Steven R. Vallance, MD, PhD, FACS
Trauma Medical Director-FRMC
Level 3 Trauma Center- Why?
• Beneficial to the injured patient
• Statewide Trauma System
• The Golden Hour
- Rural VS. Urban Trauma
• Local Hospital Benefits
Why Level 3?
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Improved patient outcomes
Prevent patients from dying of simple injuries
Patients receive quality care close to home
Decrease burden on busy level 1 centers
Most rural trauma is MVC related
– Auto Insurance coverage is decent
– Supports financial stability of local hospital
• Helps defray cost
• Enhances community awareness and perception of local
hospital
Commitments and Resources
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Hospital and Surgeons
ER physicians/Nurses
Internists
Anesthesia/Radiology
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Operating Room
ICU
Ancillary Services
EMT Services
TPM
Local Hospital
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Administrative “Buy In”
$$$$
Ancillary Support Services
Financial Rewards
SURGEONS
• General Surgery
– Trauma Medical Director
• Orthopedic Surgery
Trauma Program Manager (TPM)
• Experience
• Charlotte Oneal
Anesthesia
• IN- House NOT required
• CRNA’s Permissible
• Liaison to trauma program
Radiology
• In house or by Teleradiology
• CAT Scan 24/7
– CT tech on call
ER Physicians/Nurses
• Coordinated- Collegial Collaboration
• ATLS- Physicians
• TNCC- Nurses
EMT Services
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Effective program vital
Paradigm Shift
Trust
Transfers
– Ground VS. Air
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Trauma Alerts
PHTLS
TNCC
EMS Appreciation Dinner
Statewide Trauma System
• Support from Level 1 Centers ESSENTIAL
– UK and UL
– Resources and Guidance
– Lead hospitals for system
Medicine/Hospitalist Service
• Must be available
• Consults and Admits
Trauma Registry
• Clinical data management system
– State Registry
– UK/UL
• Training for registration
• Time Consuming
PIPS
Performance Improvement and Patient Safety
• “The concept of monitoring, evaluating, and
improving the performance of a trauma
program”
• Multidisciplinary Peer Review Committee
• Major focus of COT
Operating Room
• Readily Available 24/7
• Support of OR Staff
General Surgeons
• Foundation of Trauma Service
– Unwavering Commitment
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Board Certification
ATLS Certification
Response time- 30 minutes
Co-Director ICU
Directs Care of ICU Trauma Patients
Orthopedic Surgeons
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Absolute Requirement
Majority of OR Cases
ATLS Helpful
Liaison to Trauma Program
Involved in PIPS
The Journey
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Began program NOV. 2009
COT- Consultative Visit April 2012
COT- Verification Visit May 2013
RTTDC –
– DEC 2009
– UKMC
Trauma Flow Sheet
Trauma Alert Criteria
Trauma Patients
Year
2009
#Patients Admits Transfers Deaths
34
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(Nov-Dec)
2010
308
67%
31%
2%
2011
304
61%
38%
1%
2012
216
59%
39%
1.5%
(Jan-Aug)
Mechanism of Injury
Year Blunt
2009 82%
Falls
(14%)
Penetrating
9%
2010
86%
(17%)
12%
2011
89%
(18%)
9%
2012
91%
(28%)
7%
PIPS
• Meets monthly
• Multidisciplinary Peer review
• Chart Reviews- 3Levels
– TPM- All Transfers; Medical Admits (PI)
– TMD
– Committee
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All PEDs
All Transfers
All Deaths
Miscellaneous
Transfer Agreements
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Essential
University of Kentucky
University of Louisville
Kosairs (?)
Predefined Neuro diversion plan
Education
• Nursing
– TNCC
• Trauma Nurse Core Curriculum
• 75% Certified
• 4 year term
– Trauma Competency Training
• New procedures & equipment (FAST)
• PEDS Trauma
– Trauma Symposiums
• Physicians
– ATLS
– Trauma Symposiums
– CME
Education
• EMT’s
– TNCC
– PHTLS
– Appreciation Dinner
• Guest Speaker
Lessons Learned
1.
Collaborative Effort
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2.
Surgeons
ER physicians
Hospital
EMS
Level 1 Centers
Treat Locally VS. Transfer
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“Golden Hour”
Do NOT delay departure
Activation of Trauma Team by EMS
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Shared protocols
Learning experience
Paradigm Shift
Trauma Patient Algorithm
Resus
Stable
Unstable
Admit
Locally
Transfer
Discharge
Home
Transfer
Surgery
Transfer
Transfer
Admit
Locally
Community Outreach
• Fall Prevention
• “KIDS” Safety Day
– EMS, Police Dept., KSP, UKMC, YMCA, Dept.
Transportation
– 300 Kids
– Free Bike Helmets
Summary
• Arduous and prolonged journey
• General Surgery and Orthopedic Surgery
commitment
• Hospital “Buy In”
• TPM Essential
• Statewide Trauma System
• PIPS