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Lesson 1 Introduction and Overview of Trauma Care and PHTLS
Instructor Notes Lesson 1 will provide an introduction and overview of trauma care and the PHTLS program.
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Trauma Overview (1 of 3) Worldwide, more than 5.8 million people die from trauma annually Motor vehicle-related injuries are the leading cause of trauma deaths Ninety percent of the trauma deaths occur in low- and middle-income countries Instructor Notes Expand on the following points: Worldwide, more than 5.8 million people die from trauma annually. Motor vehicle-related injuries are the leading cause of trauma deaths. Ninety percent of the trauma deaths occur in low- and middle-income countries.
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Trauma Overview (2 of 3) In the United States, annually:
60 million injuries 40 million emergency department visits 2.5 million hospitalized 9 million disabled 8.7 million — temporarily 300,000 — permanently Instructor Notes Expand on the following points: Annually, In the United States, there are: 60 million injuries 40 million emergency department visits 2.5 million hospitalized 9 million disabled 8.7 million — temporarily 300,000 — permanently
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Trauma Overview (3 of 3) In the United States, more than 179,000 people die from trauma annually It is the leading cause of death in persons between 1 and 44 years of age 80% of teenage deaths 60% of childhood deaths Instructor Notes Expand on the following points: In the United States, more than 179,000 people die from trauma annually. It is the leading cause of death in persons between 1 and 44 years of age. Trauma accounts for 80% of teenage deaths. Trauma accounts for 60% of childhood deaths.
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Cost of Trauma Annually in the United States
Total economic impact of $684 billion Lost productivity from disabilities 5.1 million years $65 billion Trauma deaths 5.3 million years of life lost Average loss — 34 years per death $50 billion Instructor Notes Point out the staggering cost of trauma in dollars and lost years of productivity and life. The total economic impact of trauma is $684 billion annually in the United States alone. The lost productivity from disabilities equals 5.1 million years and $65 billion. Because of trauma deaths, 5.3 million years of life are lost, with an average loss of 34 years per death. $50 billion are lost due to trauma deaths. Remind participants that these numbers are further compounded by worldwide injury. Most major trauma patients are either underinsured or uninsured.
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PHTLS Goals Reduce mortality and morbidity from trauma
Provide knowledge and skills for all prehospital trauma team members Deliver appropriate care to the trauma patient in the field in a timely fashion No less No more Instructor Notes Expand on the following points: The goals of PHTLS are to: Reduce mortality and morbidity from trauma Provide knowledge and skills for all prehospital trauma team members Deliver appropriate care to the trauma patient in the field in a timely fashion No less No more
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PHTLS Philosophy (1 of 2) Trauma care should be based on research
Interventions are based on the assessment of each trauma patient Deliver the trauma patient: With the appropriate interventions To the right facility Utilizing the right mode of transport In the right amount of time As safely as possible Instructor Notes Expand on the following points: The PHTLS textbook and program are based on current available research. That research is cited throughout the textbook. Prehospital care providers should be comfortable reading research on prehospital care. Some suggested journals for prehospital research include: Prehospital Emergency Care Journal of Trauma Annals of Emergency Medicine Journal of the American College of Surgeons Journal of Emergency Medicine Academic Emergency Medicine The appropriate interventions are based on the assessment of each trauma patient. Knowing when to do something is important and knowing when not to do something may be even more important. Prehospital care providers must deliver the trauma patient: With the appropriate interventions To the right facility Utilizing the right mode of transport In the right amount of time As safely as possible
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PHTLS Philosophy (2 of 2) Research provides us with the foundation for the best practices for trauma care Research may: Validate our current practices Refute our current practices Determine future practices Instructor Notes Encourage the participants to read Chapter 3, The Science, Art, and Ethics of Prehospital Care: Principles, Preferences, and Critical Thinking, which describes how to read and evaluate research. Expand on the following points: Research provides the foundation for determining the best practices for trauma care. Research may validate current practices, refute current practices, and determine future practices. In the past, prehospital research was limited and often poorly done, but is now getting better. All research must be critically evaluated to see if the findings truly apply to individual EMS systems and patient populations before a practice is changed.
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Team Approach (1 of 2) A diverse team must work together in order to provide trauma patients with the best chance for a favorable outcome Instructor Notes Expand on the following points: Trauma care is a team sport, and prehospital care is the first component of the team structure. It involves a diverse team that must work together in order to provide trauma patients with the best chance for a favorable outcome. © Dan Myers
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Team Approach (2 of 2) This team includes: Citizens, dispatch
System activation Emergency medical responders EMS Transport services Emergency department Surgery Other specialty services Rehabilitation Instructor Notes Expand on the following points: This team includes: Citizens, dispatch System activation Emergency medical responders EMS Transport services Emergency department Surgery Other specialty services Rehabilitation
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Communication and Documentation (1 of 3)
Communication among all trauma team members is critical in ensuring that proper care is provided to the patient Timely Verbal Written Instructor Notes Expand on the following points: Communication among all trauma team members is critical in ensuring that proper care is provided to the patient. Discuss what constitutes ideal: Timely communication Verbal communication Written communication © Jones and Bartlett Publishers. Courtesy of MIEMSS.
