Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Download
Standard view
Full view
of .
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Prehospital Trauma Care

Prehospital Trauma Care

Ratings: (0)|Views: 267|Likes:
Published by seigelystic
PREHOSPITAL TRAUMA CARE

The origins of trauma care delivery are deeply rooted in the major military conflicts of the last century. During the Napoleonic Wars, Dominique Larrey established the concepts of field hospitals, the use of the “flying ambulances” and the principles of triage. In the World War I, rapid and timely evacuation of the injured from the battlefield through echelons of treatment facilities, each with increasing surgical capabilities, became the standard of care. During the World War II, in addition to reducing the time from evacuation to treatment, the principle of “resuscitation” or treatment of shock prior to transport evolved. When combined with the other advances in transfusion technology, surgical technique, antibiotics, and so on, this systematic approach to trauma care resulted in a significant decrease in mortality. This approach was further refined in the Korean conflict and the Vietnam War, when wounded soldiers were rapidly transported within minutes by helicopter to fully capable hospitals, where the entire spectrum of trauma care from initial resuscitation to definitive surgical management was delivered. Experience gained in the battlefield of trauma care for victims of “urban warfare.” However, in spite of extensive training, these same trauma surgeons were unable to provide the same level of care outside these urban hospitals. Therefore, it became clear that the system, and not the individuals, were responsible for the observed successes, and the need for trauma systems, not just trauma surgeons, became recognized.
The publication of seminal report, Accidental Death and Disability: The Neglected Disease of Modern Society, in 1966 became the catalyst in changing the delivery of trauma care. This report highlighted the magnitude of the problem in both human and economic terms and lack of an organized public or governmental response to the problem. As this became a major political issue, Congress responded by enacting the National Highway Safety Act of 1966. The resultant funding spurred the development of trauma systems in the states of Maryland, Florida, and Illinois. Additional federal funding followed passage of Titles 18 and 10 of the Medicare and Medicaid Act, the Emergency Medical Services System Act of 1973, and the Emergency Medical Services Amendments of 1976. Prompted by perceived financial gains, a large number of hospitals sought designation as “trauma centers.” With the sharp decline in funding following the Omnibus Budget Reconciliation Act of 1981, the exodus of participating institutions was as rapid as their entry into the system. The specialty care of trauma then became the purview of centers that retained an interest in caring for victims of traumatic injury in spite of the disadvantages that are associated with doing so.
Over the ensuring years, trauma systems have matured with the trauma center as their cornerstone. Adequately addressing the issue of traumatic injury is recognized to include a spectrum beginning the injury prevention and education, throughout the immediate acute care phase, and extending into the rehabilitation. The success of these systems is recognized in the ability of trauma centers, in the context of trauma systems, to reduce mortality and morbidity. Further, lessons learned are being applied in the theatre of war. Medical teams on the front lines of battle in Iraq and Afghanistan are receiving training prior to deployment at select trauma centers and employing principles refined in the civilian sector (Figure 1).



In spite of this compelling evolution, the delivery of trauma care continues to face significant challenges (Table 1). The technological advances of the last decade have increased the complexity of care, and require a multidisciplinary approach for an optimal outcome. Such as approach is associated with increasing costs, which in the face of skyrocketing malpractice premiums and declining reimbursements, challenges the financia
PREHOSPITAL TRAUMA CARE

