You are on page 1of 55

WHAT CAN WE DO AS TRAUMA

SURGEON

Ignatius Riwanto
Dep. of Surgery
Diponegoro Medical Faculty
WHAT IS TRAUMA SURGEON?
• A certificate of quality recognition is awarded
to trauma surgeons, who have completed the
whole program accredited by the European
Board of Trauma Surgeons, and have attained
a satisfactory standard.
The Trauma Surgeon Training Program
• surgical basis training (common trunk) – 2
years
• primary trauma training (part of common
trunk) – 2 years
• advanced trauma training – 2 years
THE GOAL OF TRAINING
• Training in Trauma Surgery (EBTS) has the goal
to enable surgeons to take care for all forms of
trauma, including musculo-sceletal traumata,
to get the responsibility for the coordination
of all phases of traumatised patients, in
diagnosis and treatment, including intensive
care management and rehabilitation on a
high standard level
MEMBERSHIP OF
EUROPEAN BOARD
OF SURGERY
Only trauma surgeons with a special
surgical training may have this
competence. All surgeons with
specialization for trauma surgery (like
in Germany, Belgium, Netherlands,
Switzerland or Czech Republic) or
Trauma Surgeons (like Austria,
Hungary, Spain) should join an
European Board of Trauma Surgeons,
Division of the European Board of
Surgery.
BACKGROUND
• NEED REGIONAL MAJOR TRAUMA NETWORKS IN ENGLAND

• RCS MAJOR TRUMA WORKFORCE PROJECT  TO DELIVER A


SUSTAINABLE MAJOR TRAUMA WORKFORCE

• RECONSTRUCTIVE SERVICE IN ORTHOPAEDIC, PLASTIC AND


MAXILLOFASCIAL ARE ALREADY MATURE

• 2 GAPS: 1. MAJOR TRAUMA CONSULTANT


2. RESUSCITATIVE SURGEON
Resuscitative Surgeon:
Surgical decision and
Major Trauma Consultant:
management of life
coordinator, orchestrator and clinical
threatening torso
leader for ongoing care for poly-
hemorrhage and
trauma patients.
visceral trauma.

GENERAL SURGEON,
VASCULAR SURGEON

ADDITIONAL
TRAINING

RESUSCITATIVE SURGEON
HOW ABOUT INDONESIA IN
MANAGING MAJOR POLY-TRAUMA?
• No certified trauma surgeon
• No major trauma consultant, neither resuscitative
surgeon
• Reconstructive service in orthopedic, plastic and
maxillofacial are already mature
• Torso trauma already manage by digestive and
cardiothoracic surgery mostly in top referral hospital
• Most hospital in district area only general surgeon
available with or without ATLS, DSTC, Peri-op Critically
Ill course certificate.
WHAT CAN WE DO AS TRAUMA SURGEON

WHAT CAN WE DO AS GENERAL


SURGEON IN MANAGING TRAUMA
• Does Indonesian general surgeon who already
finished ATLS, DSTC and perioperative course
have equivalent competence with trauma
surgeon (Europe) or resuscitative surgeon
(England) in managing major torso trauma?
• 100% ?, 75%?, 50%?, 25%?  Should be studied
• Should we have trauma surgeon?  conflict with
orthopedic, plastic & maxillofacial surgeon
• Should we have resuscitative surgeon who
capable manage major torso trauma? 
additional training for general surgeon (long term
plan of Indonesian College of Surgeon ?)
SHORT TERM COURSE

• Identified the RCS curriculum for major


trauma consultant and resuscitative surgery
that not be trained yet in ATLS, DSTC and
perioperative  new topics.
• Training/ re-training for ATLS, DSTC,
perioperative and new topics
• Certification based on course, experience and
paper?
WHAT CAN WE DO AS GENERAL
SURGEON WITH ADDITIONAL
COMPETENCE IN MANAGING TRAUMA?

WHAT SHOULD WE DO AS GENERAL


SURGEON WITH ADDITIONAL
COMPETENCE IN MANAGING TRAUMA?
Nine RACS Competencies
1. Collaboration and Teamwork
2. Communication
3. Health advocacy
4. Judgement - clinical decision making
5. Management and Leadership
6. Medical expertise
7. Professionalism and Ethics
8. Scholarship and Teaching
9. Technical expertise
https://www.surgeons.org/becoming-a-surgeon/surgical educationtraining/competencies/
KOMPETENSI BEDAH UMUM UNTUK TRAUMA TORAKO-ABDOMINAL

+ ATLS, DSTC,
PERIOPERATIVE
General principles of good trauma management

 The importance of injury as a public health issue.


