Trauma Care In Tennessee - TN.gov
Trauma Care Advisory CouncilTrauma Care inTennesseeA Report to the 2010 107th General AssemblyTennessee Department of HealthTrauma Care Advisory CouncilNovember 8, 2010
AUTHORSHIPJulie A. Dunn, M.D., M.S., FACSChair, Trauma Care Advisory Council andThe Tennessee Committee on TraumaProfessor of Surgery East Tennessee StateBlaine L. Enderson, M.D., MBA, FACS, FCCMVice Chair, Trauma Care Advisory CouncilProfessor of SurgeryMedical Director, Division of TraumaUniversity of Tennessee, KnoxvilleJoseph PhillipsDirector, State EMSTennessee Department of HealthRob Seesholtz, RN, EMT-PTrauma System ManagerTennessee Department of HealthBen Louis Zarzaur, M.D., MPH, FACSAssistant Professor of SurgeryUniversity of Tennessee Health Science CenterRose BoydInjury Surveillance Prevention Control ProgramTennessee Department of HealthOscar Guillamondegui, M.D., MPH, FACSAssistant Professor of SurgeryAssistant Professor of Neurosurgical SciencesVanderbilt University Medical CenterLinda BookerStatistical Analyst – Trauma RegistrarTennessee Department of HealthRhonda Phillippi, RNExecutive DirectorTN Emergency Medical Services for ChildrenStanley J Kurek, DO, FACSAssociate Professor of SurgeryMedical Director of Surgical Critical CareMedical Director of TraumaUniversity of Tennessee Medical Center at Knoxville1
Table of ContentsLetter to the General Assembly.3Executive Summary.4Injury in Tennessee.5Injury Prevention.6Pediatric Trauma Care.8Trauma Center Funding.9Trauma Registry 2007.10Research.10I:Trauma Center Locations.11II:Trauma Registry Reports. 12OverviewSystem ComponentsAppendicesPageIII: Trauma Fund Distribution 2008.26IV: Research Publication Listing. 272
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2010 EXECUTIVE SUMMARYThe Trauma Care Advisory Council (TCAC) was established in 1990 to advise the Board forLicensing Health Care Facilities (BLHCF) regarding trauma care policy and regulation. Inthe ensuing 20 years, the Tennessee Trauma System continues to evolve. When firstinstituted, the system boasted 11 trauma hospitals: 4 Level I centers (the highest level ofcare) and 7 Level II centers. Several Level III centers were later designated, bringing the totalto 13. An erosion of these services has occurred over the last decade. Today, Tennessee has6 Level I trauma centers, 1 Level II center, and 2 Level III centers. Fortunately, the 6 Level Icenters are well-distributed geographically across the state such that all Tennessee citizensare within 100 air miles.The Tennessee Trauma System continues to mature. The centers across the state providemore than just trauma care – they provide a safety net for those patients in the most dire need- 24 hours a day, 7 days a week, at the highest level available. Level I guidelines mandatethat resources include fully staffed operating rooms, intensive care units, lab, blood bank, andradiological capabilities, and professional personnel in-house and available on a momentsnotice to care for the injured. This wide array of capability provides an additional benefit totheir respective communities and regions - by also being available to care for patients withruptured aneurysms, strokes, cardiac emergencies, and other time-limited, life-threateningemergencies at a moments notice.This report provides information on geographic location and mechanisms of injury, referralpatterns, and financial statistics. Information about key system components, such as InjuryPrevention activities, System Funding, Registry Data Collection, and statewide researchefforts, is also included. All of these essential components provide valuable information tothe TCAC. Armed with this information, we can to improve patient outcomes and betterserve the needs of our citizens.In 2007, more than 20,000 patients were treated in our Trauma Centers. The overwhelmingmajority of these injuries were sustained as a result of blunt trauma: motor vehicle crashesand falls. Trauma disproportionately impacts our youth, robbing our society of productiveperson years. Sadly, many of these events were preventable.This report speaks volumes about those centers dedicated to caring for the injured patient.Whether you live in one of our largest cities, or one of our smallest townships, TraumaCenters are on standby to provide the highest level of care. Trauma Centers save lives. Aviable and robust Trauma System not only saves lives, but provides strict oversight andensures continual improvement. With ongoing support we can continue with our mission ofproviding the highest level of care, injury prevention, education, and research to minimizethe death and disability that occurs as a result of injury across the state of Tennessee4
