Committee on Trauma News bimonthly newsletter that

JANUARY/FEBRUARY 2013

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Committee on Trauma News is a bimonthly newsletter that provides the latest information on COT initiatives across the globe. For questions or suggestions, please contact us at [email protected].

ATLS® Demonstration Courses Held in LibyaLast December, the ATLS–MENA (Middle East and North Africa) group conducted Libya’s �rst ATLS demonstration course in the Abu Salim Trauma Center in Tripoli, the nation’s capital. Saud Al Turki, MD, FACS (ATLS–MENA Region Chief), and Hakim Elkholy, MD, FACS (ATLS–Egypt Chair), directed two back-to-back Student courses from December 26 to December 31, 2012. Nearly 50 students participated in the courses, and more than half of them were evaluated as having Instructor Potential. Given the success and interest demonstrated by the Libyan participants, the ATLS program is expected to of�cially promulgate within the next year.

Mohamed Alasmar, MD (ATLS–Egypt National Coordinator), who organized the courses and worked closely with regional faculty and local staff stated, “It was a really great experience for all of us… The Libyan candidates showed real interest, and the senior group of Libyan physicians were excellent role models for future participants in their country.”

Pakistan Celebrates Anniversary and RTTDC InaugurationThe College of Physicians & Surgeons Pakistan (CPSP) celebrated their 50-year anniversary in Karachi from November 9 to November 11, 2012. The Golden Jubilee celebration was hosted by Professor Zafar Ullah Chaudhry, MD, FACS, the current ATLS–Pakistan Chair and president of CPSP. The Jubilee, themed “Post Graduate Medical Education: Challenges and Innovations,” commemorated the accomplishments of the CPSP since its establishment. Hundreds of doctors from all over the world attended the three-day celebration, including a number of ACS-COT representatives, such as Jameel Ali, MD, FACS; Subash Gautam, MD, FACS; Michael Hollands, MD, FACS; Christoph Kaufman, MD, FACS; and John Kortbeek, MD, FACS.

Following the Golden Jubilee, a small team from the U.S. and Canada introduced the Rural Trauma Team Development Course® (RTTDC) on the CPSP campus to 12 students on November 11. A one-day faculty orientation course introducing the RTTDC course concepts was given to eight instructors at the CPSP the day before. Positive feedback about the course was received from both the newly trained faculty and the students in the inaugural course.

The RTTDC Program is ideally suited for promulgation into low- and middle-income countries where the burden of injury from trauma is the highest. “Across Pakistan, even in tertiary care hospitals, the doctors in accident and emergency departments are not properly trained for the care for the trauma victims,” (Jamali, AR 2008).

Jamali AR. Trauma Care in Pakistan. J Pak Med Assoc. March 2008;58(3):102-103.

Course faculty and participants gather together for a photo at the first ATLS demonstration course in Libya.

ATLS skills station in Tripoli.

Rural Trauma Team Development Course (RTTDC) in Karachi, Pakistan.

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•ATLS:AFamilyAffair•NTDB®AnnualCallforData

MEETINGS•LookingBack• InternationalMeeting•Rescheduled2012TQIPAnnualScientificMeetingandTraining

SERVICES•PerformanceImprovementActivitiesTrimReport

FYI•RegisterNowforOurUpcomingCourses!

•SavetheDate•NewRegionChiefs•NewRegionalCommitteeofTraumaChairs

PRODUCTS•NewCOTProducts!

THANK YOU•ATOMinJapanRecognizesNurses’Contributions

ABOUT OUR ORGANIZATION

•UpdateonATOM–Japan

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Chile Introduces the ATOM ProgramJust a year after the Advanced Trauma Operative Management® (ATOM) was introduced to Paraguay, neighboring Chile held its �rst course on December 10–11, 2012. Eight students participated in the promulgation, which was held in Viña del Mar at the Almirante Nef Naval Hospital. The course was co-directed by Froilan Fernandez, MD, FACS, ATLS–Chile Chair; Djin Newton Mori, MD, FACS, ATLS–Brazil Chair; and Renato Poggetti, MD, FACS, ATLS Region 14 (Latin America) Chief. The ATOM program welcomes Chile to the family!

ATLS–Iran’s Annual TLS CeremonySince the ATLS–Iran inauguration from December 2011 at Atieh Hospital in Tehran, local faculty and staff have conducted six Student courses and three Instructor courses.

Per Majid Sabaji, MD (ATLS–Iran Vice Chair), “One of our goals in expanding ATLS has been to pick the best facilities possible in the cities that suffer the highest trauma rates.” ATLS–Iran now runs courses both in Tehran and Shiraz and hopes to bring the program to more centers throughout the country.

