Objectives 1) Pre-hospital trauma care – Regional trauma systems and triage 2) Hospital care 3) Post-hospital fo

1. Objectives1) Pre-hospital trauma care – Regional trauma systems and triage2) Hospital care 3) Post-hospital follow-up care Nelson Elias, Brasil

2. Where am I now? Why? Espírito Santo - Brasil South-Eastern Region Territorial area – 46.000.000 km2 Population – 3.500.000 More than 400km of sunny coast Natural Resources - oil, natural gas Agriculture - banana,bean,cocoa coffee, corn Steel Industry Two harbors Nelson Elias, Brasil

3. Tubarão Harbor Vitória Harbor Nelson Elias, Brasil

4. The Hospital Private Hospital City: Vila Velha – population≅500.000 3,5 km from Vitória (capital- Metropolitan area) Easy access! Near the most important highway (Sun highway) Nelson Elias, Brasil

5. Sun highway – Rodovia do sol Vila Velha – Guarapari (beaches – touristic region) Extension 67 km Nelson Elias, Brasil

6. 1) Pre-hospital trauma care Regional trauma systems and triage -SAMU – Urgency Mobile Assistance Service – Brazilian Health Ministry -Phone 192 – 24 hours service –ambulances -Transfer patients for orthopedic center reference after previous contact (our hospital is reference) Nelson Elias, Brasil

7. 1) Pre-hospital trauma care Regional trauma systems and triageMotorcycle in severe casesFasterOnly during the day (not at night and when raining) – to avoid accidents Nelson Elias, Brasil

8. 1) Pre-hospital trauma care Regional trauma systems and triage Helicopter rescue (special conditions) by fire department Nelson Elias, Brasil

9. 2) Hospital care Elderly patient Multidisciplinary team (on-call hip fracture support team) Surgical priority Majority – Operated within 48 hours Early mobilization (rehabilitation program) Geriatric evaluation - falls prevention Osteoporosis investigation, treatment and prevention of others fractures Nelson Elias, Brasil

10. 2) Hospital Care Trauma patient Evaluation – trauma room Stable yes - ETC if not - DCO (external fixation) Nelson Elias, Brasil

11. 2) Hospital Care Adult patient After pre-operative evaluation the patients are operated as soon as possible If delay, more than 48 hours, the diaphyseal fractures of femur and tibia are fixed , temporary, with external fixation Nelson Elias, Brasil

12. 2) Hospital Care Pediatric patient - They are evaluated by a pediatric and orthopedic surgeon - Operated within 24 hours of trauma Nelson Elias, Brasil

13. 2) Hospital care – Orthopedic department Ten orthopedic surgeries / day Twelve orthopedic surgeons Eight orthopedic residents Trauma protocol Friday morning –clinical session Nelson Elias, Brasil

14. 2) Hospital Care Rehabilitation All operated patients are referred to physiotherapy program as soon as possible Post operative treatment: the patients are evaluated and normally discharged on day 2 or 3 after surgery Nelson Elias, Brasil

15. 3) Post-Hospital follow-up care All patients, after discharge of hospital, are oriented to return to out patient department, according to the fracture The patients without conditions to stay at home are transferred to chronic care hospital There is a special program for geriatric patients –Home care The patients are monitored by phone calls of social service and by hospital infection commission Nelson Elias, Brasil

16. 2) Hospital care – Orthopedic department - Residence in orthopaedic (Brazilian Society of Orthopedics) Sub specialty program in spine and trauma Sub specialties: - Arthroscopic - Articular reconstruction - Upper limb - Lower limb - Trauma - Hand and Microsurgery - Spine - Pediatric - Orthogeriatric Nelson Elias, Brasil

17. 2) Hospital care General hospital / 200 beds – All specialists Local research ethics committee ICU for 16 patients Emergency Department / CT scans / MRI Surgical center-10 operating rooms - 02 C arms Trauma room Nelson Elias, Brasil

18. Why ? Nelson Elias, Brasil