INJURY IN TENNESSEEInjury is the leading cause of death and disability for all Tennesseans, ages 1-44, and the thirdleading cause of death for all age groups. In 2006, over 4500 Tennesseans died from injuriescaused by motor vehicle collisions, falls, poisonings, fire/burns, suffocation, and drowning.During 2006, the national injury death rate was 58.74 per 100,000. That same year thenational rate for injury hospitalizations was 553.52 per 100,000. When compared to thenational rate, Tennessee’s death rate for injury was 79.05 and its hospitalization rate forinjury was 616.82 per 100,000. In both instances, Tennessee exceeded the national rates. Therate is also higher than the Healthy People 2010 targeted rate of 37.0 deaths per 100,000.Figure 1 illustrates the national and Tennessee rates.Injury death rates have remained fairly constant during the 20th century in the United States.In contrast, by 1980 death rates from diseases like tuberculosis and gastrointestinal disordersdeclined by 99 percent. Influenza and pneumonia have declined by 85 percent. And,infectious diseases have decreased. The deceased rates are a result of focused and targetedprevention efforts. During the same century however, injury death rates only declined by 30percent. At the present time, injury is responsible for three times as many deaths as influenzaand pneumonia combined. Every 2 hours in Tennessee, someone dies from an injury.Injuries are predictable and can be prevented. There are typical strategies that can be used atdifferent times during the actual injury - before, during and after the event (Haddon 1972).Pre - event strategies keep the injury event from occurring in the first place while injuryevent strategies work to reduce the impact of the actual event as it occurs. Lastly post-eventstrategies rely on the environment to further reduce and impact the injury event. Examples ofeach include the following:Pre-event: One of the greatest impacts of pre-event strategies is to prevent injury bypassing legislation that influences public policy. In 1978, Tennessee was the first statein the nation to pass lifesaving legislation mandating the use of child car seats. Theimpact of this legislation and others which includes primary seat belt legislation,graduated teen drivers license, required use of a helmet while riding a motorcycle andthe ban on text-messaging are expected to save many more lives throughout the state.The design of roadways is also an important pre-event strategy to prevent motor vehiclecrashes.Injury Event: Fire Escape Plan – Home escape and evacuation when the fire starts.Vehicles that include safety options such as frontal and side air bags will lessen thelevel of injury during the event.Post-event: Fire and EMS provide a quick response to the event with the necessaryequipment and supplies on operational emergency vehicles to provide transportation toa health care facility5
INJURY PREVENTIONInjuries are a serious public health problem in Tennessee. Overall, Tennessee has the 11thhighest death rate from injury in the United States. More alarmingly, Tennessee has thesecond highest homicide rate for young adults (ages 10-24) in the United States and the fifthhighest mortality rate for traffic injuries among persons aged 65 and older in the UnitedStates. Unintentional injuries (e.g., motor vehicle crashes, falls, drowning, etc.) are theleading cause of death for Tennesseans 1 to 44 years (Source: STAT Report 2010).Among all causes of death, injuries were the leading cause of premature death from 2003 to2007 among Tennessee residents younger than 65 years, accounting for nearly 500,000 yearsof potential life lost. The leading cause of injury deaths in Tennessee are: 1) motor vehiclecrashes, 2) suicide, 3) unintentional poisoning, 4) homicide and 5) falls. In addition, in 2008there were nearly 40,000 persons in Tennessee hospitalized for an injury. The leading causesof these hospitalizations were 1) falls, 2) motor vehicle crashes and 3) poisonings. Hospitalvisits (inpatient and outpatient), due to injury resulted in charges of a staggering 2.1 billionin 2007.To address this important public health problem, in 2005 the State of Tennessee, Departmentof Health – EMS Division applied for and received a 5-year grant from the Center forDisease Control - Office of Injury Response. Currently, the grant is in its final year. As partof the grant, the Injury Surveillance, Prevention and Control Program (ISPCP) wasestablished and a team of injury prevention experts and advocates were assembled fromacross the state to form the Commissioner’s Council on Injury Prevention and Control(CCIPC). The role of the council is to assist in the production of a Tennessee InjurySurveillance, Prevention and Control Strategic Plan that identifies priority injuries, buildscapacity for interventions, implements and evaluates programs, and