On December 6, 2012, faculty and staff from the ATLS–Iran team were invited to attend a ceremony recognizing the team’s efforts on the program’s one-year anniversary. The schedule was as follows:

1. Welcome by Professor Khalil Alizadeh (ATLS–Iran Chairman)

2. Overview of ATLS in Iran by Dr. Majid Sabahi (ATLS–Iran Vice-Chair)

3. Report of accidents in Iran by Mohammad Behgam Shadmehr, MD, FACS (Senior ATLS Instructor)

4. Performance report on Shiraz by Ms. Shayan (Coordinator, Shiraz) The ceremony ended with a formal dinner, cake cutting, and an appreciation award presented to Professor Alizadeh from ATLS members.

The ATLS–Iran family celebrated their one-year anniversary with a cake cutting.

Professor Khalil Alizadeh (ATLS–Iran Chairman).

December 2011 – December 2012:22 Instructors

12 Instructor Candidates8 Instructor Potentials

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ATLS: A Family Affairby Steven Hamar, MD, FACS

Matthew Hamar, DO, was 14 years old when his dad began teaching Advanced Trauma Life Support (ATLS). Dr. Hamar has been the ATLS Course Director at St. Alexius Medical Center since 1986. During an ATLS course on December 7–8, 2012, a time-honored tradition of a father passing knowledge to his son took place. Dr. Hamar was carrying out his familiar role of teaching and directing the course, while a new, yet somewhat familiar face was amid the students. Matt Hamar, a second-year resident at the University of North Dakota Family Practice program was among the students. Any observer can quickly determine that there is no mistaking the family resemblance between father and son.

Dr. Hamar was overheard saying, “Matt’s pretty nervous about taking the course… his old man’s been doing this a long time.” Scores of former ATLS students would concur that Dr. Hamar’s no-nonsense approach to the course stirs up anxiety. It is, after all, an American College of Surgeons Committee on Trauma course that teaches emergency life-saving skills performed on the most critically injured patients that the students will ever encounter.

As if Matt didn’t have enough incentive to do well in the course, Derek Kane, MD, FACS, Dr. Hamar’s nephew and Matt’s cousin, was also an instructor in the course. To make the testing fair and free of nepotism and favoritism, other instructors were assigned to evaluate Matt in the skill and written exams. Can you imagine the conversation around the holiday table if Matt would have done poorly? He would never hear the end of it!

So, a family tradition of ATLS and taking great care of trauma patients has been �rmly established and passed down within the Hamar family tree. Those of us within the St. Alexius Medical Center and the North Dakota Trauma System are fortunate to be among this family and look forward to the tradition continuing.

Left to right: Derek Kane, MD, FACS; Steven Hamar, MD, FACS; and Matthew Hamar, DO.

Dr. Hamar, the younger, inserting a chest tube.

NTDB® Annual Call for Data:Get ready, the 2013 National Trauma Data Bank (NTDB) Call for Data opened on Friday, February 25! Join the hundreds of other facilities that have chosen to participate in one of the nation’s largest aggregates of U.S. trauma registry data ever assembled. For more information, visit our website at www.facs.org/trauma/ntdb/index.html.

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LOOKING BACK: International MeetingThe 2012 ATLS International Meeting took place at the Hilton Chicago on September 29–30. More than 200 representatives from nearly 50 countries attended the informative and constructive two-day event, which was led by Dr. John Kortbeek (ATLS International Course Director) and Karen Brasel, MD, FACS (ATLS Committee Chair). The ATLS family welcomed the newly promulgated ATLS–Czech Republic team to the meeting and introduced the 9th Edition roll-out, a new Instructor course, the ATLS app, and ongoing translation and revision efforts.

To commemorate the expansion of ATLS internationally, anniversary awards were distributed to:

• College of Physicians and Surgeons Pakistan—5 years• Hong Kong Chapter of the American College of Surgeons—15 years• Chapter of Surgeons, Academy of Medicine, Singapore—20 years• Trauma Society of South Africa—20 years

The 2012 ATLS International Meritorious Award was presented to Mr. Will Chapleau for his unwavering dedication and contributions to the program throughout his time as ATLS Manager. Mr. Chapleau now serves as the Director of Performance Improvement for the American College of Surgeons. Congratulations, Will, from the ATLS International family!

Rescheduled 2012 TQIP Annual Scienti�c Meeting and TrainingFebruary 17–19, 2013Sheraton Philadelphia Downtown | Philadelphia, PA

The rescheduled TQIP conference brought together trauma medical directors, program managers, coordinators, and registrars from participating and prospective TQIP hospitals. This year, 460 conference attendees representing 201 hospitals and collaboratives participated. February’s conference included:

Focus on Care for the ElderlyA tool kit on care of the elderly trauma patient presented by the TQIP Best Practices Project Team. A panel of experts was present to comment and share their experiences.

