Trauma EMS : PAST, PRESENT AND FUTURE. Rao R. Ivatury MD, FACS, FCCM Richmond, Virginia

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1 Trauma EMS : PAST, PRESENT AND FUTURE Rao R. Ivatury MD, FACS, FCCM Richmond, Virginia

2 Trauma EMS : PAST, PRESENT AND FUTURE COI: None

3 EMS Creed Somewhere deep within us our souls are crying out, We're here to help our neighbors in their hour of pain and doubt. God gave us something special to help us see you through, we do it cause we love you and we care about you too. -Author Unknown

4 The fate of the wounded rest in the hands of the one who applies the first dressing Senn

5 Trauma EMS : PAST, PRESENT AND FUTURE Objectives : 1. Evolution of the prehospital care and EMS 2. Current state of art of EMS 3. Projections for future advances in pre-hospital care

6 First Medical System Edwin Smith Papyrus : B.C. Aashoka in India! B.C.

7 Dhoolies

8 HISTORY OF TRAUMA CARE Napolean s Chief Surgeon : Baron Dominique-Jean Larrey ( ): developed the first system of field care ( flying amb, Field hospitals) U.S. Civil War ( ) : Battle of Bull Run : Delay in evacuating soldiers with increased casualties

9 HISTORY OF EMS 1862 September : Surg General Hammond appoints Letterman as Director of Army Defined the structure and functions of ambulances, two wheeled versus four wheeled, triage, 9000 soldiers transported and treated

10 HISTORY OF EMS 1860's: First recorded use of a field ambulance : The Civil War. 1865: First ambulance : The Commercial Hospital in Cincinnati Grady and Charity followed

11 HISTORY OF EMS 1869: NYC : Bellevue : their first 74 calls calls by calls by 1891

12 HISTORY OF MVC 1865: First fatality of a young woman in London, hit by a car at 4 MPH! 1899 : First fatality in NYC. 68 yrs old Stepped off the curb and crushed by a electric car. 74 and Central Park West

13 HISTORY OF EMS 1883

14 HISTORY OF EMS 1890: The Williams family of Gainesville runs their first call for help using a horse drawn funeral carriage. 1909: The American Red Cross begins its first aid training program.

15 HISTORY OF EMS Tandem Ambulance, 1904

16 1912

17 HISTORY OF EMS 1918

18 1914 First Trauma Unit

19 The first motorized ambulance Michael Reese Hosp, Chicago Weighed 1600 lbs Battery powered Trvelled at 16 mph St. Vincent s in NY

20 The first aircraft ambulance In 1910 Built in NC, flew in Florida Crashed after 400 yards

21 The first aircraft ambulance September 6, 1901: First US President in ambuance: McKinley Buffalo, NY

25 HISTORY OF EMS 1922 The American College of Surgeons (ACS) establishes the Committee on the Treatment of Fractures

26 HISTORY OF EMS Fire Departments 1934: Columbus, Ohio begins a Basic Life Support (BLS) squad 1959: Los Angles Fire Department initiates a BLS response with extrication and first aid equipment

27 1937

28 HISTORY OF EMS 1959

29 HISTORY OF EMS

30 HISTORY OF EMS Medical Associations 1964:American Academy of Orthopedic Surgeons : 3-day course for training of emergency medical personnel 1965: The AMA: commission to study EMS

31 HISTORY OF EMS 1966: The National Academy of Sciences NRC: Accidental Death & Disability: The Neglected Disease of Modern Society

32 HISTORY OF EMS 1966: The National Highway Safety Act (P.L ) : national standards for training EMTs and minimum equipment required on an ambulance.

33 HISTORY OF EMS 1966: The National Traffic and Motor Vehicle Safety Act DOT empowered set MV standards, develop EMS systems

34 HISTORY OF EMS Accident Prevention : National Council on Accident Prevention Emergency First aid and Medical Services: Standards in Education and training of health care personnel Ambulance design and equipment Automotive and air transport in rural areas

35 HISTORY OF EMS Emergency Departments Needs - survey of the number and types Federal fund support to design, construct and in part, operate Development of a mechanism for inspection, categorization, and accreditation

36 HISTORY OF EMS Trauma Unit March 1966 : nation s first trauma center at Cook County Hospital (CCH) in Chicago Drs Robert J. Freeark, Robert J. Baker immense patient load, heavily weighted in emergencies and trauma

37 HISTORY OF EMS Trauma Registries Establishment of trauma registries in selected hospitals to continue to evaluate the natural history of the various forms of injuries.

