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Introduction . Rural Trauma More likely to die if a victim of trauma in a rural area Barriers include weather, geography, notification (direct-to-trauma center not available)Rarity of presentation of multiply injured trauma patients inc. result of current system. Tele-Trauma . Experiences from e
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1. Tele-Trauma Participant Improves Trauma Team Performance on Simulated Trauma Scenarios David G. Ellis MD, Jennifer Brown MD, Jeffrey Myers DO, James Mayrose PhD, Elizabeth Meinert, Fritz Sticht
2. Introduction Rural Trauma
More likely to die if a victim of trauma in a rural area
Barriers include weather, geography, notification (direct-to-trauma center not available)
Rarity of presentation of multiply injured trauma patients inc. result of current system
3. Tele-Trauma Experiences from early Tele-Trauma programs in Vermont and Arizona
Airway management
Recognition of intra-abdominal hemorrhage
Blood administration
System Activation / Volume
Trauma procedures
4. WNY Telehealth
New York State Tele-Stroke network
Web-based videoconferencing 10 (ten) rural ED sites
Adapting network to Tele-Trauma
NYSDOH approved Medicaid Reimbursement
All acute emergency and inpatient codes
5. Introduction Simulation
Standard training component of airline industry
Increased application in medical environment
Role in complex and rare medical presentations
6. Goals Create a realistic tele-trauma scenario using emergency medicine senior residents as primary team leaders similar to the role of rural emergency physicians in single physician coverage.
Evaluate their performance on simulated trauma patients both with and without the participation of a video trauma center specialist physician.
An additional goal was to identify any specific components of the trauma resuscitation where the presence of a video trauma center specialist participant may have a more pronounced positive or negative effect toward improving the simulated patient resuscitation team performance.
7. Methods SimMan
8. Methods Simulated Trauma Scenarios
9. Methods Telemedicine wireless roll-about
Video tape review of performance
Ratings by 2 Attending Physicians
Consensus panel for discrepancies
10. Methods Evaluation Method Holcomb et al
Rated in 5 areas of ATLS, 3-5 questions in each area
Team Organization
Airway
Breathing
Circulation
Disability
11. Methods Scores
2 = Best
1 = Average
0 = Worst
Groups
Best or Average/Worst
12. Results
13. Results
14. Discussion The results of this study show a trend toward improvement in trauma team performance when a video trauma attending physician is involved in the resuscitation exercise.
Number of cases / evaluations
Variability in attending physician involvement
15. Discussion Simulation an intermediary step toward full tele-trauma implementation
Additional senior resident evaluations
Rural emergency department attending sessions 9/07
16. Discussion Opportunities for refinement and improvement in tele-trauma system
Intensive feedback from resident and attending participants
Improvements in audio communications and interactions between team leader and consultant
17. Conclusions The tele-trauma interactions can be modeled in a simulation training setting
Performance of trauma team shows some improvement with inclusion of video trauma attending physician
Further studies indicated to identify level of improvement and key areas within ATLS