Duke Regional Advisory Committee Meeting

Transcription

1 Duke Reginal Advisry Cmmittee Meeting Date: Octber 27, 2017 Lcatin: University Twer, 3100 Twer Blvd, Durham, NC Time: 10:00 am 1:00 pm Attendees: Chrystan Cavanaugh, Heather Albert, Whitney Adams, Rene Brghese, Sarah-Mrgan Brks, Edward Burlesn, Gina Champin, Patrick Cummings, Gergina Durst, Jhn Duskey, Carlyn Fley, Sean Gibsn, Kaci Kirby, Chle Hallberg; Glen Labar; Dr. Brenda Lanan, Nicle Mills, Kevin Mumma, Nicle Ogburn, Javier Plummer, Curtney Plmsky, Sctt Preschldbell, Matthew Rugeux, Kenneth Shaw, Tricia Smar, Dr. Steven Vaslef, Karen Wdell, Sandra Landry, William Cnner Agenda Speaker Discussin Actin Steps Grup wrk: Air Activatin Criteria Gergina reviewed helicpter transprt, scene transprts and vlume by trauma activatin t Duke fr the previus year. Als reviewed air trauma transprts by ISS- 29% ver triage with 42% easily meeting criteria Gergina reviewed NC State Standards Plicy n Air activatin Decrease transprt time High pririty patient with >20 minute transprt time Advanced care nt available by grund EMS (ex. Bld prducts) Entrapped patients with >10 min. extricatin time Multiple casualty incident Glen Labar Jr presented article review An Evidence-based Guideline fr the Air Medical Transprtatin f Prehspital Trauma Patients Wrking grup lked at evidence surrunding the pre-hspital transprtatin f trauma patients Tw strng and three weak recmmendatins emerged frm prcess. They did cnclude that severely injured patient wuld highly benefit frm the mst expedient mde f transprt pssible Actin Items- Reducing n scene times & critical thinking regarding transprt decisins Javier Plumber presented article review Understanding When t Request a Helicpter fr yur Patient Review gave a brief histry f HEMS and the cmplexity f care cnsideratins that g int making the best decisin regarding patient care Challenges: Under r ver triage can activate a resurce that is 1

2 Duke Reginal Advisry Cmmittee Meeting nt needed. Imprtant t cnsider the financial impact t the patient. Cmmunicate with the patient clearly when yu plan a helicpter activatin (ex. patient agitatin; fear f flying; safety f the crew) Recmmendatins EMS needs knwledge f resurces available t varius helicpter services. Alng with patient cmmunicatin when apprpriate Actin items- Understand HEMS capabilities. Creatin f a prtcl t reduce the burden f decisin making fr grund crews by utlining certain parameters that wuld make air activatin apprpriate Grup thughts; It is imprtant t have a prtcl that is universal and available system wide. Emergency Services need t be aware f the resurces available in the field t stabilize the patient. Train yur EMS t activate air transprt and nt put n standby. Helicpter can be canceled in rute. Keeps yur resurce in the cunty. If this is presented as a tl new prtcl may be better received Next Steps: Have ne hur wrking sessins t develp a standard prtcl with EMS representatives frm within the RAC Will engage EMS medical directrs Fcused grup frm EMS will meet befre the next RAC meeting t begin draft f air activatin criteria 2

3 Grup wrk: Trauma Triage Transprt Duke Reginal Advisry Cmmittee Meeting Hspitals vary accrding t their resurces Gal is t match the patient with required resurces This decisin can be made by EMS r with Interfacility transfer Ideally perfrmed Quickly, Systematically, Safely CDC Field Triage Guidelines identifies 3 types f criteria Physilgic Criteria Helps t rapidly identify critically ill patients Abnrmal ABCDE Anatmic Criteria Identify patients with nrmal physilgy but significant anatmic injury that requires the highest level f care (resurces) Mechanism f Injury Helps t identify severe injury that culd be hidden Increases index f suspicin Trauma Triage Key Pints Transfer whenever care exceeds facility capabilities Decisin shuld be made as early as pssible-within 15 minutes f arrival fr severely injured Once decisin is made expedite transfer D nt delay transfer fr unnecessary testing that will nt affect immediate care Utilize apprpriate transprt service based n patient s current cnditin and ptential prblems Gergina reviewed with grup the resurce infrmatin that was prvided frm each RAC hspital (Facility Inventry Checklist fr Transfer Assist) t shw variance. This infrmatin prvided basis fr Patient trauma triage & Transprt Wrksheet. Please see attached checklist 3

4 Duke Reginal Advisry Cmmittee Meeting Wrksheet identifies Pririty 1, 2 and 3 trauma patients. Pririty 1: Patients with high-energy blunt r penetrating injury causing physilgical abnrmalities r significant single r multisystem anatmical injuries Pririty 2: Patients with ptentially time sensitive injuries due t a high energy event (psitive mechanism f injury) r with a less severe single system injury, but currently with n physilgical cmprmise r significant anatmical injuries Pririty 3: Patients withut physilgical cmprmise, altered mentatin, neurlgical deficit, r a significant single system injury. These patients have generally been invlved in a lw energy event. Wrksheet is divided int system and treating specialty t help aid with resurce identificatin (ex. GCS <13/Head/Neursurgery) Each pririty als recmmends transprt type (Ex. Pririty 1- Critical Care) Checklist will assist with Trauma patient triage, Crrelatin t available resurces, expedite transfer with care apprpriate transprt service Grup asked t review with ED Medical Directr s fr feedback Utilize Pre-cnference Early identificatin f pririty 1&2 trauma patients 4