seeks to support policiesthat prevent injuries and deaths from injuries. Further, the CCIPC serves as a clearing houseto provide support and research in the determination of evidence based initiatives as well asmonitoring the successful completion of strategic goals and strategies. Because TennesseeTrauma Centers are at the forefront of the care of the injured person, the Tennessee TraumaCare Advisory Council and the Tennessee Committee on Trauma have been workingcollaboratively with the CCIPC to develop and implement multilevel strategies for theprevention of injuries to fulfill a necessary requirement associated with being a designatedtrauma center in Tennessee.Using recommendations from Safe States Alliance, for an ideal injury prevention program,the Injury Surveillance, Prevention and Control Program activities include the followingactivities. 1) Collect and analyze data; 2) Research, design and implement interventions atmultiple levels; 3) Build capacity and a solid infrastructure for implementation of injuryprevention initiatives; 4) Provide technical support and training; and 5) Evaluate theeffectiveness of strategies.1) Collect and analyze data: Analysis on injury data reveals that Tennessee rates for injuryand deaths from injury exceed national injury rates (2002-2006). On the average from2002-2007, the number of Tennessee residents who die daily in Tennessee from an injuryis 12-13. During the same 24 hours, there are 52 admissions to trauma centers, 104hospital admissions, and 676 visits to the emergency room due to injury. Treatment for6
these injuries averages almost 64,000 for a motor vehicle collision, 62,000 for afire/burn, 28,000 for a fall and 14,000 for treatment of a poisoning.2) Design and implement interventions at multiple levels: Injury prevention initiativestargeting high risk populations will be implemented throughout the state. These effortswill be collaborative to increase impact, share resources and reduce costs.3) Building a solid infrastructure for injury prevention: The Department of Health isworking to integrate injury prevention initiatives within the current services that theyprovide. Underlying health conditions and interactions of medications can impair andcontribute to falls, motor vehicle collisions, and other injuries.4) Provide technical support and training: The CCIPC sponsors an annual injuryprevention symposium on a topic related to injury prevention. Other injury educationopportunities provided by the ISIPCP include the training of Matter of Balance MasterTrainers and Coaches. Additionally, the ISIPCP coordinator provides technical support todevelop programs and training related to injury prevention.5) Evaluate the effectiveness of injury prevention strategies: Partnerships associated withthe CCIPC have enabled evaluation support to determine the effectiveness of programimplementation efforts. University support is provided by Vanderbilt Graduate School ofNursing, Tennessee State University, Belmont University and Vanderbilt Peabody.The ultimate goal is to reduce the burden of injury on all Tennesseans by working to preventinjuries before they occur. The simple matrix below provides a comparison betweenapproaches to prevent disease and those utilized to prevent injury. As a result of thesecommonly used approaches, diseases like polio and TB have almost been eradicated.However, injury prevention continues to be a low priority. Being proactive is the key.Injuries are not “accidents”. They are not only predictable, they are preventable.Knowing what to do, and how to prevent injury, like disease, will not only minimizetreatment costs but ensure that everyone in Tennessee lives to their highest potential.Pre- EventEventIllness: Education onmethods to reduceSwine Flu:Cough into sleeve.Wash hands.Inoculation for theillnessInjury: Provideeducation on theprevention of thenumber cause ofdeath for childrenMotor VehicleCollisions. Norequirement toprovide education atschoolsKeep exposed childrenhome from school toavoid further spread ofthe illness.Intake of fluids andmedication to minimizesymptomsChild is wearing seatbeltminimizing their risk ofinjury and deathPost-EventMonitor the progress ofchild or infected person.Take to the physician orhospital if needed.Emergency response teamsarrive on the scene earlyand work to get injuredpersons to closest traumacenter where highly trainedmedical teams can beginlife savingtreatment/surgeries.7Gov’t /Media ResponseFunding to supportprevention of the illness:inoculation development,production of materials tocreate awareness.Strong Media involvementNote: The governmentprovides little funding tosupport education andresources needed to createawareness. The mediaresponse is to report onlydeaths and they are alwaysreferred to as “accidents”.
