Introduction to Trauma (EHS201)

Introduction to Trauma (EHS201)

• Course title: Introduction to Trauma
• Date: 8/23/2023
• Trauma care is based on research, interventions are based on patient assessment to deliver the patient appropriately.

Lesson Objectives

• Discuss international accident mortality trends
• Discuss common injuries in the UAE
• Explain the trauma patient management approach
• Discuss the "golden principles" in trauma care.

Trauma in Abu Dhabi

• Injury is the 2nd leading cause of death behind cardiovascular disease in Abu Dhabi.
• Road traffic incidents are the leading cause of fatal injuries in Abu Dhabi (67%) in 2007-2012.

World Health Organization

• More than 1.25 million people die each year from road traffic collisions.
• Road traffic injuries are the leading cause of death among people aged 15-29.
• Nearly half of road deaths involve vulnerable road users (pedestrians, cyclists, motorcyclists)
• Road traffic crashes cost most countries 3% of their GDP.
• Without continued action, road traffic crashes are predicted to become the 7th leading cause of death by 2030.

Fatal Road Traffic Injuries

• Drivers are most affected by road traffic injuries
• Seatbelt use may be a factor.

Who is at risk?

• Socioeconomic status: More than 90% of road traffic deaths occur in low-middle-income countries, and rates are highest in Africa.
• Age: People aged 15 to 44 account for 48% of global road traffic deaths.
• Sex: 73% of all road traffic deaths involve young men under 25.

Road Deaths by Age

• Teenagers, young adults, and older adults are at higher risk.
• Mortality rates vary by age group.

Leading Causes of Death in Children

• Road traffic injuries are the leading cause of child fatalities.
• Other leading causes of childhood deaths are congenital anomalies, perinatal causes, drowning, nervous system disorders, etc.

Risk Factors in Road Traffic Collisions

• Speeding
• Driving under the influence of alcohol (DUI)
• Not wearing motorcycle helmets, seatbelts, and child restraints
• Distracted driving
• Unsafe road infrastructure
• Unsafe vehicles

Life Years Lost

• 43,000 health life years were lost due to injury in Abu Dhabi in 2011.
• Injury is the 2nd leading cause of lost healthy life years in Abu Dhabi.
• The leading causes of lost healthy life years include CVD, injury, neoplasms, congenital anomalies, etc.

Cost

• 1.3 million first aid cases
• 130,000 ER visits
• 12,000 hospitalizations
• 514 fatalities

Trauma Care

• Trauma care should be based on research to validate and refute current practices.
• Deliver trauma patients with appropriate interventions to the right facility via the right transport mode in the right time frame and safely as possible.

Research

• Research provides the foundation for trauma care.
• Research validates, refutes, and determines future practices in trauma care.

Team Approach

• A diverse team (e.g., citizens, dispatch, EMS, transport services, ED, surgery, specialty services, rehabilitation) is crucial for trauma patients.

What to do?

• Principles for patient improvement or survival are based on scientific or evidence-based tenets.
• Healthcare providers determine the best course of action based on situation, patient condition, skills, protocols, and resources available.

Patient Assessment

• Assessment begins with dispatch information (chief complaint, location, scene and situation) which includes safety, available resources and number of patients.
• Mechanism of injury (kinematics) is identified.
• Patient assessment involves a primary survey (ABCDE) followed by a secondary assessment.
• Reassessment is ongoing.

Time-Critical Patients

• Transport methods (ground or air) and appropriateness of destination are crucial.
• Time-critical versus non-time-critical classifications.

Time-Critical Patients (cont'd)

• Critical patient indicators, such as airway occlusion, abnormal respiratory rate, inadequate tidal volume, hypoxia, respiratory distress, suspected skull fracture, etc., dictate the response.
• Also, uncontrolled external hemorrhage, significant internal hemorrhage, shock, significant external blood loss, altered mental status, seizures, motor deficits, penetrating trauma (head, neck, chest, abdomen), amputation, significant medical history, open or depressed skull fracture, paralysis, determine time-sensitive needs..

Errors in Trauma Care

• Errors include not establishing a safe scene; overlooking life-threatening concerns due to distraction with non-life-threatening injuries; neglecting basic measures in favor of secondary assessments and prolonged delays; overlooking signs of deterioration in patients; skipping reassessments or errors in transport/destination decisions.

Golden Principles

• Safety of providers and patients is paramount.
• Prehospital care providers need to assess the scene to gauge the needs; determine resource needs.
• Assess the mechanism of injury to discern life-threatening conditions requiring a primary survey.
• Interventions need to be swift to maximize chances for survival.
• Airway and cervical spine must be managed with a good oxygenation system to maintain 95% or greater oxygen levels in blood.
• Control external bleeding and provide basic shock therapy.
• Support ventilation, splinting, and maintain normal body temperatures while transporting to the right facility.
• Limit scene time to 10 minutes for severely injured patients.
• Provide pain relief, and accurate communication.
• Do no further harm.

References

• American College of Surgeons Committee on Trauma (2020).
• Prehospital Trauma Life Support, Ninth Edition.
• Jones & Bartlett Learning.
• Pollak (2018).
• Nancy Caroline's Emergency Care in the Streets, Eighth Edition
• Jones & Bartlett Learning.

This quiz explores key concepts in trauma care, focusing on international mortality trends, common injuries in the UAE, and trauma patient management. It emphasizes the importance of the 'golden principles' in trauma care and the impact of road traffic incidents as a leading cause of fatal injuries. Understanding these elements is crucial for effective trauma care delivery.