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INTRODUCTION TO TRAUMA
MANAGEMENT

EMERGENCY MEDICAL TECHNICIAN - BASIC

 Trauma
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 Seventh leading cause of death in Indonesia for all

age groups is traffic accidents
 Trauma
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 ADB (Asian Data Bank) estimated 30,464 deaths

from traffic accidents in 2004
 ADB estimated 2,550,000 injuries related to traffic
accidents in 2004
 Annual economic loss of 2.91 % of the GDP, or
6,032 million US dollars related to traffic accidents
 The police under report the actual numbers of
accidents and injuries

www.adb.org
 Trauma
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2004
 Trauma
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This is the number of DALY’s/1000 capita per year, meaning

the number of “disease associated life years” per 1000 people
every year affected by these injuries.
World’s lowest rate Indonesia’s rate World’s highest rate

For every 1,000,000 people in Indonesia, 3300 years

of life will be lost to traffic accidents every year, 6600
due to other injuries. Many of these life years could
be saved with rapid response and treatment.
(population in Indonesia in 2007 was 234,693,997)
 Trauma
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One-fifth to one-third of
all deaths may be
preventable
 Research Spending
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$15,000,000

$550,000,000 Cancer
Heart Disease
Trauma
$1,000,000,000

“Trauma: The Neglected Disease of Modern Society”

 Time to Care vs Survival
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Evacuation Mortality
Conflict Time (hrs) Rate (%)
World War I 18 18.0

World War II 4-6 3.3

Korea 2-4 2.4

Vietnam 1-2 1.8

What
Whatdo
dothese
thesenumbers
numberssuggest
suggestabout
abouttrauma
traumacare
carestrategies?
strategies?
When Trauma Deaths Occur

<1 hour 1-3 hours 4 to 6 weeks

“The
“The Trimodal
Trimodal Distribution”
Distribution” 9
 Immediate Deaths(<1 hour)
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 Loss of Airway
 Brain Stem Laceration
 High C-Spine Lesion
 Aortic/Heart Rupture

What
What can
can be
be done
done about
about these
these deaths?
deaths?

What
What role
role does
does EMS
EMS play?
play?
 Early Deaths (1-3 hours)
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 Epidural Hematoma
 Subdural Hematoma Why
Why dodo these
these
 Hemo/Pneumothorax patients
patients die?
die?
 Intra-abdominal Bleeding
 Pelvic Fractures
 Femur Fractures
 Multiple Long Bone Fractures
 Late (2-4 weeks)
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 Sepsis
 Multiple Organ System Failure

How
How can
can these
these deaths
deaths be
be
avoided?
avoided?
 Trauma Care Conclusions
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 Definitive Trauma Care = Surgeon’s Knife

 Short time to surgery = Improved survival
 EMS improves survival by:
 Recognizing critical trauma
 Supporting oxygenation, ventilation, perfusion
 Transporting rapidly to definitive care
 Where should the patient go?
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The most
appropriate
facility Not
necessarily the
closest one!