Where does one start to describe the vast amount of trauma education offered at this excellent two-day educational offering graciously subsidized by eChapter? The course is geared for physicians, nurses, and EMS personnel and offered 13.5 CME credits in trauma care.
Included in the guest faculty were two Professors of Surgery. Donald Trunkey, MD, FACS from Portland , Oregon and Peter Rhee, MD, FACS of Tucson, Arizona. Hao Chih Ho, MD, FACS was the host and the Medical Director of Trauma Services at Queen’s Medical Center. Every topic was given 30 minutes, so the speaker were brief and to the point, never allowing the audience to get bored at all.
The two day event offered 22 such topics starting with trauma statistics in the state of Hawaii. The revealing fact was the extended length of transfer from the outer islands to a trauma center on Oahu, the worst being 9:43 from the Big Island and 9:29 from Maui. Other statistics that day showed access to trauma care as a big predictor of survival. The “golden hour” was not even reached on Oahu with an average of 1:15. Specialty shortages on the neighbor islands especially in ortho and neuro were problems. The State of Hawaii has imposed a surcharge on certain traffic violations to help subsidize trauma care.
Current head injury care stressed that a head injury was not a static event but a physiologic event and our goal is to prevent secondary insults. Mannitol, by thinning the blood, along with hyperventilation better enables blood to go through a vessel vasoconstricted by hypocarbia. The bottom line was to avoid hypotension and hypothermia has not shown promising results.
A lot of trauma research and progress continues to come out of military experience of massive trauma. Hemostatic resuscitation success was based on 1.”permissive hypotension”, 2. minimization of crystalloids, 3. use of hypertonic saline, 4. early use of PRBC, 5. FFP/whole blood, and 6. Factor rVIIa.
The Honolulu Prosecuting Attorney, Peter Carlisle, “delighted to speak to a room full of registered voters”, set straight Hawaii’s mandatory reporting laws for substance abuse and trauma. Drivers sign a waiver when obtaining a driver’s license consenting to substance abuse testing in the case of a motor vehicle accident(MVA). The hospital is required to test for substances whenever injury or death results in a MVA. In Hawaii, it is also mandatory to report persons whose blood contains impairing drugs or meet/exceeds the alcohol limit. A lively question and answer session still showed reluctance my medical providers to get involved. Dr. Trunkey gave a compelling call to legalize drugs citing the failure of the war on drugs. He talked about the major adverse effect on Latin and South American neighbors of increased violence, corruption, and political upheaval. The Dutch experience has ben positive. He stressed instead three strategies of dealing with drugs: 1.Prevalence reduction, 2. Quantity reduction, and 3. Harm reduction. Another speaker showed successful alcohol use intervention during the open window after an accident.
Current experience in cardiac and blunt liver trauma was offered. The military has experimented with the new chitin hemostatic agents and Dr. Rhee’s experience was given. An explanation of the new American Heart Guideline of 30:2 compression/respiration rate. Apparently 15 compressions barely brings the patient’s oxygenation to the minimal threshold required, while 30 compressions takes it above and maintains it for the second 15 compressions. The conference ends with four brave surgical residents presenting actual case studies to the visiting experts and being critiqued in front of the audience.
This is the third time that I have attended this conference and recommend it to anyone interested in trauma care. Again, I thank eChapter for the scholarship.
Jullie
Julie B.H. Noyes, RN, BSN, CNOR, CRNFA
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