Module 1- The Trauma Care Continuum

Question 1

Traumatic injuries are those caused by the ________ to the tissues.

Answer 1

application of force (energy) to the tissues.

Question 2

Most traumatic injuries should NOT be referred to as _______.

Answer 2

accidents.

Like other disease conditions, traumatic injuries are rarely random or unpredictable.

Question 3

Because trauma is rarely an accident, it is largely ______.

Answer 3

preventable.

If we can predict it, we can prevent it!

Question 4

Globally, _______ is the leading cause of death for people aged 1-45 years.

Answer 4

trauma.

Question 5

Trauma is the ___ leading cause of death for all age groups in the US.

Answer 5

third.

Injury is the number 3 cause of death in all age groups, surpassed only by cardiovascular disease and cancer.

Question 6

Trauma is the most frequent cause of longterm ______ .

Answer 6

disability.

Between 8-9 million people in the US suffer disabilities annually from trauma. One-third of these will be permanently disabled.

Question 7

Worldwide, injury accounts for ____ % of all deaths on the planet.

Answer 7

10%.

Injury accounts for 10% of all deaths globally.

Question 8

The three most common trauma etiologies in the US are ______, ______, and ______ .

Answer 8

motor vehicle collisions, falls, and firearm injuries.

Question 9

Just like a heart attack or COPD, motor vehicle collisions should NOT be referred to as _____.

Answer 9

accidents.

There are very few accidents, people make choices that can impact many lives. This principle is foundational to injury prevention efforts.

Question 10

The leading cause of serious traumatic injury in the US is _____

Answer 10

motor vehicle collisions.

Car crashes account for the largest number of seriously injured patients.

Question 11

Worldwide, the number one cause of death between the ages 5-29 years is _____.

Answer 11

motor vehicle collisions. This number incudes injuries to pedestrians and cyclists.

Question 12

_____ are the most frequent injury mechanism.

Answer 12

Falls.

In the US alone, there are over 8.2 million fall injuries each year. The incidence is similar in other nations. As the global population ages, this number will continue to grow.

Question 13

Compared to other developed nations, the US experiences an extremely high number of patients injured by ______.

Answer 13

firearms.

Guns are the number one cause of fatal injuries in the United States. 45,000 deaths and 175,000 non-fatal firearm wounds are sustained each year.

Question 14

The US Centers for Disease Control considers what 5 mechanism of injury categories to be “trauma” although not all trauma systems do.

Answer 14

Suffocation, poisoning, overexertion, bites and stings, and drowning.

Check with your trauma program leaders to learn who your hospital considers a “trauma patient.”

Question 15

Name the four CDC field triage categories used to determine which patients should be sent to a trauma center.

Answer 15

The US CDC Field Trauma Triage Guidelines include four categories: Mental status and vital signs, Injury patterns, Mechanism of injury, and EMS judgment.

These guidelines provide direction to EMS personnel treating injured patients.

Question 16

Of the CDC’s field trauma triage categories, which two are the most sensitive and specific for identifying patients who require rapid transport to a trauma center?

Answer 16

Altered mental status (unable to follow commands), and Abnormal vital signs for age.

Question 17

According to the CDC’s field trauma triage categories, vital signs that meet triage criteria for urgent trauma center care include:

Answer 17

RR <10/min or >29/min; SpO2 <90%; HR>SBP
SBP < 90 mm Hg (<110 mmHg age 65 or over)

Question 18

Trauma triage criteria that should trigger urgent trauma center transport include

Answer 18

injuries associated with a high probability of a poor outcome.

Examples include: Penetrating injuries to the head, neck, torso, or proximal extremities; Suspected spinal cord injuries; Pelvic fractures; and Crushed, mangled, or pulseless extremities.

Question 19

Penetrating injury to which four body areas fall into the CDC’s Injury Pattern category for urgent trauma center transport?

Answer 19

The head, neck, torso, or proximal extremities.

These injuries are highly likely to require the surgical resources available at a trauma center.

Question 20

Patients with which head injuries meet the CDC’s field trauma triage criteria for transport to a trauma center?

