1. Steven R. Vallance, MD, PhD, FACS Trauma Medical Director-FRMC

2. Level 3 Trauma Center- Why? Beneficial to the injured patient Statewide Trauma System The Golden Hour - Rural VS. Urban Trauma Local Hospital Benefits

3. Why Level 3? Improved patient outcomes Prevent patients from dying of simple injuries Patients receive quality care close to home Decrease burden on busy level 1 centers Most rural trauma is MVC related – Auto Insurance coverage is decent – Supports financial stability of local hospital Helps defray cost Enhances community awareness and perception of local hospital

5. Commitments and Resources Hospital and Surgeons ER physicians/Nurses Internists Anesthesia/Radiology Operating Room ICU Ancillary Services EMT Services TPM

6. Local Hospital Administrative “Buy In” $$$$ Ancillary Support Services Financial Rewards

7. SURGEONS General Surgery – Trauma Medical Director Orthopedic Surgery

8. Trauma Program Manager (TPM) Experience Charlotte Oneal

9. Anesthesia IN- House NOT required CRNA’s Permissible Liaison to trauma program

10. Radiology In house or by Teleradiology CAT Scan 24/7 – CT tech on call

11. ER Physicians/Nurses Coordinated- Collegial Collaboration ATLS- Physicians TNCC- Nurses

12. EMT Services Effective program vital Paradigm Shift Trust Transfers – Ground VS. Air Trauma Alerts PHTLS TNCC EMS Appreciation Dinner

13. Statewide Trauma System Support from Level 1 Centers ESSENTIAL – UK and UL – Resources and Guidance – Lead hospitals for system

14. Medicine/Hospitalist Service Must be available Consults and Admits

15. Trauma Registry Clinical data management system – State Registry – UK/UL Training for registration Time Consuming

16. PIPS Performance Improvement and Patient Safety “The concept of monitoring, evaluating, and improving the performance of a trauma program” Multidisciplinary Peer Review Committee Major focus of COT

17. Operating Room Readily Available 24/7 Support of OR Staff

18. General Surgeons Foundation of Trauma Service – Unwavering Commitment Board Certification ATLS Certification Response time- 30 minutes Co-Director ICU Directs Care of ICU Trauma Patients

19. Orthopedic Surgeons Absolute Requirement Majority of OR Cases ATLS Helpful Liaison to Trauma Program Involved in PIPS

20. The Journey

21. Began program NOV. 2009 COT- Consultative Visit April 2012 COT- Verification Visit May 2013 RTTDC – – DEC 2009 – UKMC

27. Trauma Flow Sheet

33. Trauma Alert Criteria

36. Trauma Patients Year #Patients Admits Transfers Deaths 2009 34 ---- ----- ---- (Nov-Dec) 2010 308 67% 31% 2% 2011 304 61% 38% 1% 2012 216 59% 39% 1.5% (Jan-Aug)

37. Mechanism of Injury Year Blunt Falls Penetrating 2009 82% (14%) 9% 2010 86% (17%) 12% 2011 89% (18%) 9% 2012 91% (28%) 7%

38. PIPS Meets monthly Multidisciplinary Peer review Chart Reviews- 3Levels – TPM- All Transfers; Medical Admits (PI) – TMD – Committee All PEDs All Transfers All Deaths Miscellaneous

39. Transfer Agreements Essential University of Kentucky University of Louisville Kosairs (?) Predefined Neuro diversion plan

40. Education Nursing – TNCC Trauma Nurse Core Curriculum 75% Certified 4 year term – Trauma Competency Training New procedures & equipment (FAST) PEDS Trauma – Trauma Symposiums Physicians – ATLS – Trauma Symposiums – CME

41. Education EMT’s – TNCC – PHTLS – Appreciation Dinner Guest Speaker

42. Lessons Learned 1.Collaborative Effort Surgeons ER physicians Hospital EMS Level 1 Centers 2.Treat Locally VS. Transfer “Golden Hour” Do NOT delay departure 3.Activation of Trauma Team by EMS Shared protocols Learning experience Paradigm Shift

43. Trauma Patient Algorithm ResusStable Admit Locally Discharge Home Transfer UnstableSurgeryTransfer Admit Locally Transfer

44. Community Outreach Fall Prevention “KIDS” Safety Day – EMS, Police Dept., KSP, UKMC, YMCA, Dept. Transportation – 300 Kids – Free Bike Helmets

45. Summary Arduous and prolonged journey General Surgery and Orthopedic Surgery commitment Hospital “Buy In” TPM Essential Statewide Trauma System PIPS