Trauma is the unsolv epidemic of re...

Trauma is the unsolv epidemic of recent society.(1) Trauma patients with devastating injuries can overwhelm the resources and skills of a rural or community hospital. one patients, after initially responding to advanced life support interventions, remain too unstable for transport to a trauma center; therefore, patients with potentially survivable injuries can die unles surgical intervention with appropriate resources are brought to them. Recognition, activation, and implementation of a mobile surgical transport team (MSTT) can change patient outcomes

The importance of early resuscitation and treatment of trauma patients to shorten their morbidity and mortality rates is the universal of the "golden hour." Initiating effective and appropriate therapy in an pressing manner can have a similar weight on the outcome of all critically ill patients.(2)

BACKGROUND

Trauma is the leading cause of death among Americans between the ages of the same and 36.(3) Approximately 160,000 population die from injuries annually in the United States. one 50,000 of these deaths are related to automobile accidents, and 30000 are appropriate to ballistic weapons, predominately handguns.(4) Approximately 50 studies onward preventable deaths during the past 10 years identified, onward average, that 19.3% of injury related deaths occurring in hospitals were preventable, potentially saving 32000 lives each year with improved medical care.(5) Delaying or failing to perform lacked emergency surgery was the most numerous common cause of these preventable deaths.(6)

In 1993 1868 Oregonians died from intentional and unintentional trauma injuries. Additionally, an estimated 23000 population each year in Oregon are injured seriously enough to require hospitalization; many of these patients are permanently disabled.(7)

patterns OF TRAUMA DEATH

Trauma deaths are characterized as immediate. early, and late.

Immediate. Immediate trauma, whereby the patient dies instantly or within a scarcely any minutes of injury, constitutes approximately 50% of all trauma deaths. Immediate death usually is caused through massive destruction of vital organs, and therefore all attempts to salvage these patients usually are hopeless

Early. Early deaths meet the eye within two to three hours of injury and constitute approximately 30% of all trauma deaths. The issue of this group of patients is determined largely according to the quality of their initial assessment, resuscitation, and the rapidity with which they can be transported to and resuscitated at a trauma center

Late. Late deaths account for approximately 20% of all trauma deaths. Of these patients, 80% die of multiple organ failure, sepsis, or the one and the other With more appropriate initial surgical treatment and intensive care after surgery a late deaths might be preventable.(8)

At Legacy Emanuel Hospital and Health Center Portland, Ore, we formed our MSTT in an attempt to salvage patients with early critical injuries and to help obviate late trauma deaths. Oregon is the first Western state to lay open any sort of statewide trauma regularity and it is recognized over the nation as a leader in trauma methods development. Oregon was among the first states to evolve a trauma system that includes small rural hospitals as well as large urban and suburban facilities.

Diagnosing trauma patients is part of the challenge for community hospitals. The more difficult part of the challenge is having the personnel and resources available to quickly deliver the care the diagnosis requires.(9) Triage criteria (Table 1) and a decision scheme was used to determine patients that required trauma care.

[TABULAR DATA 1 NOT REPRODUCIBLE IN ASCII]

FORMING THE MOBILE SURGICAL TRANSPORT TEAM

A review of a three-year period (ie, 1983 to 1985) revealed that there were 255 trauma patients transferred to Legacy Emanuel Hospital from rural or community hospitals during that time. We determined that 17 of the patients had potentially avoidable deaths as a be derived of inadequate resuscitation and/or surgical intervention from the referral hospital.

The question arose as to whether these patients could have been saved. The trauma chief and trauma nursing coordinator visited referral hospitals in our area and spoke with pinch department (ED) physicians, ED nurtures surgeons, and family practitioners about developing an MSTT We perform the operations indicated ined protocols and completed inventories of instrumentation, monitoring capabilities, and vital current products. Hospital administrators were involved to discuss sudden [i]or[/i] unexpected occurrence medical staff privileges and medical liability.

We formed an MSTT that consisted of a trauma surgeon a trauma OR nourish a Life Flight nurse, a trauma resuscitation encourage and a perfusionist when necessary. Since its origin in 1985 our MSTT has treated one as well as the other trauma and nontrauma patients.

INDICATION FOR ACTIVATION

Any critically ill patient who would benefit from rapid surgical intervention or resuscitation that is not readily available at the referral hospital is a candidate for help from the MSTT The MSTT can put forward level I trauma resuscitation and surgical and bypass intervention to patients who otherwise might not survive transport to a trauma center to be ascribed to injuries that may include