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?
• 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
• Hospital and Surgeons • Operating Room
• ER physicians/Nurses • ICU
• Internists • Ancillary Services
• Anesthesia/Radiology • EMT Services
• TPM
 Local Hospital
• 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
• Effective program vital
• Paradigm Shift
• Trust
• Transfers
– Ground VS. Air
• 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
• Board Certification
• ATLS Certification
• Response time- 30 minutes
• Co-Director ICU
• Directs Care of ICU Trauma Patients
 Orthopedic Surgeons
• Absolute Requirement
• Majority of OR Cases
• ATLS Helpful
• Liaison to Trauma Program
• Involved in PIPS
The Journey
• 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 #Patients Admits Transfers Deaths
2009 34 ---- ----- ----
(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 Falls Penetrating
2009 82% (14%) 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
• All PEDs
• All Transfers
• All Deaths
• Miscellaneous
 Transfer Agreements
• 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
• Surgeons
• ER physicians
• Hospital
• EMS
• Level 1 Centers
2. Treat Locally VS. Transfer
• “Golden Hour”
• Do NOT delay departure
3. Activation of Trauma Team by EMS
• Shared protocols
• Learning experience
• Paradigm Shift
 Trauma Patient Algorithm
Resus

Stable
Unstable

Admit
Locally Transfer Surgery Transfer

Discharge Admit
Transfer Transfer
Home 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