PEDIATRIC TRAUMA CAREThe state legislature unanimously passed the TN EMSC (Emergency Medical Services forChildren) legislation in 1998 and revised in 2007 creating a standing committee on pediatricemergency care (CoPEC) which reports directly to both the Board for Licensing Health CareFacilities (BLHCF) and the Emergency Medical Services Board (EMSB). Tennessee CodeAnnotated 68-11-251 and 68-140-521. (http://state.tn.us/sos/acts/105/pub/pc0599.pdf). Theselaws also mandated minimum preparedness for pre-hospital and hospital emergencydepartments and requiring both a medical and trauma hospital recognition system. The rulesand regulations that established this trauma and medical system also mandated writtenpediatric inter-facility guidelines and agreements for every hospital with an emergency roomin TN.In response to the legislation and CoPEC recommendations, the BLHCF and EMS Boardshave promulgated rules and regulations to ensure compliance with the law. These rulesinclude a requirement to promote a family focused approach to the care of the child,including children with special healthcare needs, as well as accounting for ethnic diversity.The rules include specific pediatric equipment, drugs, and education for physicians, nurses,and pre-hospital providers to care for both the child injured by trauma and medical diseases.CoPEC holds primary responsibility for the pediatric trauma system and interfaces with theTrauma Care Advisory Council by having pediatric representation from CoPEC as membersof TCAC.Below is a small sample of the data that will be forthcoming in the Tennessee InjurySurveillance, Prevention and Control Strategic Plan 2010-2014 a collaboration betweenTCAC and CoPEC in the Tennessee Department of Health, Division of Emergency MedicalServices and the Bureau of Licensure and Regulation.Data for unintentional injury deaths for children, youth and teens, ages 1-18 during theyear 2007 in Tennessee.Facts about Injury in Children, Ages 1-4, in 20071. The number one causes of death from unintentional injury are Drowning and MotorVehicle Collisions2. Fires and Suffocation are the second cause of unintentional injury deaths.3. The third leading cause of death from injury is a result of pedestrian traffic.Facts about Injury in Children, Ages 5-14, in 20071. The number one cause of death from unintentional injury was from motor vehiclecollisions.2. The number two cause of death from unintentional injury was from fires/burns.Facts about Injury in Teens, Ages 15-18, in 20071. The leading cause of death from unintentional injury in 2007 was due to motorvehicle collisions. It is seven times greater than the second leading cause of injurydeath for this group.8
2. This age group also experienced injury deaths associated with unintentionalpoisonings.3. Drowning, fire/burns, and ATV collisions were the third, fourth and fifth causes ofinjury deaths associated with teens, ages 15-18.CoPEC is in the final stages of a three year strategic planning process and will be providingan update in the annual report in July 2010 regarding the current status of emergency medicalservices for children.TRAUMA CENTER FUNDINGWith the passage of the Tennessee Trauma Center Funding Law of 2007, the Trauma CareAdvisory Council was charged with developing recommendations on how to distributeTrauma System Fund reserves. In keeping with the intent of the new statute, three broadcategories for disbursement were identified:1. Money to support the trauma system infrastructure at the state level.2. Readiness costs to designated trauma centers and comprehensive regionalpediatric centers.3. Money for uncompensated care.Trauma System Infrastructure 150,000Once administratively able to establish the Adult and Pediatric Trauma Coordinatorpositions provided by the bill’s