The origins of trauma care delivery are deeply rooted in the major military conflicts of the last century. During the Napoleonic Wars, Dominique Larrey established the concepts of field hospitals, the use of the “flying ambulances” and the principles of triage. In the World War I, rapid and timely evacuation of the injured from the battlefield through echelons of treatment facilities, each with increasing surgical capabilities, became the standard of care. During the World War II, in addition to reducing the time from evacuation to treatment, the principle of “resuscitation” or treatment of shock prior to transport evolved. When combined with the other advances in transfusion technology, surgical technique, antibiotics, and so on, this systematic approach to trauma care resulted in a significant decrease in mortality. This approach was further refined in the Korean conflict and the Vietnam War, when wounded soldiers were rapidly transported within minutes by helicopter to fully capable hospitals, where the entire spectrum of trauma care from initial resuscitation to definitive surgical management was delivered. Experience gained in the battlefield of trauma care for victims of “urban warfare.” However, in spite of extensive training, these same trauma surgeons were unable to provide the same level of care outside these urban hospitals. Therefore, it became clear that the system, and not the individuals, were responsible for the observed successes, and the need for trauma systems, not just trauma surgeons, became recognized.
The publication of seminal report, Accidental Death and Disability: The Neglected Disease of Modern Society, in 1966 became the catalyst in changing the delivery of trauma care. This report highlighted the magnitude of the problem in both human and economic terms and lack of an organized public or governmental response to the problem. As this became a major political issue, Congress responded by enacting the National Highway Safety Act of 1966. The resultant funding spurred the development of trauma systems in the states of Maryland, Florida, and Illinois. Additional federal funding followed passage of Titles 18 and 10 of the Medicare and Medicaid Act, the Emergency Medical Services System Act of 1973, and the Emergency Medical Services Amendments of 1976. Prompted by perceived financial gains, a large number of hospitals sought designation as “trauma centers.” With the sharp decline in funding following the Omnibus Budget Reconciliation Act of 1981, the exodus of participating institutions was as rapid as their entry into the system. The specialty care of trauma then became the purview of centers that retained an interest in caring for victims of traumatic injury in spite of the disadvantages that are associated with doing so.
Over the ensuring years, trauma systems have matured with the trauma center as their cornerstone. Adequately addressing the issue of traumatic injury is recognized to include a spectrum beginning the injury prevention and education, throughout the immediate acute care phase, and extending into the rehabilitation. The success of these systems is recognized in the ability of trauma centers, in the context of trauma systems, to reduce mortality and morbidity. Further, lessons learned are being applied in the theatre of war. Medical teams on the front lines of battle in Iraq and Afghanistan are receiving training prior to deployment at select trauma centers and employing principles refined in the civilian sector (Figure 1).



In spite of this compelling evolution, the delivery of trauma care continues to face significant challenges (Table 1). The technological advances of the last decade have increased the complexity of care, and require a multidisciplinary approach for an optimal outcome. Such as approach is associated with increasing costs, which in the face of skyrocketing malpractice premiums and declining reimbursements, challenges the financia

More info:

Published by: seigelystic on Sep 18, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOCX, PDF, TXT or read online from Scribd
See more
See less

01/18/2013

pdf

text

original

 
 
 
 
You can get more notes at www.medicalvillage.blogspot.com
 
 
 MEDICAL SPECIAL REPORT
 
MEDICAL SPECIAL REPORT 2The origins of trauma care delivery are deeply rooted in the major military conflicts of the lastcentury. During the Napoleonic Wars, Dominique Larrey established the concepts of field hospitals,
the use of the “flying ambulances” and the principles of triage. In the World War I, rapid and timely
evacuation of the injured from the battlefield through echelons of treatment facilities, each withincreasing surgical capabilities, became the standard of care. During the World War II, in addition to
reducing the time from evacuation to treatment, the principle of “resuscitation” or treatment of 
shock prior to transport evolved. When combined with the other advances in transfusiontechnology, surgical technique, antibiotics, and so on, this systematic approach to trauma careresulted in a significant decrease in mortality. This approach was further refined in the Koreanconflict and the Vietnam War, when wounded soldiers were rapidly transported within minutes byhelicopter to fully capable hospitals, where the entire spectrum of trauma care from initialresuscitation to definitive surgical management was delivered. Experience gained in the battlefieldof trauma
care for victims of “urban warfare.” However, in spite of extensive training, these same
trauma surgeons were unable to provide the same level of care outside these urban hospitals.Therefore, it became clear that the system, and not the individuals, were responsible for theobserved successes, and the need for trauma systems, not just trauma surgeons, becamerecognized.The publication of seminal report
 , Accidental Death and Disability: The Neglected Disease of ModernSociety 
, in 1966 became the catalyst in changing the delivery of trauma care. This report highlightedthe magnitude of the problem in both human and economic terms and lack of an organized public orgovernmental response to the problem. As this became a major political issue, Congress respondedby enacting the National Highway Safety Act of 1966. The resultant funding spurred thedevelopment of trauma systems in the states of Maryland, Florida, and Illinois. Additional federalfunding followed passage of Titles 18 and 10 of the Medicare and Medicaid Act, the EmergencyMedical Services System Act of 1973, and the Emergency Medical Services Amendments of 1976.
Prompted by perceived financial gains, a large number of hospitals sought designation as “traumacenters.” With the sharp decline in fund
ing following the Omnibus Budget Reconciliation Act of 1981, the exodus of participating institutions was as rapid as their entry into the system. Thespecialty care of trauma then became the purview of centers that retained an interest in caring forvictims of traumatic injury in spite of the disadvantages that are associated with doing so.Over the ensuring years, trauma systems have matured with the trauma center as theircornerstone. Adequately addressing the issue of traumatic injury is recognized to include a spectrumbeginning the injury prevention and education, throughout the immediate acute care phase, andextending into the rehabilitation. The success of these systems is recognized in the ability of traumacenters, in the context of trauma systems, to reduce mortality and morbidity. Further, lessonslearned are being applied in the theatre of war. Medical teams on the front lines of battle in Iraq andAfghanistan are receiving training prior to deployment at select trauma centers and employingprinciples refined in the civilian sector (Figure 1).
PREHOSPITAL TRAUMA CARE 
 