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Communication and Documentation (2 of 3)
Clear, concise, accurate, and complete communication between the prehospital care provider and the receiving hospital facilitates optimal care Instructor Notes Expand on the following points: Clear, concise, accurate, and complete communication between the prehospital care provider and the receiving hospital facilitates optimal care. It allows the receiving hospital to prepare for the patient and have the trauma team fully assembled upon the patient’s arrival. Courtesy of Anthony Caliguire, NREMT-P.
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Communication and Documentation (3 of 3)
Good documentation is required: To maintain continuity of care Copy of prehospital care report left at receiving hospital For medical and legal reasons For trauma research To support trauma system funding Instructor Notes Expand on the following points: Good documentation is required to maintain the continuity of care. To ensure this, a copy of the prehospital care report is left at the receiving hospital. Documentation is also essential: For medical and legal reasons For trauma research To support trauma system funding
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PHTLS Around the World Instructor Notes
Expand on the following points: The PHTLS program is presented throughout the world and is changing the way trauma patients are treated globally. The countries with PHTLS programs are in red.
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PHTLS Based on the Advanced Trauma Life Support (ATLS) course by the American College of Surgeons Committee on Trauma (ACS-COT) A joint effort between the ACS-COT and the National Association of EMTs (NAEMT) First offered in 1983, has been offered in 57 countries, and has trained more than 700,000 providers Instructor Notes Expand on the following points: PHTLS is based on the Advanced Trauma Life Support (ATLS) course created by the American College of Surgeons Committee on Trauma (ACS-COT). PHTLS is a joint effort between the ACS-COT and the National Association of Emergency Medical Technicians (NAEMT). PHTLS was first offered in 1983, has been offered in 57 countries, and has trained more than 700,000 prehospital care providers.
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PHTLS Course (1 of 3) Builds upon each participant’s current knowledge base and skills to enhance critical thinking and problem-solving abilities Stresses teamwork between providers with diverse levels of knowledge, skills, and resources Provides a structured environment to practice trauma assessment and treatment skills Instructor Notes Expand on the following points: PHTLS builds upon each participant’s current knowledge base and skills to enhance critical thinking and problem-solving abilities. PHTLS stresses teamwork between prehospital care providers with diverse levels of knowledge, skills, and resources. PHTLS provides a structured environment to practice trauma assessment and treatment skills.
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Medical practices change!
PHTLS Course (2 of 3) We must critically examine everything we do (i.e., how and why) Science is always evolving and helps us verify or disprove our approach to trauma care Health care providers must be lifelong learners Medical practices change! Instructor Notes Expand on the following points: Medical practices change, and they change quickly. Trauma team members must stay abreast of current knowledge and changes in practice. Trauma team members must critically examine everything we do (i.e., how and why). Science is always evolving and helps to verify or disprove our approach to trauma care. Health care providers must be lifelong learners.
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PHTLS Course (3 of 3) Based on available research
Updated every 4 years as supported by new research Teaches the principles of care rather than focusing on preferences Instructor Notes Expand on the following points: Optimal trauma care relies on up-to-date knowledge and technical expertise. Skills rapidly deteriorate when unused and require ongoing practice. PHTLS is based on available research and updated every 4 years as supported by new research. PHTLS teaches the principles of care rather than focusing on preferences.
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Trauma Care (1 of 3) Principle is what needs to be done for a patient based upon the assessment Preference is how the principle is accomplished This will change depending on the: Situation at the scene Severity of the patient Knowledge and skills of the prehospital care provider Resources available Instructor Notes Expand on the following points: The principle is what needs to be done for a patient based upon the assessment. The preference is how the principle is accomplished. The principle remains the same regardless of the level of prehospital care provider. The preference of how the principle is accomplished is affected by: The situation at the scene The severity of the patient The knowledge and skills of the prehospital care provider The resources available
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Trauma Care (2 of 3) Based on assessment
Begins long before you reach the patient Information provided from the call for help Scene and situation Safe Available resources Number of patients Instructor Notes Expand on the following points: Certain situations will alter the trauma care provided (e.g., wilderness, combat, tactical) Trauma care is based on assessment. It begins long before reaching the patient with the information provided from dispatch. The scene and situation impact trauma care. Is the scene safe? What are the available resources? How many patients are present?
