sinalization and groundirregularities

  36. Spinal cord injury BRAZIL No national prevalence data Growth big cities (urbanization) Growth small cities (motorcycle) Estimated: 60- 70 cases/ million

  37. HCFMUSP ORTHOPAEDIC INSTITUTE SCI UNIT 20 BEDS NEW PATIENTS 03 SCI / month Acute care: Respiratory care Spinal cord decompression Spine stabilization Injuries associated

  38. male 17 years student C4 ASIA A motorcycle

  39. PATIENT PROFILE 2000-2010 424 new SCI patients. 59% paraplegia 41% tetraplegia Male - 84% Mean age: 35 (11-78) years ASIA A 85% (high complexity care reference)

  40. ETIOLOGY HCFMUSP Falls 37% Motor vehicle crashes 31% Gunshot 19% Diving 07% Others 06%

  41. HCFMUSP ORTHOPAEDIC INSTITUTE SCI Rehabilitation program: Simplified Rehabilitation Programme(SRP) Start 1995 prevention joint deformities and pressure sores promotion of mobility and transfers bladder and bowel management pain control self-care independence caregiver training - tetraplegia Orientation for patients' home adaptation.

  42. SRP TEAM Physiatrist, Physiotherapist Rehabilitation nurse Occupational Therapist Psychologist Social Worker Little supply and equipment Tetraplegics ASIA A/ B paraplegics patients

  43. SRP • Educational programme. • Training patient and / or the caregiver • Positioning • Passive movements, • Changing positions to prevent pressure sore, • Self-catheterization (caregiver), • Bowel management, • Transfers (bed to wheel chair and vice-versa)

  44. SRP Patients and family are oriented in bed and wheelchair (nurse and PT): PRESSURE SORE To assume different positions (ventral, dorsal /lateral) To protect the osseous protuberance To perform a “push-up “ when on wheelchair. DEFORMITIES To perform passive motion DAILY ACTIVITIES Self–care (dressing, basic cleaning, and bathing). Adaptations for tooth brushing, eating or clothing SELF -CATHETERIZATION

  45. SRP WHEEL CHAIR Prescribed (Seat-clinic) SCI wheelchair cost (not for tetraplegics or any special need) U$ 600, 00 (R$ 1200,00)

  46. SRP Public health system provides (by medical prescription / three to six months) the 1st wheelchair and a new one, every four years. Most of the patients remain in the hospital during 30- 60 days and they receive the SRT care until the discharge. After discharge trauma center – take 3-6 months to be accepted and start rehabilitation program with high risk of complications. They return for follow-up evaluation 30-60 days after the discharge.

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