Focus on BleedingIn relation to new venous thromboembolism prophylaxis data dictionary �elds and new hemorrhage control �elds. This session was also in anticipation of our next Best Practices Guidelines on Massive Transfusion Protocols.

Poster SessionThis session, followed by a lively reception, showcased 31 excellent posters that gave TQIP hospitals the opportunity to share the challenges and solutions for vexing problems faced by their hospitals. This was an ideal opportunity for TQIP centers to network and compare issues at each hospital.

We were honored to welcome our keynote speaker, Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), who gave a rousing talk on the future of quality in health care at the governmental level.

During the breakout sessions, experts spoke on this year’s “hot topics,” including using TQIP in your performance improvement program, appropriately coding data dictionary elements, drilling down into your data, using and understanding TQIP reports, and the importance of the TQIP team.

We heard from states and collaboratives engaging in TQIP and from our Pediatric TQIP pilot leaders, Michael Nance, MD, FACS, and Randy Burd, MD, FACS. Our TQIP Medical Director, Avery Nathens, MD, FACS, led us through many aspects of the program and into the future of TQIP.

Throughout the entire event, there was a cooperative atmosphere of learning with ample opportunity for interaction among with attendees.

We have gotten a lot of positive comments and constructive feedback to take to our next conference. We hope you will be able to join us for the upcoming TQIP conference November 17–19, 2013 in Phoenix, AZ.

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Performance Improvement Activities Trim Report Turnaroung Time for the VRCby Nels Sandal

Recently, the Veri�cation, Review, & Consultation (VRC) program of the COT became a victim of its own success. The program has seen remarkable growth in trauma center consultation and veri�cation visits over the past few years. In 2012 teams conducted 216 site visits—up from the previous year’s total of 158 and marking a 36% increase in one year. That jump created significant challenges in both scheduling and report completion. The scheduling issue has been resolved through the dedication of our volunteer surgical reviewers and the addition of a full-time scheduler to support the VRC. We anticipate that with the selection and training of additional reviewers, this process will run even more smoothly in the future.

The report generation process required a bit more sophisticated approach to manage. At its high point it was taking an average of 12 to 14 weeks. The �rst challenge was to analyze the problem. The report undergoes a number of “hand-offs” on its journey from the site visit team’s (SVT) hands until it reaches the trauma center. Those steps include:

1. Writing and transmission by the SVT to the VRC of�ce 2. Staff preparation prior to going to an external editor 3. Editing 4. Transmission to the VRC committee for adjudication5. Final editing and formatting 6. Final review and ruling by the VRC committee chair7. Transmission to the trauma center The �rst step in correcting the process was the acquisition of real-time data pertaining to each hand-off described above. With the assistance of Howard Tanzman and the American College of Surgeons IT staff, we were able to capture those elements in a newly developed administrative database. From there, we were able to graph each report in a stacked bar fashion so that we could determine where the common delays were occurring and also examine signi�cant outliers more closely (see Figure 1).

Figure 1.

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1. The transmission from the SVT had been slowed due primarily to the increased number of visits that had been caused by the increased demand. The only logical answer to that (until the development of an automated electronic report writer) was to increase the pool of

reviewers to reduce the demand on any single reviewer.

2. The second issue centered on the quality of some of the reports, which was exacerbated by the antiquated report writer currently in use, and, again, by the sheer volume of reports on our senior reviewers’ desks. That issue was approached by providing “track changes” documents back to the teams so they could more fully understand the expectations surrounding the quality and content of each report.

3. The program was also experiencing variability in how each of several editors where approaching their task. This issue continues to be attacked by a series of conference calls and meetings between the editors, staff, and the VRC Chair.

4. The process of adjudication by the VRC was taking signi�cant amounts of time due in part to volume and also by the fact that some members were assuming that since the process only required a quorum of the VRC membership, “someone else would review and

return rulings.” This issue was signi�cantly improved by dividing the membership into two tally groups, each responsible for 50 percent of the reports, thereby decreasing the amount of time any VRC member had to commit to the process and increasing the expectations of responsibilities.

5. Finally, the VRC program has made a commitment to hiring quali�ed temporary staff to manage and contribute to the editing process, until such time as a new position can be created and �lled. Additionally, the VRC Chair, Chris Cribari, MD, FACS, invested in a tablet that allows him to do the �nal review of the reports without being tied to his desktop. These commitments positively affect steps �ve through seven above.

The sum of these efforts is that the mean report generation time has decreased from the high of 12 to 14 weeks seven months ago to an average of six to eight weeks today. This downward trend is encouraging and represents the results of a focused effort led by Molly Lozada, the VRC program administrator, and her talented team (see Figure 2).

