Emergency Trauma Care A New Modular Trauma Care Course C. James Holliman, M.D., F.A.C.E.P. Program...
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Transcript of Emergency Trauma Care A New Modular Trauma Care Course C. James Holliman, M.D., F.A.C.E.P. Program...
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Emergency Trauma Care
A New Modular Trauma Care Course
C. James Holliman, M.D., F.A.C.E.P.Program Manager, Afghanistan Health Care Sector Reconstruction ProjectCenter for Disaster and Humanitarian Assistance MedicineUniformed Services UniversityBethesda, Maryland, U.S.A.
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Goals of the Emergency Trauma Care (E.T.C.) Course
ƒ Provide medical personnel with a standardized systematic approach to caring for trauma victims
ƒ Encompass the care needed for major and for minor trauma
ƒ Simplify and standardize the information presented by instructors
ƒ Allow some flexibility in course content
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Core Lectures in the E.T.C. Course
ƒ Introduction, Initial Assessment
ƒ Airway management / ventilation
ƒ Shockƒ Intravenous fluids & linesƒ Chest traumaƒ Abdominal traumaƒ Pelvic traumaƒ Genitourinary traumaƒ Cervical traumaƒ Head traumaƒ Facial traumaƒ Extremity traumaƒ Trauma personnel duties
ƒ Prehospital trauma management
ƒ Mammal bites, rabies, tetanus
ƒ Flame & scald burnsƒ Electrical injuriesƒ Hypothermia & frostbiteƒ Near - drowningƒ Snakebitesƒ Gunshot woundsƒ Wound care & repairƒ Pediatric traumaƒ Trauma in pregnancyƒ Interhospital transfers
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Specific Skills Covered in the E.T.C. Courseƒ Primary & secondary patient assessmentƒ Airway opening maneuvers & ventilationƒ Orotracheal & nasotracheal intubationƒ Peripheral & central intravenous line
placementƒ Intraosseous line placementƒ Spine & limb immobilization techniquesƒ Radiographic identification of injuriesƒ Surgical procedures : cricothyroidotomy,
venous cutdown, pericardiocentesis, thoracentesis, thoracostomy tube, peritoneal lavage, local anesthesia, wound repair
ƒ Reduction of common joint dislocations
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Target Audiences for the E.T.C. Course
ƒ Physicians practicing in rural hospital emergency departments
ƒ Junior emergency medicine, surgery, & family practice residents
ƒ Military general medical officersƒ Physician assistants & nurse
practitionersƒ Physicians from other countries which
are just starting to develop emergency medicine
ƒ Medical students
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Choice of Formats for the E.T.C. Courseƒ Minimum : 3 days
–24 hours of lectures, 1 hour written test
ƒ Preferable : 4 days–24 hours of lectures, 4 hours practical skills sessions, 1 hour written test & 1 hour practical skills test
ƒ Add-on options :–Additional practical skills or simulated patient assessment sessions–Cadaver or animal surgical laboratory
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Advantages of the E.T.C. Course Compared to the A.T.L.S. Course
ƒ Broader range of trauma topics coveredƒ Care beyond that of initial resuscitation &
referral is coveredƒ Lecture slides contain core information to be
learned rather than just outlines or topic headings
ƒ Greater applicability to countries without organized trauma referral systems, or in situations where there is limited availability of trauma surgeons
ƒ Flexibility to adjust course content to local needs
ƒ Less expensive if animal surgical lab not included
ƒ Does not require surgeons for instructors
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Field Testing of the E.T.C. Course
ƒ All core lectures already presented as emergency medicine Grand Rounds
ƒ Entire course presented in Taegu, Korea, April 1995 to 60 Korean physicians & nurses ; all passed written test in Korean
ƒ 5 day course first in Slovenia Feb. 1997ƒ Presented several times in Slovenia and
Turkeyƒ Presented in Croatia in 2004ƒ A standard course in Romania since 2003ƒ Presented in the U.A.E. with goat lab in
2003
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New Additions to the E.T.C. Course Utilized since 1997
ƒ Afternoon hands-on sessions on use of ultrasound in trauma
ƒ Small group sessions on radiograph interpretation
ƒ Lecture & discussion on trauma team member roles and duties
ƒ More case simulation small group discussion sessions
ƒ Entire course materials rewritten and reformatted in 2002
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Written Test Options for the E.T.C. Course
ƒ 50 question true / falseƒ 100 question multiple choiceƒ Open versus closed book (using
the slide printout course manual)–Open book may be appropriate if participants' English skills are not great
ƒ Simulated cases (as in ATLS)ƒ Present a mini-lecture
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Equipment Needed for the Practical Skills Sessions of the E.T.C. Courseƒ Backboards with straps, cervical collarsƒ Extremity splintsƒ IV catheters and needlesƒ Suture kits (clamps, needle holders, scissors,
scalpels, prep & drape materials, sutures)ƒ Chest tubes & waterseal hookupsƒ Airways, bag-valve-masks, laryngoscopes, stylets,
endotracheal tubesƒ X-ray films for teaching & testing sessionsƒ Optional moulage kits for simulated injuries for the
testing sessionsƒ Mannequins (for IV's, intraosseous, etc.)
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Goals for Use of the E.T.C. Course in Other Countries
ƒ Introduce standardized quality trauma care to areas lacking this service
ƒ Develop cadres of local instructors to provide ongoing training in trauma care
ƒ Adjust the course content to reflect local trauma care needs & capabilities
ƒ Provide a relatively inexpensive means to have a large positive effect on public health by training trauma care providers