fiscal note, we are certain they will prove to be a valuableresource in overseeing the fund, overseeing the trauma registry, ensuring optimal andequitable care, and ensuring quality of care throughout the system.Readiness Costs 3,340,000Readiness costs vary from approximately 7-14 million annually for each Level I TraumaCenter and there are significant costs for Level II and III facilities as well. While the fundcannot realistically compensate centers for these costs, certain key elements must be inplace to ensure state designation is maintained. The most basic of trauma staffingrequirements were used to establish a baseline readiness cost for each center. Amountsdesignated for each center may be found in appendix III.Uncompensated Care Methodology 5,746,800The new law provides for uncompensated care funding to be distributed to: 1) designatedtrauma centers 2) regional pediatric centers and 3) other acute care hospitals functioningas a part of the trauma system. Actual hospital claims data was selected by the committeeto determine the levels of trauma care provided by each center/hospital and theuncompensated costs related to that care.While designated trauma centers and regional pediatric centers are automatically eligiblefor participation in this portion of the fund, not all acute care hospitals are. Criteria usedto determine which hospitals “function as a part of the trauma system”, include: 1)Utilization - the percentage of all claims that are trauma related and 2) Acuity – the acuityof the trauma injuries seen by a hospital. Acute care hospitals, which prove to have a9
utilization rate and acuity equal to or greater than the minimum utilization and acuityrates of the designated centers, are eligible for participation in the pool.Distribution to eligible hospitals is based on: 1) the level of funding within the reserveaccount following infrastructure and readiness costs and 2) the documented level of eachhospital’s uncompensated trauma cost. Though this amount will vary from year to year,at the end of 2008 this portion of the fund was approximately 5,746,822. Appendix IIIshows the payments made to eligible hospitals.TRAUMA REGISTRY 2007The Tennessee Trauma Registry is the centralized database for collection of informationregarding trauma injuries experienced by the 9 participating trauma centers and the 4comprehensive regional pediatric centers. 2007 was the first year in which submissions weremade for the entire year, and the following report contains the 2007 information.Trauma Registry ProfileTotal Submissions:20792Number of Adult Facilities: 9Number of Pediatric Facilities 4(**Note – submissions for Vanderbilt Children’s Hospital were included in the file withVanderbilt Medical Center (adult facility); therefore, the children’s hospital submissions willnot appear as a separate entity in this report.) Appendix 1 illustrates the Trauma RegistryContributors by county location and trauma center level.Trauma Registry, Injury Prevention and Injury Surveillance SystemThe TN Department of Health, EMS Division performs Injury Prevention analysis ofTennessee injuries based on Hospital Discharge data for all hospitals in the State as well asER and Vital Records. The Trauma Registry serves as a source of information that is notprovided in these three sources.RESEARCHLevel 1 Trauma Centers are charged with performing research. These endeavors spurimprovements in care on an ongoing basis. Appendix IV represents just a sample of statewide research publication efforts.10
Appendix I:Trauma Center Location & Level Designation11
