TeleTrauma Participant Improves Trauma Team Performance on Simulated Trauma Scenarios

1
Tele-Trauma Participant Improves Trauma Team
Performance on Simulated Trauma Scenarios

• David G. Ellis MD, Jennifer Brown MD, Jeffrey
  Myers DO, James Mayrose PhD, Elizabeth Meinert,
  Fritz Sticht

University at Buffalo (SUNY) Department of
Emergency Medicine, Division of Telehealth and
Healthcare Informatics
2
Introduction

• Rural Trauma
• More likely to die if a victim of trauma in a
  rural area
• Barriers include weather, geography, notification
  (direct-to-trauma center not available)
• Rarity of presentation of multiply injured trauma
  patients inc. result of current system

3
Tele-Trauma

• Experiences from early Tele-Trauma programs in
  Vermont and Arizona
• Airway management
• Recognition of intra-abdominal hemorrhage
• Blood administration
• System Activation / Volume
• Trauma procedures

4
WNY Telehealth

• New York State Tele-Stroke network
• Web-based videoconferencing 10 (ten) rural ED
  sites
• Adapting network to Tele-Trauma
• NYSDOH approved Medicaid Reimbursement
• All acute emergency and inpatient codes

5
Introduction

• Simulation
• Standard training component of airline industry
• Increased application in medical environment
• Role in complex and rare medical presentations

6
Goals

• Create a realistic tele-trauma scenario using
  emergency medicine senior residents as primary
  team leaders similar to the role of rural
  emergency physicians in single physician
  coverage.
• Evaluate their performance on simulated trauma
  patients both with and without the participation
  of a video trauma center specialist physician.
• An additional goal was to identify any specific
  components of the trauma resuscitation where the
  presence of a video trauma center specialist
  participant may have a more pronounced positive
  or negative effect toward improving the simulated
  patient resuscitation team performance.

7
Methods

• SimMan

8
Methods

• Simulated Trauma Scenarios

9
Methods

• Telemedicine wireless roll-about
• Video tape review of performance
• Ratings by 2 Attending Physicians
• Consensus panel for discrepancies

10
Methods

• Evaluation Method Holcomb et al
• Rated in 5 areas of ATLS, 3-5 questions in each
  area
• Team Organization
• Airway
• Breathing
• Circulation
• Disability

Holcomb JB, Dumire RD, Crommett JW, et al,
Evaluation of trauma team performance using an
advanced human patient simulator for
resuscitation training. J Trauma. 2002
Jun52(6)1078-85 discussion 1085-6
11
Methods

• Scores
• 2 Best
• 1 Average
• 0 Worst
• Groups
• Best or Average/Worst

Holcomb JB, Dumire RD, Crommett JW, et al,
Evaluation of trauma team performance using an
advanced human patient simulator for
resuscitation training. J Trauma. 2002
Jun52(6)1078-85 discussion 1085-6
12
Results
Odds of getting 0 or 1 when attending present
0.7823 95 CI of 0.5942, 1.03 and a p-value of
0.08
13
Results
14
Discussion

• The results of this study show a trend toward
  improvement in trauma team performance when a
  video trauma attending physician is involved in
  the resuscitation exercise.
• Number of cases / evaluations
• Variability in attending physician involvement

15
Discussion

• Simulation an intermediary step toward full
  tele-trauma implementation
• Additional senior resident evaluations
• Rural emergency department attending sessions
  9/07

16
Discussion

• Opportunities for refinement and improvement in
  tele-trauma system
• Intensive feedback from resident and attending
  participants
• Improvements in audio communications and
  interactions between team leader and consultant

17
Conclusions

• The tele-trauma interactions can be modeled in a
  simulation training setting
• Performance of trauma team shows some
  improvement with inclusion of video trauma
  attending physician
• Further studies indicated to identify level of
  improvement and key areas within ATLS

18
Questions