Description of Rotation or Educational Experience

To acquire a fundamental knowledge and appreciation of the community trauma system which supports the care of the acutely injured patient.

Patient Care

Goal

Health care providers must attend to patients in a compassionate, appropriate, effective, and timely manner. Understanding the support systems that coordinate and initiate care of the acutely injured patient in the pre-hospital setting can improve inpatient management by the trauma service. Residents are expected to:

Competencies

• Identify the most common injury mechanisms that can lead to death at the trauma scene
• Demonstrate knowledge of components of appropriate crime scene investigation as is applicable to the trauma population
• Demonstrate an understanding of the principles of emergency medical dispatch for the care of the acutely injured patient
• Demonstrate an understanding of the principles of pre-hospital acquisition and care of the trauma patient, as performed by emergency medical technicians/paramedics
• Develop independent skills in assessing acutely injured patients and decision-making in such patients at the trauma scene and during pre-hospital transport
• Demonstrate a knowledge of accurate trauma patient coding in the national data bank

Objectives

• Observe/assist the medical examiner/coroner in the performance of autopsies of trauma victims (one week)
• Observe/assist the medical examiner/coroner at crime scene investigations of trauma victims
• Tour the local 911/dispatch office (1/2 – 1 day)
• Take part in emergency medical ground transport ride alongs (2-3 days)
• Take part in emergency medical air transport fly alongs (2-3 days)
• Assist with accurately categorizing acutely injured patients in the trauma registry

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Demonstrate the ability to acquire medical knowledge and apply such knowledge to patient care
• Utilize information technology to increase medical knowledge and guide care of the trauma patient in the pre-hospital setting
• Identify the specialty boards/task forces that advocate for trauma prevention
• Identify the specialty boards/task forces that serve to assess and improve quality care of the trauma patient

Objectives

• Read the TSPEC Gray Book and BISS
• Read appropriate chapter regarding pre-hospital care in authoritative texts:
• Chapter 46 in the ACS text by Britt
• Chapter 7 in Trauma by Moore, Feliciano, Mattox
• Chapter in Trauma by
• Review the Trauma Systems bibliography
• Review the documents produced by the American College of Surgeons entitled “Trauma Systems Consultation”
• Observe/intern at the Southern Nevada Health District (3 days)
• Attend a meeting of the:
• Medical Advisory Board
• Board of Health
• Rural Trauma Advisory Board
• Trauma Medical Audit Committee
• Attend a meeting or be involved in an activity of the:
• Safe Kids Committee
• Injury Prevention Task Force
• “Every Fifteen Minutes” Committee

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies  

• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
• Use information technology to optimize learning
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learner

Objectives

• Maintain a log of the autopsy case experience. Document the type of trauma and associated injuries, and interventions that could be utilized at the scene in similar cases to possibly prevent death
• Provide a list of all informational resources utilized during the trauma systems elective. The list will be inserted into a resident databank. Example resources include:
• authoritative texts
• journals
• evidence-based web sites
• peers/consultants
• other health care specialty providers
• Actively participate in the education of fellow residents, students, and other healthcare providers. The fellow will receive evaluations from the above peers, which will include feedback regarding areas for suggested improvement

Systems Based Practice

Goal

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Advocate for quality patient care and optimal patient care systems
• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Demonstrate an awareness of and utilize all available resources to improve patient care quality

Objectives

• Attend weekly morbidity/mortality conference
• List ancillary health care services and other resources utilized most frequently to optimize patient care during the trauma systems elective. Examples include:
• emergency dispatch
• emergency medical personnel
• police staff
• fire staff
• medical examiner/coroner
• data registry personnel

Professionalism

Goal

Competencies

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Demonstrate administrative competencies, which include completion of tasks as requested, following directions, responding in a timely manner to staff needs, following up on patient care issues, and being punctual
• Interact in a compassionate and respectful manner with a diverse group of patients and health care professionals

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member or leader of a health care team or other professional group
• Act in a consultative role to other physicians and health professionals as indicated

Objectives

• Provide thorough oral presentations regarding patient condition, using appropriate medical terminology
• Following a procedural intervention, be able to accurately describe the procedure performed, and expected course to the patient, patient's family member, or other health care personnel
• Work as a respectful team member, which includes interaction with students, fellow residents, attendings, consultants, and emergency medical staff

Teaching Methods

• direct supervision by medical examiner/coroner, to include involvement in autopsies and crime scene investigations
• direct supervision by leader of emergency medical evacuation team, to include involvement in ground ride and air fly alongs
• attendance of lectures, conferences, board/task force meetings
• review of appropriate reading materials
• self-guided study, pertinent to patient problem list

Assessment Method (residents)

Utilizing the e-value system of self-assessment and outside assessment

Assessment Method (Program Evaluation)

Utilizing the e-value system of self-assessment and outside assessment

Level of Supervision

Direct supervision by above mentioned mentors

Educational Resources

Trauma, 5th edition, Moore et al., McGraw-Hill, 2004