Tele-Trauma Participant Improves Trauma Team Performance on Simulated Trauma Scenarios

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