KGMU Trauma 2

Levels of trauma centre* The different levels (i.e. Level 1-5) refer to the kinds of resources available in a trauma centre and the number of patients admitted yearly. *(American college of surgeons and COT)

Level 5 A Level 5 Trauma Centre provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care. Elements of Level 5 Trauma Centres Include: Basic emergency department facilities to implement ATLS protocols  Available trauma nurse(s) and physicians available upon patient arrival. Has developed transfer agreements for patients requiring more comprehensive care at a Level I to III Trauma Centres.  

Level 4 A Level 4 Trauma Centre has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma centre.  It provides evaluation, stabilization, and diagnostic capabilities for injured patients.

Elements of Level 4 Trauma Centres Include: Basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage.   Available trauma nurse(s) and physicians available upon patient arrival. May provide minor surgery and critical-care services if available.   Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Centre.  Incorporates a comprehensive quality assessment program Involved with prevention efforts and must have an active outreach program for its referring communities. 

Level 3 A Level 3 Trauma Centre has demonstrated an ability to provide prompt assessment, resuscitation, Gen surgery, intensive care and stabilization of injured patients.

Elements of Level 3 Trauma Centres Include: 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anaesthesiologists.  Incorporates a comprehensive quality assessment program Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.  Provides back-up care for rural and community hospitals. Involved with prevention efforts and must have an active outreach program for its referring communities. 

Level 2 A Level 2 Trauma Centre is able to initiate definitive care for all injured patients. Elements of Level 2 Trauma Centres Include: 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopaedic surgery, neurosurgery, anaesthesiology, radiology and critical care.  Tertiary care needs such as cardiac surgery, haemodialysis and micro vascular surgery may be referred to a Level I Trauma Centre.  Provides trauma prevention and to continuing education programs for staff.  Incorporates a comprehensive quality assessment program.

Level 1 Level 1 Trauma Centre is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level 1 Trauma Centre is capable of providing total care for every aspect of injury – from prevention through rehabilitation. .

Elements of Level 1 Trauma Centres Include: 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopaedic surgery, neurosurgery, anaesthesiology, radiology, plastic surgery, oral and maxillofacial, paediatric and critical care.  Referral resource. Leadership in prevention, public education to surrounding communities.

Continuing education of the trauma team members. Comprehensive quality assessment program. Teaching and research effort to help direct new innovations in trauma care. Program for substance abuse screening and patient intervention. Meets minimum requirement for annual volume of severely injured patients

Primary survey ABCDEs of trauma care A Airway and c-spine protection B Breathing and ventilation C Circulation with hemorrhage control D Disability/Neurologic status E Exposure/Environmental control

Airway Assessment and Intervention Airway should be assessed for patency Assume c-spine injury in patients with multisystem trauma Supplemental oxygen Suction Chin lift/jaw thrust Oral/nasal airways Definitive airways RSI for agitated patients with c-spine immobilization ETI for comatose patients (GCS<8)

Breathing Assessment and Intervention Inspect, palpate, and auscultate Deviated trachea, crepitus, flail chest, sucking chest wound, absence of breath sounds CXR to evaluate lung fields Ventilate with 100% oxygen Needle decompression if tension pneumothorax suspected Chest tubes for pneumothorax / hemothorax Occlusive dressing to sucking chest wound If intubated, evaluate ETT position

Circulation Assessment and Intervention Rapid assessment of hemodynamic status Level of consciousness, Skin color, Pulses in four extremities and Blood pressure and pulse pressure. Cardiac monitor Apply pressure to sites of external hemorrhage Establish IV access Cardiac tamponade- decompression if indicated Volume and Blood resuscitation

Disability Abbreviated neurological exam Level of consciousness Pupil size and reactivity Motor function GCS (Glasgow Coma Score)

Exposure Complete disrobing of patient Logroll to inspect back Rectal temperature Warm blankets/external warming device to prevent hypothermia

Trauma 1 and Trauma 2 Trauma 1 New emergency And Trauma centre

Phase wise facilities at Trauma 2 (From 1st Jan 2016 to 31st may 2016) Level 3-4 facility 40 beds 3 ventilators Phase 2 (From 1st June to 30th Sep2016) Level 3 facility 100 beds 6 ventilators

Treatment of all kind of trauma patients, including general surgery , orthopaedic surgery, oral surgery, plastic surgery, critical care. All patients of head injury will be entertained but patients having GCS <10 or requiring active neurosurgical management (operation) will be transferred to KGMU Trauma 1. All pathological investigations and ultrasound will be available round the clock. CT Scan & X-ray machines to be installed soon.

Phase 3 (From 1st Oct 2016 to 31st march 2017) Level 2 facility 218 beds 28 ventilators Phase 4 (From 1st April 2017 onwards) Level 1 facility, With teaching and research and to start Super speciality courses

The activist is not the man who says the river is dirty The activist is not the man who says the river is dirty. The activist is the man who cleans up the river. (Ross Perot)

Sapne unhi ke sach hote hain, jinke sapno mai jaan hoti hai hai. Sirf pankh hone se kuchh nahi hota, hausalon se udaan hoti hai.

Thankyou