38 HISTORY OF EMS 1969: COT of ACS, and the Committee on Injuries of the AAOS, and The Division of EMS develop basic definitions and establish guidelines for delivery of emergency care.

39 HISTORY OF EMS Results of "White Paper" 1969: LA initiates ALS response. 1970: Seattle, Washington goes ALS. 1971: Nassau County, LI Grand Rapids, Michigan train police/paramedics.

40 1970: NHTSA mission is to save lives, prevent injuries and reduce traffic-related health care and other economic costs. The goal of NHTSA's EMS Division is to develop/enhance comprehensive EMS systems to care for the injured patients involved in motor vehicle crashes.

41 EMS Agenda For the Future EMS of the future will be communitybased health management fully integrated with the overall health care system. identify and modify illness and injury risks, provide acute illness and injury care and follow-up, contribute to treatment of community health monitoring

42 HISTORY OF EMS 1973: The United States Congress enacts the EMS Systems Act providing $170 million to enhance EMS over a three year period. Trauma systems identified as essential 1975: Seattle study shows improved survivability of heart attack victims with early intervention of Advanced Life Support (ALS).

43 HISTORY OF Trauma 1976 : ACS : Optimal Hospital Resources for Care of Injured Patient

44 R Adams Cowley

45 HISTORY OF Trauma 1985 : NRC and IOM publish: Injury in America : A continuing Public Health Problem

46 HISTORY OF Trauma 1990 : Injury Control Act Establishes division of Injury epidemology and control at CDC

47 NREMT NAEMT

48 Pop Culture For EMD : William Shatner s post Star Trek life began Rescue 911 : teacher of public safety access and pre-arrival instructions in the late 1980 s Emergency! for ED Docs and Paramedics ER in the late 90s and 2000s introduced the specialty American households MASH and the trauma surgeon and nurse

49 Future Trends in EMS Regionalization of Care in Trauma Cannot overtax Level 1 centers So where do EMS systems go? Level 2 s? Level 3 stabilization centers? Challenge of differential triage

50 Challenges Tough patients: The young The elderly The intoxicated

51 Controversies Spinal immobilization?field clearance How much sedation? Or paralysis? How much resuscitation?

52 More Controversies? MAST? Intubation? Scoop and run Or Stay (and play) in place

53 More Controversies? Scoop and run Or Stay (and play) The sniper story of VA

54 ON THE HORIZON Bleeding control Rapid intubation Imbedded sensors Field pronouncement

55 ON THE HORIZON Hypertonic saline Antioxidants Blood substitutes Hypothermia Sonography Point-of-care

56 ON THE HORIZON Better equipment, interchangeability Digital EMS Integration of : systems,equipment industry Video Imaging

57 ON THE HORIZON Distant learning Patient sims More academic More judgement based care Better Education

58 ON THE HORIZON Better, faster transport Better and faster communication Better and faster treatment ( damage-control )

59 DAMAGE- CONTROL AT GROUND ZERO

60 GROUND ZERO : Places of our activity America s uncivil war

62 Damage control Experts

63 Extrication

64 A,B,C s Spinal integrity Bleeding control ED prep

65 Fracture Immobilization Brain & Spinal cord protection

67 300,000 In 26 countries Survival 5%

68 David R. Boyd MD Living legend of EMS

70 Thank you!!

Charge to the Institute of Medicine Committee on Military Trauma Care s Learning Health System and its Translation to the Civilian Sector May 18, 2015

National Highway Traffic Safety Administration Charge to the Institute of Medicine Committee on Military Trauma Care s Learning Health System and its Translation to the Civilian Sector May 18, 2015 Drew