Tool that might be used to improve the trauma system in the region

1. Tool that might be used to improve the trauma system in the region Witaya Chadbunchachai Trauma and Critical Care Center Khon Kaen Regional Hospital

4. landslide Thailand risk area” Risk chance earthquake Industrial hazard terrorism

6. Thai EMS situation observed by the Swedish EMS mission team during Tsunami catastrophe :- • Weak coordination at a national level • Inadequate dispatch center at regional and local level • The need for a national emergency phone number; known to the public • Poor training of rescue foundation staff as well as no certification of volunteers • Non specialized and non standardized training for EMS personnel • No or insufficiently developed helicopter, sea rescue • Weak emergency rescue procedures and standards

7. “It couldn’t happen to us” is an un acceptable excuse for being ill prepared to deal with a major incident. T.J. Hodgetts K. Mackway-Jones เพราะเชื่อว่า “เหตุการณ์อย่างนี้ไม่เกิดขึ้นในบ้านของเราหรอก” ก็เลยไม่คิดที่จะเตรียมการรับมือกับสถานการณ์ ความเชื่อนี้เป็นความเชื่อที่ใช้ไม่ได้และรับไม่ได้

8. Development Frame : An Inclusive Trauma Care System • PREVENTION • TRAINING • EVALUATION SYSTEM DEVELOPMENT Major Trauma Patients All Injured Patients LEADERSHIP • PREHOSPITAL • Communication • Medical Direction • Triage • Transport INTERFACILITY TRANSFER ACUTE CARE FACILITY WITHIN A TRAUMA SYSTEM other injured patients TRAUMA CENTER most severity injured or SPECIALTY CARE FACILITY peds, burns, and so on LEGISLATION FINANCE REHABILITATION Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, 1992

9. Trauma Registry System Khon Kaen Hospital

10. Trauma Registry Objective • To establish data base to monitor and modify trauma care system • To define nature and extend of trauma for prevention • To define factors for patients mortality and morbidity • To determine manpower requirement • To estimate expenditures

11. Ideal Character of Injury Surveillance System 1.Usefulness 2. The quality of surveillance • Simplicity • Flexibility • Acceptability • Sensitivity • Positive predictive value • Representative • Timeliness

12. Ideal Character of Injury Surveillance System 3. Validation of Data Collection Methods 4. Reliability of The Coding System

13. Key Components • Team work • Work sites • Data collection equipment • Data Collection form • Data collection program with a data entry manual • Data flow system • Data analysis and report

14. Work site at Registration Unit

15. Work siteat ER

16. Work site at ER

18. Minimal Basic Data SetModified from * Text Book of TraumaChampion & FelicianoChapter 2 Trauma Scoring

19. American College of Surgeon • Minimal basic data set • Hospital identifier No. • Hospital patient No. • Age • Sex • Race/Ethnic origin • E-code • Transferring hospital • Transferred to, from or not transferred • Date of Admission • Time of Admission

20. American College of Surgeon • On arrival in ER • Systolic BP, pulse, RR, GCS • In OR • CPT, code, date, time, surgeon, identifier • Diagnosis • ICD – 9 (List) • Disposition • Died (Yes or No) • Date of discharge • Disposition if alive

21. Data Recording Form

22. Injury Surveillance Record  Hospital name …………..…………… Province………………………..…... Present1 In this province address  2 Not in this province  3 Unknown First name…………………….…….Last name…………….… HN………………………… Sex  1 Male  2 Female Date of Birth……………..…or Age ………….. Yr …...... Month. Or Approximately ….… Yr. Occupation  01 Govt. Officials  02 Police/Soldier  03 Govt. enterprise  04 Private company  05 Unskilled worker  06 Business  07 Agriculture  08 Students  others……….

23. Recorders name………………………………………………………………………………

24. Fourth Phase (1999) Data collection by ER nurse And trauma center clerk Trauma Patients Immediate key in on scene at ER By trauma center clerk Discharge Admit Summarized form for Dx, BR, AIS and key in by trauma center nurse at Trauma Center Office Analysis by IS output program and trauma center programmer

25. Documents

26. Number of Injury Classified by Type

27. Number of Dead Classified by Type

28. Age and Sex of Injury 2005

29. Type of External Cause of Injury 2005

30. Organ Injury of the Admitted Case 2005

31. Dead of Organ Injury and External Cause of Injury 2005

32. Day in Week of Injury 2005

33. Time of Arrival 2005

37. Utility of trauma registry • Traffic Injured Patients Data for Insurances Office every morning • Public Service • Trauma Auditing • Medical Audit • Nursing Audit • Referral Audit • EMS Audit • ER Audit

38. Utility of trauma registry • Trauma prevention • Provincial Safety Committee review situation monthly • Medical Institute for Injury and Disaster • Epidemiology Department ; MOPH • Monitoring • Study and Research

39. THE UTILIZATION OF DATA FROM TRAUMA REGISTRY FOR TRAUMA CARE IMPROVEMENT

40. Severity Assessment TRISS Methodology Ps = 1/1+e-b Ps = Probability for survival e = 2.7183 (base on Napierian logarithms) b = b0+b1(RTS)+b2(ISS)+b3(A) RTS = Revised Trauma Score ISS = Injury Severity Score A = 1 if age >54 = 0 if age <54

41. The Variable for Calculation of Ps 1. GCS 2. Blood pressure 3. Respiratory rate • ISS • Age 6. Mechanism of injury

42. Recent Application • Trauma Auditing • Medical Audit • Nursing Audit • Referral Audit • EMS Audit • ER Audit

43. MEDICAL AUDIT The technique to assess the quality of care

44. Component for Trauma Audit • Trauma registry • Medical record • Trauma audit recording form • Guideline for recording data and definition • Peer group review

45. Hospital Trauma Audit Committee Assessment I

46. Hospital Trauma Audit Committee Assessment II

47. Peer Review • Leader • Peer group • Surgeon • Neuro Surgeon • CVT • Anesthetist • Orthopedist • Coordinator

48. Technique for Audit • Set up committee • Set up the content for audit • Set up the coordinator • Committee meeting • Design the time, date, place for review • Peer group review • Analyze and report

49. Death Rate of Patient Classified by Severity of Injury in 1994 Before Audit Filter Application

50. Grouping for Type of Mortality by Trauma Audit Committee in 1994 Before Audit Filter Application