1. Heather Wicks, RN, BSN

2. Part I: Program Overview Leaders in trauma program Trauma activation Components of trauma program Part II: Improvement Activities Data collection and analysis Results Outreach

3. Dr. Christopher Lee Trauma Medical Director General Surgeon ATLS Certified Heather Wicks, RN, BSN Trauma Coordinator Emergency Department Nurse Instructor of TNCC, ENPC, ACLS, PALS ATCN Certified Dr. Allan Supak Emergency Department Director EMS Director Emergency Department Physician ATLS Certified Kiera Pattison, RN, BSN Emergency Department Manager Training Center Faculty Instructor TNCC, ENPC, ACLS, PALS ATCN Certified Mary Ellen Szafranski, RN, BSN Emergency Preparedness Coordinator CHEC and ADLS Certified

4. Two tier decision scheme StandbyAlert Minor Anatomical CriteriaMajor Anatomical Criteria MechanismPhysiological Special Consideration

5. Yellowstone National Park Gateway Hose Company LFR Paradise Valley Clyde Park Cooke City Wilsall Private Vehicle

6. StandbyAlert ED Physician/NurseSurgeons RadiologyHouse Supervisor/ICU nurse LaboratorySurgical Services Cardiopulmonary (if in house) Nurse Anesthetist Trauma Coordinator Pharmacy

7. ED physician In house 24hrs a day ATLS Certified Peer Review Meetings ED nurses One ED nurse 24hrs a day 2 nd ED nurse Fri-Mon 11-23 TNCC and ENPC Monthly meetings Trainings ICU nurses/House Supervisors 2 nd nurse TNCC Trainings

8. Radiology Technician 0700-2100 in house On call 24hrs a day Laboratory Technician 0600-2300 in house Night 6 days every two weeks On call 24hrs a day Respiratory Therapist 0700-1900 in house Standby if in house Alerts on call 24hrs a day

9. OR nurses Two on call 24hrs a day One PACU nurse on call 24hrs a day TNCC Nurse Anesthetists One on call 24hrs a day ATLS General Surgeon On call 67% 2013 ATLS Meetings Orthopedic Surgeon On call 96% 2013 Meetings

10. Improvement Activities

11. Targeted modification of trauma care practices EMS ED Ancillary Services Process Overview Determine criteria for ideal care (care points) Quarterly analysis Implement solutions

12. Gather charts ICD-9 codes- 1600 charts per year Review each chart State trauma charts- 70 charts per year Performance Improvement Case to case Record care point statistics on charts General Chart Information Total charts reviewed Total charts with performance improvements Total charts submitted to the state Mechanism Activation/Accuracy

13. Quarterly Meetings Evaluation Monitor future statistics for improvement

17. Triage 2013

18. EMS Care Points Chart available Correct O 2 applied GCS charted and circled Activation called in field Intervention times recorded Warming measures IV catheter size Scene time

19. Emergency Department Care Points Trauma chart used Trauma team response Tetanus Initial temperature Full set of vital signs Correct O2 applied Cardiac monitor IV catheter size GCS Primary/secondary survey Warming measures Off backboard < 20min Repeat temperatures Time in ED <3hrs < 2 liters infused

20. RadiologyLaboratory Chest x-rayTime until lab draw Pelvis x-rayCBC CT time in ScannerChemistry CT time until readBlood Banking Currently Adopting Process Care points:

21. Emergency Medical Services Meetings TXA Disaster Preparedness training IV Protocol Emergency Department Pediatric Cart Lead/ PPE TXA Auto-transfuser Pericardiocentesis Kit Cricothyroidotomy Kit EZ-IO

22. Cardiopulmonary O 2 application McGrath ETCO2 Monitoring Obtain ABG Imaging Services Bucky with portable machine Mobile Ultrasound CT (4 to 32 slice)

23. Laboratory O-negative blood Trauma binder Massive transfusion guidelines Surgical Services In-services OR auto-transfuser TNCC New orthopedic surgeon General surgeon fill-in coverage

27. Thanks for listening!