Rural Trauma Team Development Course© (RTTDC) A Brief Overview Slide #1 – Title Slide This is a picture from a real scene in rural Alaska.

The Purpose of RTTDC To train rural hospital and clinic personnel in a team approach to the initial assessment and resuscitation of the injured patient To rapidly initiate transfer to definitive care when appropriate Slide #2 – The Purpose of RTTDC

RTTDC Objectives To improve care of the rural trauma patient by: Establishing a trauma team using the personnel and resources available at a facility Developing a team approach to trauma resuscitation, stabilization and prompt transfer Identifying key factors in organizing and preparing the resuscitation area and equipment Slide #3 – RTTDC Objectives

Who teaches RTTDCs? RTTDCs are taught by personnel from an area’s level I, II or III trauma center Builds the working relationship between a trauma center and its referring facilities Allows personnel at the area trauma center to see first-hand the resources available at the referring facility Slide #4 – Who teaches RTTDC?

Who is the RTTDC audience? Anyone who is available and able to play a role on a facility’s trauma team, including…. Physicians Nurse Practitioners Physician Assistants Nurses Pre-hospital providers ED, radiology, respiratory and laboratory technologists Administrative personnel Slide #5 – Who is the RTTDC audience?

Rural Trauma Team Composition Teams have a core of at least three members Suggested roles depend on available personnel Team leader (Physician, NP or PA) Team member #1 (Nurse) Team member #2 (Nurse, technician, prehospital provider, other) Teams may have more than three members Extended team members are personnel available to support the core team Slide #6 – Rural Trauma Team Composition

Course Site Requirements Room large enough to seat audience for lectures Additional room(s) for Team Performance Scenarios Ideally held in rural facility’s ED AV equipment (LCD, screen, speakers) Microphone for instructors Laptop computer Important to make a trial of the course slides on the actual laptop that will be used at the course Slide #7 – Course site requirements If the Team Performance Scenarios are held in one room, it must be large enough that conversations at other stations are not a distraction. If it is not possible to conduct the scenarios in the team’s ED, the room or rooms should follow that setup as closely as possible. ED setup is part of the information gathered in the pre-course arrangements. The RTTDC course slides have embedded videos, so speakers are necessary in order for the participants to hear the audio tracks.

Equipment requirements Minimal equipment needed Intubation heads, adult and pediatric Endotracheal tubes and laryngoscopes Broselow® tape Chest tube and needle for chest decompression Scenarios can use manikins, or patient models if available Slide #8 – Equipment requirements Most trauma centers will already have the type of simulators useful in an RTTDC. The picture on the slide is a pediatric patient model with simulated injuries (moulage).

RTTDC Format 8 ½ hour course Can be taught in modules also Interactive lectures and patient scenarios Teams sit and work together throughout course Course worksheets Completed by teams during course Help to identify and note individual team member responsibilities Slide #9 – RTTDC Format The RTTDC course text has a worksheet for the primary assessment chapters (airway, breathing, circulation, disability, exposure and environment) and for the transfer to definitive care chapter. The worksheets have sections for participants to complete regarding facility preparation, individual responsibilities and opportunities for improvement.

RTTDC Format: Lectures ABCDE of trauma Airway Breathing Circulation Disability Exposure and environment Transfer to definitive care Pediatric trauma Slide #10 – RTTDC Format: Lectures This slide and the next list the lectures presented in the first part of the course. A patient scenario is introduced at the start of the lectures, and new information on the patient is given at each step of the primary assessment and transfer to definitive care lectures.

RTTDC Format: Lectures Special considerations in trauma Pregnancy Burns Geriatric PIPS (performance improvement and patient safety) Communications General overview of subject in video lecture Role-playing scenarios on video Slide #11 – RTTDC Format: Lectures

RTTDC Format: Scenarios Team Performance Scenarios Teams rotate through three patient scenarios With prior approval, may substitute real cases for course scenarios Staged as closely to team’s ED as possible Information on facility resources gathered pre-course Helps identify areas to change Critiquing by instructors Self-critiquing by teams Slide #12 – RTTDC Format: Scenarios The teams spend the majority of the afternoon rotating through three scenario stations. With approval from the ACS Trauma Programs office, the faculty and the facility may use a real case, or create one that would specifically address areas that the facility has indentified as needing improvement.

RTTDC Policies ACS provides 8.25 CMEs for physicians Non-physicians can claim credits from other organizations Can have up to 30 participants Course can be held for teams from multiple facilities Courses must be approved by Chair of RTTDC committee and ACS staff Slide #13 – RTTDC Policies

RTTDC Costs RTTDC 3rd edition text Other possible costs $50.00 each, plus shipping Other possible costs Travel for course faculty Venue rental AV equipment rental Lunch and breaks Miscellaneous small expenses (phone, copying, postage, etc.) Slide #14 – RTTDC Costs RTTDC texts are ordered from the ACS Trauma Programs office.

How To Request An RTTDC Rural facility identifies a facilitator to work with course coordinator Facilitator makes on-site arrangements and helps organize participants into teams Facilitator contacts course coordinator at area trauma center Course coordinator sends pre-course questionnaire to gather information about facility resources and needs Slide #15 – How to Request an RTTDC

Does RTTDC Make a Difference? An ongoing study in West Virginia has found that RTTDC significantly reduces delays in the transfer process of rural trauma patients. Slide #16 – Does RTTDC Make a Difference? “Does the Rural Trauma Team Development Course Shorten the Interval from Trauma Patient Arrival to Decision to Transfer?” Journal of Trauma, February 2011 - Volume 70 - Issue 2 - pp 315-319 Kappel, David A. MD, FACS; Rossi, Daniel C. DO, PGY-V; Polack, Edward P. MD, MA, FACS; Avtgis, Theodore A. PhD; Martin, Matthew M. PhD

Summary Teaches rural trauma teams to quickly assess patients for injuries requiring prompt transfer Using faculty from the area trauma center builds working relationships Tailored to a facility’s resources and needs Shown to improve time to decide to transfer Designed to be simple and economical to present Slide #17 – Summary

For Further Information The RTTDC program is administered by the American College of Surgeons Trauma Programs office. For more information or for other assistance with RTTDC, please call (312) 202-5380 or email to rttdc@facs.org. Slide #18 – For Further Information July 2011