Answer 20

Paitients with a skull deformity or a depressed skull fracture will require the neurosurgical resources of a trauma center.

Question 21

Which musculoskeletal injuries meet the CDC’s field trauma triage criteria for urgent transport to a trauma center?

Answer 21

Pelvic fractures; 2 or more proximal long bone fractures; Crushed, degloved, or mangled extremities; and Amputations above the wrist or ankle.

These complicated musculoskeletal injuries will require the expert orthopedic surgical services available at a trauma center.

Question 22

True or False: Patients with an unstable chest wall meet the CDC’s field trauma triage criteria for transport to a trauma center for care?

Answer 22

True.

An unstable chest wall (aka flail chest) indicates a significant amount of force was applied to the thorax, making many injuries possible. Moreover, flail chest quickly compromises ventilation.

Question 23

True or False: A patient with a suspected spinal injury and sensory deficits meets the CDC’s field trauma triage criteria for transport to a trauma center.

Answer 23

True.

Any patient with a potential spine injury who has motor or sensory deficits likely has a spinal cord injury, which needs to be managed at a trauma center.

Question 24

“Proximal long bone fractures” refers to injuries to which bones?

Answer 24

The femur and humerus.

Fractures to the humerus and femur can potentially cause significant hemorrhage into their respective compartments. Multiple long bone fractures can lead to fatal blood loss.

Question 25

External bleeding severe enough to require a ______ or ______ meets triage criteria for trauma center care.

Answer 25

a tourniquet / wound packing with continuous pressure.

The frequency of tourniquet use is steadily increasing as injury prevention efforts, such as the Stop the Bleed campaign, become widespread.

Question 26

The CDC’s two RED field trauma triage categories are______ and ______ .

Answer 26

Injury patterns / Mental status and vital signs.

These two categories evaluate a patient’s current anatomical and physiological status to determine whether a trauma center’s resources are necessary.

Question 27

The CDC’s two YELLOW field trauma triage categories are______ and ______ .

Answer 27

Mechanism of injury / EMS judgement.

Patients who fall into the MOI category have experienced an injury mechanism that places them at moderate-to-high risk. The EMS judgment category recognizes the expertise of prehospital personnel who have concerns about patients who don’t meet other triage criteria.

Question 28

Using the CDC’s field trauma triage criteria, name 3 situations that make a motor vehicle crash “HIGH-RISK.”

Answer 28

Ejection; Intrusion >12 inches into the occupant compartment or >18 inches anywhere; Extrication; Death in the same passenger compartment;
Child unrestrained or in an unsecured safety seat; Telemetry data consistent with severity; Rider separated from a vehicle with impact;
Pedestrians or bicyclists hit, thrown, or run over.

Question 29

Extrication from a vehicle means _________.

Answer 29

special equipment was requried to remove an entrapped person from a vehicle.

These patients are at increased risk for a poor outcome related to delays to trauma center arrival and emergency interventions.

Question 30

Intrusion > ______ inches/cm into the occupant compartment or > ______ inches/cm anywhere on a vehicle is defined as a high-risk MVC.

Answer 30

12 / 18

Intrusion >12 in (30 cm) into the occupant compartment or >18 in (45 cm) anywhere on the vehicle. Compartment space intrusion suggests more energy was transferred to vehicle occupants.

Question 31

Falls > ______feet/m are defined as MODERATE-risk for severe traumatic injury.

Answer 31

10 feet (3 m)

Question 32

The CDC’s field triage EMS Judgement criteria for low level falls include what age groups?

Answer 32

Kids ? 5 years and adults ? 65 years

Question 33

Name 3 of the CDC’s EMS Judgement triage criteria considered MODERATE-RISK for severe traumatic injury.

Answer 33

Falls kids ? 5 years or adults ? 65 years
Anticoagulant use; Pregnancy > 20 weeks
Special high-resource healthcare needs
Burns in conjunction with trauma; Suspicion of child abuse

Question 34

A globe injury refers to injury to ______.

Answer 34

The eye. These special injuries require the resources of a trauma center with opthalmalogic surgery available.