5 Duke Reginal Advisry Cmmittee Meeting Welcme Dr. Brenda Lanan Intrductins Apprval f July 2017 meeting minutes 1 st mtin f apprval Sean Gibsn 2 nd mtin f apprval Sarah Mrgan Brks Mass Casualty Phne List Update- Grup asked t update any phne numbers fr EMS dispatch and ED charge nurse s. Will be utilized by Duke Hspital in the event f Mass Casualty but will als be useful as cntact list State Injury and Sctt Average Day Injury Vilence Preschldbell Within RAC Preventin Branch 3 Deaths Data 34 Hspitalizatins Update 331 ED Visits Within Nrth Carlina 21 Deaths 224 Hspitalizatins 2,582 ED Visits 2016 Leading Causes f Injury Deaths Duke RAC Ttal = 981 Unintentinal Pisning 195 Unintentinal MVC- 188 Unintentinal Falls- 164 Suicide- 152 Hmicide- 134 Other Unspecified 92 Unintentinal Suffcatin 31 Unintentinal Fire/Burn 13 Unintentinal Drwning 12 Death Rates Variable Between 2007 and 2016 Unintentinal Pisning up 61% Unintentinal Mtr Vehicle Crash dwn 28% Unintentinal Falls up 124% Suicide up 7% Hmicide up 1% 5

6 Duke Reginal Advisry Cmmittee Meeting Duke Trauma Prgram Updates Sean Gibsn Fall Trauma Wrkshp rescheduled fr December 1, :15 AM 4:30 PM Duke Reginal Hspital 3643 Nrth Rxbr St Durham, NC $25.00 RN and Allied Health $50.00 Physician and APPS. 6.7 Credits will be awarded lunch prvided Duke Trauma Center site survey year began-september 1st and ends August Please visit Duke Trauma website fr mre infrmatin n the Fall Trauma Wrkshp Tricia Smar, Injury Preventin Crdinatr Updates Stp the Bleed -Natinal initiative Fcused in Durham Cunty Current fcus- Train the trainer 1 hur training t lay persns n hw t stp bleeding befre EMS arrives. Gal fr the initiative is t make this training as cmmn as CPR training. Please cntact Tricia Smar if yu are interested in becming a trainer fr Stp the Bleed Duke Healthcare Preparedness Calitin Updates Carlyn Fley Registry Updates Registry Team 60 t 70 days current in ur data with a gal f 45 days by the end f Nvember Sean has secured funding fr additinal help Tw new remte wrkers added t the team. Kenneth Shaw 5-year budget has been apprved and currently mving frward with perfrmance measures. New perfrmance measures with 3 key measures Surge Evaluatin Crdinatin Currently evaluating perceived capabilities in ur regins. Cllecting survey infrmatin t find the challenges Thank yu fr yur supprt and assistance cmpleting these surveys. 6

7 DRAC Crdinatr Updates Educatinal Opprtunities Duke Reginal Advisry Cmmittee Meeting Gergina Durst PwerShare update- Clud based imaging transfer system Past Visits Durham C EMS Durham VA- C-Cllar educatin Granville Cmpetency day Trauma Day- Maria Parham New Grad Trauma day- SRMC New Grad TNCC at SRMC Stp the Bleed-Bull City United/Durham C EMS Persn Memrial Hspital leadership Patient fllw-up. Gergina Durst 2018 Annual Trauma Sympsium- Save The Date: March 29 th, 2018 Educatin pprtunities Dec TNCC- Teer huse Nv ENPC - Teer huse Dec ENPC - Teer huse ABLS Nw $175 Nn- Physicians/$300 Physicians Reginal Updates Heather Albert Caswell C EMS New Medical Directr- Dr. Yarbrugh Currently in the prcess f updating EMS prtcls New EMS Directr als ver Emergency Management Barry Lynch Assistant EMS Directr- Jasn Watlingtn New Shift 24/72 as f Octber 1 st. Nt Present Caswell Family Medical Center Nicle OgBurn Durham VA New Interim Directr Chief Nurse is retiring lking fr replacement On Divert fr dialysis Nt Present Durham C EMS Sarah Mrgan Duke Hspital Emergency Department Brks N updates Nt Present Duke Raleigh Hspital 7

8 Duke Reginal Advisry Cmmittee Meeting Edward Burlesn Gina Champin Glen Labar Nt present Patrick Cummings Granville EMS Fully staffed Update prvided n truck security Maria Parham Franklin Reginal Hspital Phase ne pening -mid 2018 free standing ED will pen Phase 2 pening- Behaviral health beds including 13 Geri-psych beds Persn C EMS Upcming 1 st Respnder Training Substance Abuse updates 143 trauma calls since last meeting One traumatic arrest 2 needle decmpressins Average scene time 16 minutes 43 sec Persn Memrial Hspital Jint Cmmissin currently nsite Steven Strud is new Nurse Directr, n lnger interim Rbersn C EMS Patrick Cummings is the New EMS Directr, n lnger interim calls this year Cape Fear nw has helicpter Sandra Landry Javier Plummer SRMC Ging live with EPIC Nvember 5. New Blanket/fluid warmer Vance CO Staffing imprved Apprx.1430 calls this quarter 6% trauma Average time n scene Case Study Dr. Steven Vaslef Adjurn Gergina Durst Next Meeting January 26th,