scholarly journals Disaster Preparedness Should Represent an Augmentation of the Everyday Trauma System – But Are We Prepared?

2020 ◽  
Author(s):  
Jørgen Joakim Jørgensen ◽  
Peter Wiel Monrad-Hansen ◽  
Christine Gaarder ◽  
Pål Aksel Næss
Keyword(s):  
Disaster Preparedness ◽  
Trauma System ◽  
Working Hours ◽  
Trauma Team ◽  
Trauma Centers ◽  
Team Members ◽  
National Trauma ◽  
The Everyday ◽  
Holiday Season ◽  
System Requirements

Abstract IntroductionMass casualty incidents (MCI) range from natural disasters to terrorist attacks. The increased frequency, geographical spread and the heterogenicity in type of terror incidents, challenge healthcare systems all over the world. Trauma systems constitute the base upon which disaster preparedness is being build. The largest MCI in Norway took place 22 July 2011 and several lessons were learnt including the importance of having designed the everyday trauma infrastructure to be able to increase activity and adjust according to needs. Norway is sparsely populated, with a national trauma system consisting of four regional trauma centers (TCs) and 35 acute care hospitals treating trauma (non-trauma centers; NTCs) We wanted to assess how well hospitals fill the national trauma system requirements for competence, and the degree of awareness of existing MCI plans.MethodsWe conducted a cross-sectional survey of the on-call trauma team in all 39 Norwegian hospitals during two time periods: July-August (HS; holiday season) and September – June (NHS; non-holiday season). A standardized questionnaire was used to evaluate the MCI preparedness.ResultsA total of 347 trauma team members participated with 173 during HS and 174 during NHS. Over 95% of the team members were aware of the hospital MCI plan, only half had read the plan during the last 6 months, whereas 63% at the TCs and 74% at NTCs were confident with their designated role in the event of an MCI. Trauma team exercises were conducted regularly and 86% had ever participated, primarily residents and nurses. Only 63% at the TCs and 53% at the NTCs had participated in an MCI exercise. The proportion of resident surgeons and anesthetists with >4 years clinical experience was significantly higher in TCs (88% and 63%) than in NTCs (27% and 17%). At NTCs 38% of the resident surgeons were on call from home after working hours. All the on-call consultant surgeons were at home after working hours, leaving interns in charge at several of the hospitals. All resident surgeons at the TCs were ATLS providers compared to 64% at the NTCs and almost 90% of the consultant surgeons had participated in advanced trauma surgical courses. ConclusionDespite increased focus on disaster preparedness at a national level after the 2011 attacks, we identified limited compliance with trauma system requirements concerning competency and training. Strict guidelines to secure immediate notification and early presence of consultants whenever a situation that might turn into an MCI occurs should be a prerequisite. The awareness and content of existing MCI plans should be continuously improved to be able to meet the challenges of future MCIs.

scholarly journals Disaster Preparedness Should Represent an Augmentation of the Everyday Trauma System – But Are We Prepared?

2020 ◽  
Author(s):  
Jørgen Joakim Jørgensen ◽  
Peter Wiel Monrad-Hansen ◽  
Christine Gaarder ◽  
Paal Aksel Næss
Keyword(s):  
Disaster Preparedness ◽  
Trauma System ◽  
Trauma Team ◽  
Mass Casualty ◽  
Trauma Centers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Team Members ◽  
Holiday Season ◽  
System Requirements

Abstract Background The increased frequency, geographical spread and the heterogenicity in mass casualty incidents (MCI), challenge healthcare systems worldwide. Trauma systems constitute the base for disaster preparedness. The largest MCI in Norway took place 22 July 2011 and several lessons were learnt. Norway is sparsely populated, with four regional trauma centers (TCs) and 35 hospitals treating trauma (non-trauma centers; NTCs). We wanted to assess whether hospitals fill the national trauma system requirements for competence, and the degree of awareness of MCI plans.Methods We conducted a cross-sectional survey of on-call trauma teams in all 39 hospitals during two time periods: July-August (HS; holiday season) and September-June (NHS; non-holiday season). A standardized questionnaire was used to evaluate the MCI preparedness.Results A total of 347 trauma team members participated (173 during HS and 174 during NHS). Over 95% of the team members were aware of the MCI plan, half had read the plan during the last 6 months, whereas 63% at the TCs and 74% at NTCs were confident with their designated MCI role. Trauma team exercises were conducted regularly and 86% had ever participated. Only 63% at the TCs and 53% at the NTCs had participated in an MCI exercise. The proportion of resident surgeons and anesthetists with >4 years clinical experience was significantly higher in TCs (88% and 63%) than in NTCs (27% and 17%). At NTCs 38% of the resident surgeons were on call from home. All the on-call consultant surgeons were at home, leaving interns in charge at several of the hospitals. All resident surgeons at the TCs were ATLS providers compared to 64% at the NTCs and almost 90% of the consultant surgeons had participated in advanced trauma surgical courses. Conclusion Despite increased national focus on disaster preparedness, we identified limited compliance with trauma system requirements concerning competency and training. Strict guidelines to secure immediate notification and early presence of consultants whenever a situation that might turn into an MCI occurs should be a prerequisite. The awareness and content of existing MCI plans should be continuously improved to be able to meet the challenges of future MCIs.

scholarly journals Disaster preparedness should represent an augmentation of the everyday trauma system, but are we prepared?