Question 35

“An organized approach to the acutely injured patient that provides personnel, facilities, and equipment for optimal care on an emergency basis, within a defined geographical area, available 24 hours a day.” This is the definition of a

Answer 35

trauma system.

Question 36

Limited ______ to care explains the high trauma mortality seen in rural areas.

Answer 36

access

A shorter time from injury to trauma center care improves outcomes in trauma patients. There are many rural and frontier communities where injured individuals experience prolonged delays to trauma center care.

Question 37

A severely injured patient has a ______ % better chance of survival when treated at a designated trauma center.

Answer 37

25-30%.

For many people living in rural communities, the nearest trauma center may be hundreds of miles away.

Question 38

In the US, State Departments of Health (or other governmental agencies) are responsible for ______ trauma centers according to State or local criteria.

Answer 38

designating

Therefore, criteria for trauma center levels (I-V) vary from state to state.

Question 39

State trauma center DESIGNATION is ______.

Answer 39

mandatory

A hosptial cannot call itself a trauma center unless designated by the State (or other governmental agency) responsible for assigning trauma center levels.

Question 40

The American College of Surgeons (a NON-governmental agency) ______ trauma centers based on adherence to a standardized list of resources and processes that must be in place.

Answer 40

verifies

States (or governmental agencies) designate trauma centers at a certain level; designation is mandatory. Trauma centers can also seek American College of Surgeons (ACS) verification to validate their level of resources and quality outcomes. Some states require trauma centers to achieve ACS verification.

Question 41

American College of Surgeons VERIFICATION is _______.

Answer 41

optional in some states but required in others

Question 42

American College of Surgeons verification requires trauma center participation in the ______ and their ______ .

Answer 42

The National Trauma Data Bank (NTDB) / Trauma Quality Improvement Program (TQIP).

Question 43

In the US, there are ______ recognized trauma center levels.

Answer 43

Five.

Level I trauma centers have the entire spectrum of available resources for trauma patients, while Level V centers may provide only critical access services and may not be open 24/7. Not all states utilize Level IV or V trauma center designation.

Question 44

Who determines how many and what level trauma centers are found in a state?

Answer 44

Each state identifies the appropriate number and level of trauma centers to meet its population’s needs. Both the number of centers and their levels are subject to change as needed.

Question 45

What 4 resources must ACS Level I trauma centers have that are not required of lower-level trauma centers?

Answer 45

A high volume of severely injured trauma patients
Trauma surgery specialist and subspecialist availability
A trauma surgery residency
A robust research program

Question 46

ACS Level II trauma centers are not required to have a trauma surgery ______ program or a large-scale program of ______ .

Answer 46

residency / research

Question 47

ACS Level III trauma centers are not required to have a ______ in-house 24/7.

Answer 47

trauma surgeon

At ACS Level III centers, surgeons have up to 30 minutes from the time of notification to arrive at the patient’s bedside.

Question 48

The priorities for ACS Level IV trauma centers are initial ______ and ______ of the injured patient.

Answer 48

evaluation / stabilization

Transfer to higher-level care should not be delayed for imaging or definitive management of identified injuries.

Question 49

Trauma center designation reflects the level of ______ available NOT ____.

Answer 49

resources

Designation levels refer to the resources (personnel, equipment, supplies, and procedures) available at a trauma center, not to the level of commitment, competence, or quality of care provided.

Question 50

Designation as a ______ requires a comprehensive, hospital-wide commitment to the care of injured patients that involves multiple services.

Answer 50

trauma center

Question 51

Providing post-acute care _____ services is a trauma center requirement shown to improve long-term outcomes and speed return to function.

Answer 51

rehabilitation

Inpatient rehabilitation units are not required, but trauma centers must provide rehabilitation specialists to assist trauma patients in their transition from acute care to the rehab setting.

Question 52

Data collection, analysis, and action-plan implementation are elements of a trauma center’s ______ program that are required for optimal trauma patient outcomes.

Answer 52

performance improvement (or quality improvement)

Question 53

Trauma is the most ______ of diseases.

Answer 53

preventable