Presentation by Dr Andy Buck and Dr Amit Maini, founders of the Emergency Trauma Management Course, at the ACEM Winter Symposium in Broome, June 2013. Breaking new ground in trauma education explains why trauma education is important, and compares the old methods to the modern ways emergency doctors are learning about this difficult subject.
3. • Trauma is a major health problem
world-wide, and it’s on the up
• Responsible for 10% of global
deaths, and by 2020, MVA will be
3rd leading cause of death in the
world
• All trauma is managed in the
Emergency Department first
• ACEM defines it as core, and high
and expert level knowledge is
expected
Trauma is COMMON!
4. • Heterogenous - no two traumas are
the same
• Multisystem injuries - time critical
decisions, and skills can affect
outcomes
• Many confounders - extremes of age,
pregnancy, obesity, intoxication
• Conflicting priorities in management
• Managing the room - co-ordinating
the “team” - human factors
• In our system - most ED’s don’t
manage major trauma, but we all
need to know how
Trauma is HARD!
5. Trauma is EXPENSIVE!
• Affects all ages, in Australia, peak incidence in 15-24y age group
• Large economic burden attached to this:
• hospital treatment
• productive life years lost to morbidity & mortality
• social / psychological cost - families, staff
6. But does education affect clinical outcomes?
• Aim of education – to improve quality of care
• Outcomes are the key, but are difficult to
measure:
• Heterogeneity of trauma
• Poor methods for assessment of morbidity
• Difficulty measuring intervention that
affects only one aspect of patient care
7. Trauma Education – the old way
Textbooks Working at a trauma centre One short course
8. Trauma Education Needs Survey *
* Trauma Education Needs Survey via www.edexam.com.au and www.edtcc.com November 2012
Less than 50% who attended an alternative trauma
course feel adequately prepared to confidently
manage trauma patients.
9. • Old article but validates utility of
face to face short course format
• Lectures, small group sessions,
skill stations and scenarios – seen
to be effective
• Demonstrated improved
compliance with guidelines
• Hard to demonstrate effect on
clinical outcomes
• Studies show combination of
online learning & face to face
teaching better than either alone
Face to face courses
10. Would you consider doing a trauma course other than
EMST / ATLS if it was designed to meet your trauma
education / experience needs?*
* Trauma Education Needs Survey via www.edexam.com.au and www.edtcc.com November 2012
12. www.etmcourse.com
Course manual in iBook format with video, audio & digital images
Accessible & up to date
Blog Podcast3 Day Course
Face to face
Interactive
Relevant
ED Focused
CommonTrauma a major health problem world wide.And all trauma is managed in the Emergency Department First. ACEM defines it as core, and high and expert level knowledge is expected.Hard!HeterogenousMultisystem injuries where time critical decisions, and skills can affect outcomesMany confounders - extremes of age, pregnancy, obesity, intoxicationConflicting priorities in managementManaging the room - co-ordinating the “team” - human factorsIn our system - most ED’s don’t manage major trauma, but we all need to know how. CostlyIt’s a disease that afflicts all ages, but, here in Australia, peak incidence in 15-24y age group.There is a large economic burden attached to thishospital treatmentMany productive life years lost to morbidity & mortalitySocial / psychological cost - families, staffOutcomesTo improve the quality of care delivered after going through the educational process.Outcomes are the key, but are difficult to measure.Heterogeneity of traumaPoor methods for assessment of morbidityDifficulty measuring intervention that affects only one aspect of patient care
CommonTrauma a major health problem world wide, and it’s on the up.According to WHO, responsible for 10% of global deaths, and by 2020, MVA will be 3rd leading cause of death in the world.And all trauma is managed in the Emergency Department First. ACEM defines it as core, and high and expert level knowledge is expected.
Hard!HeterogenousMultisystem injuries where time critical decisions, and skills can affect outcomesMany confounders - extremes of age, pregnancy, obesity, intoxicationConflicting priorities in managementManaging the room - co-ordinating the “team” - human factors.In our system - most ED’s don’t manage major trauma, but we all need to know how.
CostlyIt’s a disease that afflicts all ages, but, here in Australia, peak incidence in 15-24y age group.There is a large economic burden attached to thishospital treatmentMany productive life years lost to morbidity & mortalitySocial / psychological cost - families, staff
OutcomesAnd perhaps the most important thing – you would hope that it has some affect on outcomes, because that’s the point!To improve the quality of care delivered after going through the educational process.Outcomes are the key, but are difficult to measure.Heterogeneity of traumaPoor methods for assessment of morbidityDifficulty measuring intervention that affects only one aspect of patient care
Traditionally, in the past, there are 3 main avenues for learning how to manage traumaTextbooksHalf of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half–so the most important thing to learn is how to learn on your own.David Sackett, often referred to as the “father of evidence-based medicine,”Much has been said about the utility of the textbooks, but pre-internet, that’s all there was!JournalsRestricted accessA lot of it is quite surgically focused and nor relevant to our practice in the emergency department,Short CoursesEMST / ATLS - James Styner (1980)Held over 2-5 days, intensive. Use generic ABC system. Concentrate on initial assessment - subsequent management missed.Often considered the “ Gold Standard” - though not sure how this can be measured. They have stood the test of time, and provided a well accepted method of managing trauma patients, but this was developed before emergency medicine really took off as a specialty, and In many ways, we have surpassed it, in terms of what we do. Despite the widespread acceptance of these courses, concerns have been raised at the ability of students to retain the knowledge and skills, especially if they are not utilizing these skills often. Work in a Trauma CentreHow many of you work in a major trauma receiving hospital?Most of us don’t work in trauma centres, or have only spent limited rotations there as part of our training. A lot of folks rotating through miss out - In my own hospital, I have come across trainees who have not put a chest tube in for the whole 6 months they are there, and have to battle it out with other trainees for learning opportunities. Indeed myself and Andy have both seen final year advanced trainees who have not been taught how to put a chest tube in for managing traumatic pneumothorax.
Old article but validates the utility of the face to face short course formatCombination of lectures, small group sessions, skill stations and scenarios – seen to be effectiveDemonstrated improved compliance with guidelinesHard to demonstrate effect on clinical outcomes