Appendix II: Trauma Registry ReportsFigure1: Injury and Hospitalization death rates.13Figure2: Trauma Registry by County Admissions.14Figure3: Incidents by County Residency. 15Figure4: Trauma Registry Admits by Facility.16Figure5: Trauma Registry Admits by Age Group and Percentage.17Figure 6a: Trauma Registry Admits by Race and Percentage. 186b: Admits by Race and Age GroupFigure 7a: Trauma Registry Admits by Gender and Percentage.7b: Admits by Gender and Age Group19Figure 8a: Trauma Registry Incidents by Transport Category.8b: Trauma Registry Incidents by Geographic Region and Percentage20Figure9: Top 10 Trauma Registry Admits by Mechanism.21Figure 10: Population and Injury Percentage per state geographical grand divisions.22Figure 11a: Trauma Registry Admits by ED Disposition.11b: Number of Admits by Hospital Disposition23Figure 12a: Case Fatalities by Mechanism of Injury.12b: Case Fatalities by Gender24Figure 13a: Admits by Top 10 Payor Codes.13b: Average hospital charges for top 3 trauma admissions2512
Figure 1:Tennessee Compared to The United StatesInjury Death Rates Per 100,0002002 - 4United 4Tennessee Compared to The United StatesInjury Hospitalization Rates Per 100,000 (Crude Rates)2003 - ssee604.12636.56618.54622.78616.82United States531.89537.05543.6530.41553.52Source: Tennessee Department of Health, Division of Health Statistics (Hospital Discharge Data)WISQARS-CDC Injury CenterProduced by: Tennessee Department of Health, EMS & Division of Health Care Facilities13
Figure 2:14
Figure 3:Incidents by County ResidencyPatient 12119Patient icoiUnionVan lsonGrand 6,348,716Total admits 20,792; non-resident admissions 15412014986398067221345614812214,863
Figure 4:Trauma Registry Admits by FacilityHospital NameAdmitsAthens Regional Medical Center185Blount Medical Center562East Tennessee Children's Hospital355Erlanger Medical Center2992Erlanger T. C. Thompson's Children's Hospital94Johnson City Medical Center1783LeBonheur Medical Center1146Regional Medical Center at Memphis3883U. T. Medical Center, Knoxville3585Vanderbilt Medical Center3422Wellmont Bristol Regional Medical Center1090Wellmont Holston Valley Medical Center1695Total:2079216
Figure 5:Age Group0 to 1819 to 2425 to 4445 to 6465 Not AvailableAdmits4815236055104215290798517Average Age of Group1020314760Not Reported
Figure 6a:Figure 6b:18
Figure 7a:Figure 7b:19
Figure 8a:Figure 8b:20
Figure 9:21
Figure 10:Population and Injury Percentage per state geographical grand divisions22
Figure 11a:Figure 11b:23
Figure 12a:Figure 12b:24
Figure 13a:Figure 13b:Average hospital charges for top 3 trauma admissions25
Appendix III2008 Trauma Fund DistributionLevel Hospital NameHospitalTrauma Uncomp- ensatedClaims * Trauma Cost *Hosp. % ofStateUncompCostHospitalSpecific PoolPaymentReadinessCostsTotal HospitalDistributionPaymentLev IVanderbilt University Hospital4,544 25,635,49934.3% 1,971,470 613,000 2,584,470Lev IRegional Medical Center (The Med)3,35122,148,06829.6%1,703,273 389,0002,092,273Lev IUT Memorial Hospital3,6559,675,63812.9%744,094 409,0001,153,094Lev IErlanger Medical Center3,3216,849,7929.2%526,776 613,0001,139,776Lev IJohnson City Medical Center1,9893,192,3734.3%245,506 290,000535,506Lev IWellmont Holston Valley Medical Ctr1,5201,651,3812.2%126,998 290,000416,998Lev IIWellmont Bristol Regional Medical Ctr1,018833,7041.1%64,115 151,000215,115Lev IIIBlount Memorial Hospital503120,1600.2%9,241 62,00071,241Lev IIIAthens Regional Medical Center30131,8570.0%2,450 62,00064,450PEDMethodist Healthcare - Le Bonheur1,043713,1041.0%54,840 257,000311,840PEDEast Tennessee Children's Hospital239 204,000204,000Skyline Medical Center543419,3300.6%32,24832,248Maury Regional Hospital813405,5100.5%31,18531,185Middle Tennessee Medical Center671364,3410.5%28,01928,019University Medical Center475323,3650.4%24,86824,868Saint Mary's Health System874312,6520.4%24,04424,044Southern Hills Medical Center295293,9740.4%22,60822,608Henry County Medical Center487225,7180.3%17,35917,359Methodist Medical Ctr of Oak