 
 
 
You can get more notes at www.medicalvillage.blogspot.com
 
 
 MEDICAL SPECIAL REPORT
 
MEDICAL SPECIAL REPORT 2In spite of this compelling evolution, the delivery of trauma care continues to face significantchallenges (Table 1). The technological advances of the last decade have increased the complexity of care, and require a multidisciplinary approach for an optimal outcome. Such as approach isassociated with increasing costs, which in the face of skyrocketing malpractice premiums anddeclining reimbursements, challenges the financial health of trauma centers. Increased involvementof multiple specialists makes the logistics of providing adequate emergency room coverage andcoordination of care a potentially daunting task. The workforce of trained trauma surgeons isshrinking as new graduates from general surgery training programs see trauma, in all but selectprograms, as a predominantly nonoperative specialty.
 
 
 
 
You can get more notes at www.medicalvillage.blogspot.com
 
 
 MEDICAL SPECIAL REPORT
 
MEDICAL SPECIAL REPORT 2Trauma surgeons are essentially viewed as specialists who prepare injured patients for surgicalprocedures conducted by other specialists. Mandated reductions in resident work hours havelimited their ability to maintain the traditional continuity of care that until recently was the hallmarkof a surgical residency program. Such reductions have also raised concerns regarding the operativeexperience of current trainees. Additionally, in contrast to elective surgical patients, trauma patientspose unique challenges including the need to address nutritional concerns, issues of substanceabuse, need for neuropsychological support, rehabilitation, and requirements for social supportafter resolution of the acute event. Further, additional considerations need to be entertained whenmanaging special populations including children, pregnant women, and the elderly. Finally,educational outreach activities and continued research are an integral part of the efforts to improveoutcomes. Unfortunately, despite the magnitude of its impact as the leading cause of death anddisability in the first four decades of life, funding for trauma sadly trails that of diseases such ascancer or heart disease.In order to overcome these challenges, we need to redefine the philosophy of trauma surgery andtrauma surgeons. The purpose of this review is to describe efforts that are currently under wayother potential solutions currently being entertained to optimize patient care.ORGANIZING THE INITIAL CARE OF TRAUMA PATIENTSPrehospital CommunicationDirect communication between the trauma center and emergency medical personnel is the key. Theheads-up on the nature and number of arriving trauma victims along with the estimated time of arrival allows for better preparation of required personnel and equipment. This becomes morerelevant when multiple casualties are involved and team members of varying levels of experienceare designated
according to patient’s severity of injuries. In specific circumstances, it also allows
certain specialists to be called in even before the patient arrives (e.g., the neurosurgeon for a
traumatic quadriplegia). Activation of “surge capacity” procedu
res for mass casualty events can bedone with the maximum lead time. In addition, medical direction can be provided to prehospitalpersonnel in cases outside the realm of those in standard operating procedures.

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->