Workshop for Setting Regional and National Road Traffic Causality Reduction Targets in the ESCWA Region 16-17June, 2009 16-17June, 2009 Abu Dhabi, United Arab Emirates Abu Dhabi, United Arab Emirates Junaid Abdul Razzak MD PhD FACEP Associate Professor and Chairman Department of Emergency Medicine Aga Khan University, Pakistan Emergency Trauma Care – Evidence for Impact on Survival
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Junaid Abdul Razzak MD PhD FACEP Associate Professor and Chairman Department of Emergency Medicine
Emergency Trauma Care – Evidence for Impact on Survival. Junaid Abdul Razzak MD PhD FACEP Associate Professor and Chairman Department of Emergency Medicine Aga Khan University, Pakistan. Workshop for Setting Regional and National Road Traffic Causality Reduction Targets in the ESCWA Region - PowerPoint PPT Presentation
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Workshop for Setting Regional and National Road Traffic Causality Reduction Targets in the ESCWA Region
16-17June, 200916-17June, 2009 Abu Dhabi, United Arab Emirates Abu Dhabi, United Arab Emirates
Junaid Abdul Razzak MD PhD FACEPAssociate Professor and Chairman
Department of Emergency MedicineAga Khan University, Pakistan
Emergency Trauma Care – Evidence for Impact on Survival
Outline
1. Why is Trauma Care Important?
2. Trauma Center versus Trauma System
3. Evidence for Effectiveness of Trauma System in Saving Lives
4. Conclusion
WHY IS TRAUMA CARE IMPORTANT?
Issue 1
Time and Trauma DeathsPrimary
PreventionStrategies
Trauma Systems
Trauma Systems &
Rehabilitation
The Probability of Survival
MinutesMinutes
%
% S
urv
ival
Su
rviv
al
00
2020
4040
6060
8080
100100
3030 6060 9090
Survival Is Related ToSeverity and Duration
TRAUMA CARE SYSTEMIssue 2
Definitions of Terms
• “Inclusive Trauma Systems”– Not just hospitals for acute care; – Care from site to hospital to home to work
• “Regionalization”– Geographical Definitions– Based on Population
• “Public Health Approach”– Research Based; System Wide;
Multidisciplinary;
Inclusive Trauma Care System
Pre Hospital Phase
Hospital and Post Hospital Phase
Regional Trauma System
An organized and coordinated response that ensures a continuum of care at a Regional
Level Public access to the system through a uniform emergency
number Out of hospital emergency medical services (EMS) with
medical control Timely triage and transport to an appropriate level of
hospital care Reliable communication between EMS &
hospital personnel Access to trauma centers if needed Seamless transfer to rehabilitation The key to disaster care
EVIDENCE FOR EFFECTIVENESS
Issue 3
Do Trauma Centers Make a Difference?
Skamania Conference July, 1998
Journal of Trauma Sept, 1999
A symposium to evaluate the evidence regarding the effectiveness of trauma centers and systems
Skamania Symposium – Conclusions
• Evidence to date is fragmented• Largely based on preventable death
studies conducted in local areas • A few population based studies have been
conducted – using administrative data and historical controls
• Existing studies have focused on hospital mortality
• No data on VALUE !
PERCENT OF ALL SERIOUSLY INJURED (ISS PERCENT OF ALL SERIOUSLY INJURED (ISS >> 9) 9) WHO DIEWHO DIE
Pe
rce
nt o
f in
jure
d p
atie
nts
wh
o e
xpir
e
If Care Was Equally Good..If Care Was Equally Good..
Potential for saving hundreds of thousands of lives?
Change in Mortality of one in pre and post PHTLS changes the p value from 0.046 to 0.06 Ali et al. J Trauma 1997
Training for Pre-Hospital Care Providers and Mortality
The p-value become
insignificant with an increase in just
one death
Training for Pre-Hospital Care Providers and Mortality