2021 ◽  
Vol 6 (1) ◽  
pp. e000760
Author(s):  
Jørgen Joakim Jørgensen ◽  
Peter Wiel Monrad-Hansen ◽  
Christine Gaarder ◽  
Paal Aksel Næss
Keyword(s):  
Disaster Preparedness ◽  
Trauma System ◽  
Trauma Team ◽  
Trauma Centers ◽  
Cross Sectional Survey ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Team Members ◽  
Holiday Season ◽  
System Requirements

BackgroundThe increased frequency, geographical spread and the heterogenicity in mass casualty incidents (MCIs) challenge healthcare systems worldwide. Trauma systems constitute the base for disaster preparedness. Norway is sparsely populated, with four regional trauma centers (TCs) and 35 hospitals treating trauma (non-trauma centers (NTCs)). We wanted to assess whether hospitals fill the national trauma system requirements for competence and the degree of awareness of MCI plans.MethodsWe conducted a cross-sectional survey of on-call trauma teams in all 39 hospitals during two time periods: July–August (holiday season (HS)) and September–June (non-holiday season (NHS)). A standardized questionnaire was used to evaluate the MCI preparedness.ResultsA total of 347 trauma team members participated (HS: 173 and NHS: 174). Over 95% of the team members were aware of the MCI plan; half had read the plan during the last 6 months, whereas 63% at the TCs and 74% at NTCs were confident with their MCI role. Trauma team exercises were conducted regularly and 86% had ever participated. Only 63% at the TCs and 53% at the NTCs had participated in an MCI exercise. The proportion of resident surgeons and anesthetists with >4 years’ clinical experience was significantly higher in TCs (88% and 63%) than in NTCs (27% and 17%). All the on-call consultant surgeons were at home, leaving interns in charge at several of the hospitals. All resident surgeons at the TCs were ATLS providers compared with 64% at the NTCs, and almost 90% of the consultant surgeons had participated in advanced trauma surgical courses.DiscussionDespite increased national focus on disaster preparedness, we identified limited compliance with trauma system requirements concerning competency and training. Strict guidelines to secure immediate notification and early presence of consultants whenever a situation that might turn into an MCI occurs should be a prerequisite.Level of evidenceLevel IV. Study type: cross- sectional.

scholarly journals National Trauma System Establishment Based on Implementation of Regional Trauma Centers Improves Outcomes of Trauma Care; A Follow-up Observational Study in South Korea

2021 ◽  
Author(s):  
Kyoungwon Jung ◽  
Junsik Kwon ◽  
Yo Huh ◽  
Jonghwan Moon ◽  
Kyungjin Hwang ◽  
...  
Keyword(s):  
Trauma Care ◽  
Death Rate ◽  
Injury Severity ◽  
Trauma System ◽  
Trauma Centers ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
National Trauma ◽  
Trauma Death

Abstract Background: Although Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates (> 30%). Since 2012, Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness.Methods: We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores.Results: The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47806) to 1.9% (1062/55057) (p = 0.041).Conclusions: Establishment of the national trauma system was associated with significant improvements in performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.

scholarly journals Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jing Zhou ◽  
Tianbing Wang ◽  
Igor Belenkiy ◽  
Timothy Craig Hardcastle ◽  
Jean-Jacques Rouby ◽  
...  
Keyword(s):  
South Africa ◽  
Trauma Care ◽  
Hospital Care ◽  
Life Support ◽  
Trauma Registry ◽  
Trauma System ◽  
Emerging Countries ◽  
Trauma Centers ◽  
Trauma Systems ◽  
National Trauma

AbstractAs emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.

scholarly journals National trauma system establishment based on implementation of regional trauma centers improves outcomes of trauma care: A follow-up observational study in South Korea

2022 ◽  
Vol 2 (1) ◽  
pp. e0000162
Author(s):  
Kyoungwon Jung ◽  
Junsik Kwon ◽  
Yo Huh ◽  
Jonghwan Moon ◽  
Kyungjin Hwang ◽  
...  
Keyword(s):  
South Korea ◽  
Death Rate ◽  
Injury Severity ◽  
Trauma System ◽  
Trauma Centers ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
National Trauma ◽  
Trauma Death

Although South Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates of more than 30%. Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness. We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels, and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores. The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47 806) to 1.9% (1062/55 057) (p = 0.041). The establishment of the national trauma system was associated with significant improvements in the performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care

1995 ◽  
Vol 10 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Michael J. VanRooyen ◽  
Edward P. Sloan ◽  
John A. Barrett ◽  
Robert F. Smith ◽  
Hernan M. Reyes
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Age Groups ◽  
Mortality Rates ◽  
Trauma Centers ◽  
Field Triage ◽  
Pediatric Trauma Center

AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

Mortality Among Seriously Injured Patients Treated in Remote Rural Trauma Centers Before and After Implementation of a Statewide Trauma System

Medical Care ◽  
2001 ◽  
Vol 39 (7) ◽  
pp. 643-653 ◽  
Author(s):  
N. Clay Mann ◽  
Richard J. Mullins ◽  
Jerris R. Hedges ◽  
Donna Rowland ◽  
Melanie Arthur ◽  
...  
Keyword(s):  
Trauma System ◽  
Trauma Centers ◽  
Before And After ◽  
Injured Patients

scholarly journals Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

2021 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Edoardo Picetti ◽  
Israel Rosenstein ◽  
Zsolt J. Balogh ◽  
Fausto Catena ◽  
Fabio S. Taccone ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Trauma Team ◽  
Narrative Review ◽  
Brain Protection ◽  
Team Members ◽  
Complex Patients ◽  
Polytrauma Patients ◽  
Challenging Situation

Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.

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