An excellent presentation from Dr James French at Trauma Rounds this morning.

Take home messages:

• New Brunswick needs a ‘Multiagency Trauma Research Registry’ in order to understand the problems and develop systems to address those problems
• All doctors that work in Emergency Departments in all hospitals need to have ATLS certification at a minimum
• Major Trauma is a relatively rare event. Training for major trauma must involve simulation. Simulation helps clinicians to become experts at managing rare events.
• Most trauma deaths in New Brunswick occur in the 1st hour. The average transfer time to a Level 1 Trauma Centre is >1hr. Dr French welcomes the introduction of Advanced Care Paramedics in New Brunswick, but suggest that further Critical Care Paramedics skills are needed to perform the the emergency interventions required to reduce this early mortality.

Multiagency Trauma Research Registry

We already have some NB data on trauma cause and location. Download Dr Benoit Phelan’s  research poster here.

But we could do better. See this online visual database as an example of how it could be done.

Simulation

Preparing for rare events (dealing major trauma is a relatively rare event for individual physicians and paramedics) requires ‘deliberate practice and mastery training’. Doing it again and again, practicing pitfalls, analysing mistakes, learning how to do it perfectly. The only way to do this is with simulation. Simulation needs to look and feel as close to reality as possible. Dress up – Cosplay!

Check Lists

How often have you struggled to quickly get your hands on the right equipment for a emergency procedure? Process mapping and planning assist in the development and maintenance of a system. Checklists augment clinical knowledge and training but do not replace it.

Post RSI hemodynamic instability is common. Following a checklist can help to reduce complications of infrequently performed procedures.