Introduction to Trauma EHS201

Introduction to Trauma (EHS201)

• The course introduces trauma care, focusing on international trends, UAE-specific data, and the management approach.
• Lesson objectives include discussions of accident mortality trends, common injuries in the UAE, the trauma patient management approach, and "golden principles" in trauma care.

Trauma in Abu Dhabi

• Injury is the second leading cause of death (behind cardiovascular disease) in Abu Dhabi.
• Road traffic incidents are the leading cause of fatal injuries in Abu Dhabi, accounting for 67% of fatalities from 2007-2012.
• In Abu Dhabi, in 2011, injuries were the second leading cause of death of a total of 2902 deaths in the emirate.

World Health Organization Data

• Road traffic collisions result in over 1.25 million deaths globally annually.
• Road traffic injuries are the primary cause of death among 15-29-year-olds globally.
• Vulnerable road users, including pedestrians, cyclists, and motorcyclists, account for roughly half of those dying on the world's roads.
• Road traffic crashes cost most countries 3% of their gross domestic product.
• Without intervention, road traffic crashes are projected to become the seventh leading cause of death by 2030.

Fatal Road Traffic Injuries in Abu Dhabi (2008-2011)

• Drivers are the most common victims in traffic collisions.
• Seatbelt usage rates are low.
• Pedestrians and drivers are substantially impacted in traffic collisions.

Who is at Risk?

• Socioeconomic status plays a crucial role; over 90% of road traffic deaths occur in low-middle-income countries, and Africa has the highest road traffic fatality rate.
• Age is significant; those aged 15 to 44 account for 48% of road traffic deaths.
• Sex is a risk factor; approximately 73% of deaths involve young men under 25.

Road Deaths by Age

• Adolescents and young adults and the elderly are at higher risk for road deaths.
• The mortality rate per 100,000 population is different across various age groups.

Leading Causes of Death in Children

• Road traffic injuries are a leading cause of childhood fatalities in Abu Dhabi.
• Various other causes of death in children, like congenital anomalies and infections, are also significant.

Risk Factors in Road Traffic Collisions

• Speeding.
• Driving under the influence of alcohol or drugs (DUI).
• Lack of helmet use for motorcycle, seat belts, and child restraints.
• Distracted driving.
• Unsafe road infrastructure.
• Unsafe vehicles.

Life Years Lost in 2011

• Injuries is the second leading cause of global healthy life years lost in Abu Dhabi, with 43,000 health life years lost in 2011.

Cost of Trauma in Abu Dhabi

• 1.3 million first aid cases annually.
• 130,000 emergency room visits per year.
• 12,000 hospitalizations annually.
• 514 fatalities.

Trauma Care

• Trauma care should be based on thorough research and individualized interventions.
• Deliver the trauma patient appropriately, considering the facility, mode, and time.
• Interventions must be rapid, safe, and directed to the appropriate facility.

Research

• Research in trauma care validates existing practices, disproves certain practices, and establishes directions for future practices.

Team Approach in Trauma Care

• Trauma care requires collaborative efforts involving diverse teams including citizens, dispatch, Emergency Medical Services, transport services, emergency departments, surgeons, specialty services, and rehabilitation professionals.

What to Do?

• Trauma care principles are fundamentals for improvement or survival based on scientific evidence.
• The specific approach is influenced by the patient condition, knowledge of healthcare providers, protocols, and available resources.

Patient Assessment

• Patient assessment begins with dispatch information, chief complaint, location, scene situation, safety, available resources, and number of patients involved.
• Mechanism of injury is determined.
• Primary survey (XABCDE) and secondary assessment are performed, followed by reassessment.

Time-Critical Patients

• Transportation mode (ground versus air) and destination are critical decisions for time-sensitive trauma cases.
• Time-critical trauma cases must be differentiated from non-time-critical ones.

Time-Critical Patient Criteria

• Severe airway occlusion or difficulty in maintaining a patent airway.
• Abnormal respiratory rate and inadequate tidal volume.
• Hypoxia and respiratory distress.
• Suspected skull fractures, flail chest, pneumothorax, hemothorax, and tension pneumothorax.
• Pelvic fractures.
• Two or more proximal long bone fractures.
• Crushed or mangled extremities.
• Multisystem trauma.
• Suspected brain injury.
• Uncontrolled external hemorrhages and internal hemorrhages.
• Signs and symptoms of shock, significant external blood loss, and altered mental status (GCS less than 14).
• Seizure activity, sensory-motor deficit, penetrating trauma, and limb/body amputations.

Errors in Trauma Care

• Safety in the scene and early assessment of threats.
• Distracting non-life threatening injuries should not be prioritized over the most critical issues.
• Quick assessment using the "basics" and scene management are key for trauma care.
• Addressing signs of deterioration and failure to reassess are crucial errors to avoid.
• Transport and destination choices should be thoroughly considered.

Golden Principles in Trauma Care

• Safety for prehospital personnel and patients is primordial in trauma care.

• Thorough assessment of scene to manage resources appropriately and quickly.

• Recognizing and understanding the kinematics involved in the injuries during the assessments.

• Utilizing primary surveys to identify imminent threats to establish priorities and action plans for intervention.

• Intervention should take quick action to have the best chance of outcome.

• Implementing and managing airway, and addressing any cervical spine issues is critical.

• Supplemental Oxygen to maintain SpO2 greater than 95% and immediate management of hemorrhaging is a priority during interventions.

• Managing musculoskeletal and body temperature control is important to address immediate needs followed by the management of shock.

• Immobilizing and transporting to the appropriate facility following EMS arrival.

• Minimizing scene time.

• Early intravenous fluid replacement is a strategy to address shock while transferring the patient using adequate preparation.

• Collecting and documenting medical history and a thorough secondary assessment following initial management.

• Thorough communication following injury needs to be properly communicated with the treating hospital.

• Do no further harm/damage

• Document and record all actions/decisions/situations.

References

• Authors and publications from specific years on Trauma care.