 The importance of the injury mechanism in predicting actual injuries.
 The differing implications of blunt and penetrating injury.
 The importance of triage.
 The importance to the triage process of:
o injury mechanism, physiological status, evident injuries.
 The differing risk exposures and injury patterns in children, young
adults and the elderly.
 The patterns of associated injuries that are commonly observed.
 The commonly documented deficiencies in acute injury management.
 The importance of an integrated trauma treatment service in a hospital.
 The importance of a triage-based team approach to acute injury assessment.
 The value of a protocol-directed approach and practice guidelines to acute
injury assessment and management.
 The importance of regional trauma care systems that link injury prevention
activities, pre-hospital care, acute care hospitals with differing roles, and
rehabilitation services.
http://www.surgwiki.com/wiki/Principles_of_trauma_management
http://www.anzjsurg.com/view/0/index.html
RESPONSIBILITY OF SURGEON ON
TRAUMA CHAIN
ROLE OF SURGEON IN TRAUMA CHAIN
• Optimizing resuscitative strategy
• Surgical technique
• Logistic and resource allocation
• Disaster management
• Development of strategies in resources poor
location
• Collecting, reporting and auditing data
• Research
WHAT ARE USUALLY DONE BY INDONESIAN
SURGEON IN MANAGING TRAUMA?
• Trauma team in hospital? No
• Resuscitation (partly or
sometimes)
• Surgery (always)
• Collaboration for early
Rehabilitation
• Others (???)
SURGEON
++

COLABORATION
TRAIN
DO
& DO

• Optimizing resuscitative strategy


• Surgical technique
GENERAL SURGEON: ON CALL
FOR ABDOMINAL TRAUMA

A&E: Accident and Emergency


AFTER ABDOMINAL
CT-SCAN
• Logistic and resource
allocation
• Disaster management
• Development of strategies
in resources poor location

collaboration
BNPB
SURGEON
Government, NGO
++

TRAIN COLABORATION
TRAIN
DO
& DO

• Optimizing resuscitative strategy


• Surgical technique
TRAIN-WORKSHOP
• TRAINING/ RETRAINING
• CONTINUING EDUCATION
• Logistic and resource • READING
allocation
• Disaster management
• Development of strategies CONTINUE
in resources poor location UPDATING

• Collecting, reporting
collaboration and auditing data
STAKE HOLDER SURGEON
• Research
++

TRAIN COLABORATION
TRAIN
DO
& DO

• Optimizing resuscitative strategy


• Surgical technique
Trauma Surgery to Acute Care Surgery:
Defining the Paradigm Shift
The Journal of Trauma: Injury, Infection, and
Critical Care. 68(5):1024-1031, MAY 2010

• Trauma surgery is gradually evolving into acute care surgery (ACS)


• Study compared averages for trauma surgeons with general, oncology,
and vascular surgeons of 85 institution, 2007-2008
• Total procedures for each specialty were similar: trauma 660, general
surgery 715, surgical oncology 713, vascular 835
• Cholecystectomy were comparable between trauma and general surgery
(388 vs. 452); both groups perform about 75% of the cholecystectomies
laparoscopically
• Appendectomies, trauma surgeons (180) exceeded general surgeons
(128). Each group performed approximately 65% laparoscopically.
NEXT IN INDONESIA
• GENERAL SURGEON +
(ATLS,DSCTC,PERIOPERATIVE COURSE) +
OTHERS ?
• TRAUMA SURGEON (AS IN EUROPE) ?
• RESUSCITATIVE SURGEON (AS IN UK) ?
• ACUTE CARE SURGEON (AS IN US) ?
• OTHERS ?
SUMMARY
• Trauma surgeon (Europe), major trauma consultant, resuscitative
surgeon (England), who manage major trauma patients need
special training.
• In Indonesia there is no trauma surgeon, nor resuscitative surgeon,
but only general surgeon with additional course regarding trauma
(ATLS, DSTC, perioperative). Additional training to get equal
competence in managing trauma may be needed.
• Surgeon should participate in every step of trauma chain; training
for first aid, training and doing for BLS & ALS, doing resuscitative
surgery and doing collaboration with medical rehabilitation.
• Surgeon should participate to be member of hospital trauma team,
disaster hospital team and making coordination with other disaster
team
• There is paradigm shift from trauma surgeon to acute care surgeon.