Continued re�nements in the performance improvement process and ongoing examination of outliers, including loop closure of individual and systemic problems, will continue. According to Nels Sanddal, PhD, Manager of the Trauma Systems and Trauma Center Veri�cation Programs, “After all, why should we hold trauma centers to rigid performance improvement and patient safety standards if we are not undergoing similar efforts relative to our internal processes? Whereas PIPS processes improve patient outcome and satisfaction at the trauma center, we trust that our efforts will do the same for the customers we serve.”

Figure 2.

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Register Now for Our Upcoming Courses!March 17, 2013 Medical Disaster Response—Las Vegas, NV

March 18–20, 2013 Trauma, Critical Care and Acute Care Surgery—Las Vegas, NV

June 3–5, 2013 Point/Counterpoint, Acute Care Surgery—National Harbor, MD

Information for these courses can be found at www.facs.org/trauma/cme/traumtgs.html.

The NTDB is currently undergoing the process to become an ANSI-approved standard through Health Level Seven.

Save the Date!2013 TQIP Annual Scienti�c Meeting and Training November 16–19, 2013Arizona BiltmorePhoenix, AZwww.facs.org/trauma/ntdb/save-the-date.pdf

New Region ChiefsRegion 13Colonel Jeffrey A. Bailey, MD, FACS, succeeding Colonel Brian J. Eastridge, MD, FACS (ret)

New Regional Committee on Trauma ChairsRegion 3 PennsylvaniaSimon D. Lampard, MD, FACS, succeeding Keith D. Clancy, MD, FACS

Region 5 MichiganWayne E. VanderKolk, MD, FACS, succeeding Joe H. Patton, Jr., MD, FACS

MinnesotaJohn K. Cumming, MD, FACS, succeeding Steven D. Eyer, MD, FACS

Region 10 IdahoBrian E. O’Byrne, MD, FACS, succeeding Drew W. McRoberts, MD, FACS

Region 14 BrazilNewton Djin Mori, MD, FACS, succeeding Francisco D. S. Collet e Silva, MD, FACS

ChileFroilan A. Fernandez Sanchez, MD, FACS, succeeding Carlos Carvajal Hafemann, MD, FACS

EcuadorJuan Carlos Serrano Montesinos, MD, FACS, succeeding Enrique A. Guzmán Cottallat, MD, FACS

MexicoMoises Zielanowksi Mansbach, MD, FACS, succeeding Mauricio Di Silvio, MD, FACS

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New COT Products!ATLS Student Manual 9th EditionThe ATLS Program was developed to teach emergency care providers one safe, reliable method for assessing and initially managing the injured patient. This publication was written for use in ATLS Student courses and is updated approximately every four years. This ninth edition manual, released in September 2012, features a companion app to serve as both a bedside reference tool and supplemental educational resource.

RTTDC Student Manual 3rd Edition in SpanishThis newly translated Spanish manual has been developed for participants in the Rural Trauma Team Development Course (RTTDC). The course helps rural facilities create a trauma team of at least three core members, each with de�ned roles and responsibilities, and is taught by personnel from an area’s Level I, II, or III trauma center, on-site at the rural facilities. The goal of the course is to teach a team approach to the rapid assessment of trauma victims for injuries that require immediate transfer using the resources that are speci�cally available to each team.

2011 Research Dataset 2013 Data Dictionary TQIP Geriatric GuidelinesThe NTDB 2011 Research Dataset is available and can be requested at www.facs.org/trauma/ntdb/ntdbapp.html.

The National Trauma Data Standard is available for download at www.ntdsdictionary.org.

Currently available to TQIP centers and sent out in December.

ATOM in Japan Recognizes Nurses’ ContributionsNurses who participate in ATOM courses at the Jichi Medical University in Japan are formally acknowledged for their contributions. Alan Lefor, MD, who has led a steady promulgation of ATOM throughout Japan, shared with us that course sites throughout the country have begun to distribute nurse certi�cates to those “who play such an active role in each ATOM course.”

The certi�cates were so well received that they will now be issued to all nurses who participate in the program worldwide, per Sharon Henry, MD, FACS (ATOM Program Chair).

The ATOM Program Of�ce thanks ATOM–Japan for creating such recognition, as well as the nurses who have contributed to the program!

The Advanced Trauma Operative Management (ATOM) course is an effective method of increasing surgical competence and con�dence in the operative management of penetrating injuries to the chest and abdomen. For more information on ATOM, please visit www.facs.org/trauma/atom/index.html.

ATOM nurse participants in Japan show off their new certificates.

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About Our OrganizationThe American College of Surgeons (ACS) was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College has worked to establish guidelines for the care of the trauma patient. The Advanced Trauma Life Support Course teaches a systematic, concise approach to the early care of the trauma patient. This course is vital to guiding care for the injured patient in emergency department trauma rooms. The course training provides a common language that can save lives in critical situations.

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Committee on Trauma News bimonthly newsletter that