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Trauma Care (3 of 3) Mechanism of injury (kinematics) Patient
Primary assessment Secondary assessment Reassessment Instructor Notes Expand on the following points: The mechanism of injury (kinematics) directly impacts trauma care. The results of the entire patient assessment will direct trauma care: Primary assessment Secondary assessment Reassessment
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Patient Assessment (1 of 2)
Primary assessment A-B-C-D-E approach Taught sequentially, performed “simultaneously” Assess for and correct immediate threats to life Secondary assessment “Head-to-toe” assessment Assess for all other injuries — usually non-life-threatening Includes measurement of vital signs Instructor Notes Expand on the following points: Primary assessment Emphasize that although the A-B-C-D-E approach is taught in a sequential fashion as individual assessment points, in reality, the points should be accomplished virtually simultaneously. The prehospital care provider assesses for and corrects immediate threats to life during this phase. Secondary assessment This phase is the head-to-toe assessment. The prehospital care provider assesses for all other injuries — usually non-life-threatening. This phase includes the measurement of the patient’s vital signs.
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Patient Assessment (2 of 2)
Reassessment Important to look for changes in the patient’s condition Response to treatment Ongoing to determine any apparent change in patient status Instructor Notes Expand on the following points: During the reassessment phase, it is important to look for changes in the patient’s condition and response to treatment. The reassessment phase is ongoing to determine any apparent change in patient status.
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Critical Trauma Patient (1 of 2)
Primary assessment Treat at the scene versus treat while en route Knowing when to do something is important; knowing when not to do something is even more important Reassessment Secondary assessment Only when time and situation allow Instructor Notes Expand on the following points: In the critical trauma patient, the following modifications to the patient assessment process are made. Primary assessment Determine whether to treat at the scene versus treating while en route. Knowing when to do something is important; knowing when not to do something is even more important. Perform reassessment to determine any apparent change in patient status. Secondary assessment Perform only when time and situation allow.
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Critical Trauma Patient (2 of 2)
Transport Ground versus air Mode of transport Emergent versus non-emergent Appropriate destination Instructor Notes Expand on the following points: The factors to weigh when determining transport for the critical trauma patient include: Ground versus air The best mode of transport Emergent versus non-emergent patient The location of the appropriate destination for the patient
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Potential Pitfalls of Assessment and Management (1 of 3)
Not establishing a safe scene Overlooking life threats by not adequately assessing or exposing the patient Focusing on distracting, non-life-threatening injuries Performing a secondary assessment prior to stabilizing all life threats Instructor Notes Expand on the following points: The potential pitfalls of assessment and management include: Not establishing a safe scene Overlooking life threats by not adequately assessing or exposing the patient Focusing on distracting, non-life-threatening injuries Performing a secondary assessment prior to stabilizing all life threats
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Potential Pitfalls of Assessment and Management (2 of 3)
Performing “advanced” interventions before “basic” procedures Not performing a secondary assessment when appropriate Prolonged scene times Instructor Notes Expand on the following points: The potential pitfalls of assessment and management include (continued): Performing “advanced” interventions before “basic” procedures Not performing a secondary assessment when appropriate Prolonged scene times
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Potential Pitfalls of Assessment and Management (3 of 3)
Overlooking signs of deterioration in a patient who initially appeared noncritical Failure to reassess Transport or destination decision error Instructor Notes Expand on the following points: The potential pitfalls of assessment and management include (continued): Overlooking signs of deterioration in a patient who initially appeared noncritical Failure to reassess the patient Transport or destination decision error Consider starting a discussion using the questions below: What are some things we can do, as prehospital care providers, to make sure we are detecting changes in the patient’s condition? How can we continue to improve in providing prehospital trauma care? How do we best determine the appropriate resources for the patient based on the patient’s assessment?
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Prevention Trauma is preventable
Prevention training is available for everyone PHTLS faculty and providers should be advocates for and active participants in trauma prevention programs Prehospital care providers are the “eyes” of the prevention effort Instructor Notes Expand on the following points: Prehospital care providers are the only health care providers to actually see the trauma scene and assess for preventable causes. Trauma is preventable. Prevention training is available for everyone. PHTLS faculty and providers should be advocates for and active participants in trauma prevention programs. Prehospital care providers are the “eyes” of the prevention effort.
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Course Mechanics Housekeeping How the course will run
Course expectations Evaluation process Instructor Notes At this point, the course coordinator should describe to the participants the logistics for the course (e.g., breaks, meals, stations). Expand on the following items: Housekeeping (e.g., breaks, meals, stations) How the course will run (i.e., the course schedule) Course expectations The evaluation process
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Questions? Instructor Notes
Allow time for a question and answer session to answer any questions about the topics presented in the lesson.
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