Trauma center

trauma management

1. Pembimbing: dr. Yogi Prabowo, SpOT(K), Sp. EM dr. Ario Baskoro dr. Natanael Parningotan Agung d r. Gasha Aryapratama dr. Herdy Adriano dr. Adlina Karisyah trauma center

2. INTRODUCTION Trauma centres play an essential role in the trauma system providing acute care to the most seriously injured, system leadership, and education and research programs. The trauma centre is a medical centre where resources are dedicated and/or prioritized to ensure the acutely injured patient can receive full and timely resuscitation, assessment and definitive care on a 24-hour basis. Adult Trauma Centres are classified numerically (Levels I – V) and two levels of Pediatric Trauma Centre (P-I, P-II) have also been defined. Resources For Optimal care of The Injured Patient. Commitee On Trauma American College of Surgeons. 2014

3. To develop, implement and provide oversight of a comprehensive trauma care system that: Prevents injuries. Saves lives. Improves the care and outcomes of trauma patients. Mission

4. Trauma: Severe injury or injuries requiring rapid evaluation and transport to specific hospitals with trauma care capabilities .“ Worst of the worst ”. Trauma system: Organized approach to treating patients with acute injuries . Trauma registry: Repository of data on patients who receive hospital care for certain types of injuries. DEFINITION

5. Cause of Injury Categories Cut/Pierce Drowning/Submersion* Fall Fire/Burn Fire/Flame Hot object/substance Firearm Machinery Motor Vehicle Traffic Pedal Cyclist, Other Pedestrian , Other Transport, Other Natural/Environmental Bites and Stings Overexertion Poisoning* Struck By, against Suffocation*

6. Trauma System 6

7. trauma center scope 7 Emergency Preparedness Multiple trauma centers expressed doubt whether they could handle a mass casualty event New funding could provide necessary training and capability to more adequately prepare for a mass casualty situation Staff Training and Education Potential new funding could allow more centers to pursue residency programs Funding could also allow for staffing of new dedicated performance improvement systems Recruitment and Retention Initiatives With trauma specialists becoming more expensive and difficult to retain, additional funding would allow centers to improve incentives for high-quality personnel

8. Level I 8 Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation. Elements of Level I Trauma Centers Include: 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care. Referral resource for communities in nearby regions. Provides leadership in prevention, public education to surrounding communities. Provides continuing education of the trauma team members. Incorporates a comprehensive quality assessment program. Operates an organized teaching and research effort to help direct new innovations in trauma care. Program for substance abuse screening and patient intervention. Meets minimum requirement for annual volume of severely injured patients

9. Level II 9 A Level II Trauma Center is able to initiate definitive care for all injured patients. Elements of Level II Trauma Centers Include: 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center. Provides trauma prevention and continuing education programs for staff. Incorporates a comprehensive quality assessment program.

10. Level III 10 A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations. Elements of Level III Trauma Centers Include: 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists. Incorporates a comprehensive quality assessment program. Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center. Provides back-up care for rural and community hospitals. Offers continued education of the nursing and allied health personnel or the trauma team. Involved with prevention efforts and must have an active outreach program for its referring communities.

11. Level IV 11 A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients. Elements of Level IV Trauma Centers Include: Basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage. Available trauma nurse(s) and physicians available upon patient arrival. May provide surgery and critical-care services if available. Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center. Incorporates a comprehensive quality assessment program. Involved with prevention efforts and must have an active outreach program for its referring communities.

12. Level V 12 A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care. Elements of Level V Trauma Centers Include: Basic emergency department facilities to implement ATLS protocols. Available trauma nurse(s) and physicians available upon patient arrival. After-hours activation protocols if facility is not open 24-hours a day. May provide surgery and critical-care services if available. Has developed transfer agreements for patients requiring more comprehensive care at a Level I through III Trauma Centers.

13. In a Level I Pediatric Trauma Center: At least 2 surgeons who are board certified or eligible in pediatric surgery At least 1 board certified or eligible orthopedic surgeon with pediatric fellowship training and one additional board certified or eligible orthopedic surgeon with demonstrated interests and skills in pediatric trauma care At least 1 board certified or eligible neurosurgeon with pediatric fellowship training and one additional board certified or eligible neurosurgeon with demonstrated interests and skills in pediatric trauma care At least 2 physicians who are board certified or eligible in pediatric critical care medicine or in pediatric surgery and surgical critical care. At least 2 physicians who are board certified or eligible in pediatric emergency medicine Pediatric intensive care unit and pediatric section of emergency department must be staffed by individuals credentialed by the hospital to provide pediatric trauma care in their respective area Pediatric Trauma Center 13

14. In a Level II Pediatric Trauma Center At least 1 board certified or eligible pediatric surgeon At least 1 board certified or eligible orthopedic surgeon with demonstrated interests and skills in pediatric trauma care At least 1 board certified or eligible neurosurgeon with demonstrated interests and skills in pediatric trauma care Pediatric intensive care unit and the pediatric section of the emergency department must be staffed by individuals credentialed by the hospital to provide pediatric care in their respective areas Pediatric Trauma Center 14

15. Components Trauma center consists of : E mergency Departement Ambulans ce Laboratorium Radiolog y OT Intensive Care Unit (ICU) Rehabilit ation Pharmacyst Inte 15

16. Trauma Center in Indonesia Facilities : Minimum type D Hospital . Available for Emergency Departement/ Unit . Available for Operation Theathre . Surgeon . Esensial Specialist doctors : Rehabilitation , ortop haedy , Lung , Internist, and cardiologist Established team for work related injury consist of adminisration. Surgeon, GP/EM Doctor and Nurses Available for Pharmacyst/ drugs depo . 16

17. Human Resources Doctor : Qualified with work related injuries training sertificate . Qualified with Advanced Cardiac Life Support (ACLS) – Advanced Trauma Life Support (ATLS) Legaly Registered and owned practical permission liscence Nurse /Paramedi c : Qualified with work related injuries training sertificate . Qualified with Basic Trauma Life Support (BTLS). Legaly Registered and owned practical permission liscence ) 17

18. THANK YOU 18