"24/7 consultant led trauma teams produce the best outcomes"
The Debate - Tim Parke
Outline
Trauma Debate
Tim Parke
Clinical Director
Adult Emergency Department
Auckland City Hospital
The Proposition
“24/7 consultant-led trauma teams produce the best outcomes”
Before and After
The Emergency Room:
Justifying the Proposition
Do we need trauma teams?
Do we need consultants to lead?
Do we need them 24/7?
Is there an alternative?
Do We Need Trauma Teams?
Trauma resuscitation requires horizontal management = >1 person
Who Should Be In the Team?
Emergency medicine / Critical care
secure airway & ventilation
circulatory support
injury list / investigations
Trauma surgeons
rapid transit to OR
formulate definitive care plan
ED nurses (for everything!)
Do We Need Consultant-led?
In-house consultant trauma surgeons do not affect outcome
Minnesota 1999
Delaware 2002
Kansas 2003
But..in most of these studies an ED consultant was present for all cases
ED Consultant-led Resus
ED seniority improves outcome in trauma
UK Trauma and Audit Network (Lancet 2000)
odds death ratio 1997 / 1989 = 0.63
portion treated by senior rose from 32% to 60%
Scottish Trauma Audit Group (Hlth Blltn 2000)
survival ISS>15 rose 65% (‘92) to 75% (‘98)
portion treated by consultant rose from 32% to 41%
Wyatt Study (Injury 1999)
Alternative is not an Option
Trainees may
be technically good
know more stuff
Trainees are not yet fully versed in the dark arts of being a consultant
Future Medical Staffing
Less registrar based care
Fewer trainees
Training for shorter periods
Competency based
Consultant delivered care will be the norm
Health care will improve as a result
Training will improve as a result
24/7 Consultants?
Trauma demographics:
70% presents out of hours
300 - 400 per year
Trauma is the tip of a resus ice-berg
9,515 patients last year triage 1 and 2
Need 24/7 front door acute care specialist
Bad things happen in ED at night…..
Don’t Wake the Bear…..
Trauma team leader?
Or Trauma Team Leader?
|
Ministry
of Health