Ridge840205,8230.3%15,82915,829Memorial Healthcare System731204,1790.3%15,70215,702Horizon Medical Center309192,1050.3%14,77414,774Williamson Medical Center467173,1910.2%13,31913,319Regional Hospital of Jackson208145,9760.2%11,22611,226Harton Regional Medical Center29597,7950.1%7,5217,521Laughlin Memorial Hospital32589,6530.1%6,8956,895Fort Sanders Sevier Medical Center21577,4290.1%5,9555,955Hendersonville Medical Center19875,1200.1%5,7775,777Southern Tennessee Medical Center23074,7760.1%5,7515,751Cumberland Medical Center38167,1570.1%5,1655,165Memorial North Park Hospital29148,9340.1%3,7633,763Baptist Hospital - West17944,8140.1%3,4463,446Roane Medical Center21833,8970.0%2,6072,60747,946 74,727,315Totals26100.0% 5,746,823 3,340,000 9,086,823
RESEARCH PUBLICATIONS:1. Lindsey KA, Brown RO, Maish GO 3rd, Croce MA, Minard G, Dickerson RN.Influence of traumatic brain injury on potassium and phosphorus homeostasis incritically
instituted, the systemboasted 11 trauma hospitals: 4 Level I centers (the highest level of care) and 7 Level II centers. Several Level III centers were later designated, bringing the total to 13. An erosion of these services has occurred over the last decade. Today, Tennessee has 6 Level I trauma centers, 1 Level II center, and 2 Level III centers.File Size: 2MB
The assessed content included prima - ry survey, secondary survey, airway and ventilation, circulation, shock, thoracic trauma, head/spinal trauma, abdomen/pelvis trauma, musculoskeletal trauma, paediatric trauma, geriatric trauma, obstetric trauma, trans - fer of care, and other course specific inclusions.
Behind the Term: Trauma Prepared in 2016 by Development Services Group, Inc., under contract no. HHSS 2832 0120 0037i/HHSS 2834 2002T, ref. no. 283– 12–3702. 1 Behind the Term: Trauma Related terms: complex trauma, historical trauma, human-caused trauma, naturally caused trauma, trauma,
categories of trauma as a framework for trauma assessment. “Little t” trauma “Big T” trauma Complex trauma “Little t” Trauma “Little t” trauma involves events that we encounter day to day that can make life difficult but are not out of the ord
LEVEL I PEDIATRIC TRAUMA CENTER The Level I Regional Pediatric Trauma and Burn Center at Children’s Hospital Colorado is a large, multi-disciplinary program. We provide timely, comprehensive, cost- . Trauma/Burn Medical Director Trauma/Burn Program Manager Trauma Coordinators Trauma Registrars Staff Assi
Historical trauma - Cumulative emotional and psychological wounding from massive group trauma across generations, including lifespan Historical trauma response (HTR) is a constellation of features in reaction to massive group trauma, includes . historical unresolved grief (similar to Child of Survivors Complex re: Jewish Holocaust survivors and
Kern County Emergency Medical Services Division 4 Trauma Policies and Procedures Effective Date: 07/01/2015 V. PREHOSPITAL TRAUMA SYSTEM ACTIVATION A. If a trauma patient meets the “Trauma Triage Criteria”, the Kern County Trauma Care System shall be activated as follows: 1. The following personnel are authorized to triage and then activate .
Connie J. Mattera, M.S., R.N., EMT-P I. Epidemiology of chest trauma A. Incidence 1. Chest injuries are common occurrences following blunt and penetrating trauma. 2. Isolated chest trauma is uncommon; the majority of these patients will have additional injuries. 3. Prevention efforts a major key 4. Thoracic trauma accounts for ⅓ all trauma .
KERN COUNTY EMS Kern 1 Kern County Kern Medical Center 1830 Flower Street Bakersfield, CA 93305 Hospital: (661) 326-2161 (Public) Trauma: (661) 326-5658 11/01/2001 California Designated Trauma Centers as of October 2013 Page 3. Appendix E Level I Trauma Center Level I Trauma Center Level II Trauma Center Level I Trauma .
