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Back To The Basics- Trauma I
Bob Blumm, MA, PA-C, DFAAPA
As I look at both the demographics and the job openings on this site, it is obvious that many PAs and NPs serve or wish to work, in emergency medicine. I am a surgical PA by my employment history but I have spent 12 years in emergency medicine not including my two and a half years in Vietnam where I saw trauma on a daily basis. Emergency Medicine is both a primary specialty for many as well as a moonlighting or secondary job for both professions. In the past 10 years I have seen a large number of NPs working side by side with their PA counterparts in this exciting area. Many APC’s start their EM career in the Fast Track but as they accumulate knowledge and sharpen their skills they are readily noticed by the EM director and move to the trauma team. This is indeed a privilege as it is an acknowledgement of your skill level and competency in many areas. We really only have a few post graduate residencies in emergency medicine with trauma as a component therefore most of us have developed our trauma skills “on the job.”
It is my intention for the next six weeks to introduce some of you to trauma in a specific manner that reflects the teaching of the TEAM Program of the American College of Surgeons. Team is the acronym for Trauma Evaluation and Management and reflects the didactic portion of the ATLS course and is usually given to Medical Students and to APC’s. Those that wish to may apply for the standard ATLS Course however according to the regulations there may only be sixteen people in a course and four of them or 25% may be PAs and NPs. I will be giving a four hour workshop on TEAM at the AFPPA CME Conference in Orlando this spring as well as at the Georgia Academy CME meeting this summer and the Washington, D.C. meeting of the AFPPA in August. I give this program around the country when requested but this is basically an overview of trauma and does not replace the solid lectures specific to certain areas such as blunt abdominal trauma which will be given by my friend and colleague, Terry Mize at the GAPA meeting this summer.
ATLS has its genesis in acknowledgement that hospitals across the country were treating trauma differently and without a structure which had a negative result for a surgeon and his family after a plane crash. Three years later this gave birth to the ATLS Course for Doctors. We have worked hard for more than a dozen years and now PAs and NPs may take this course alongside physicians and receive the same credit and an ATLS card of completion. The goals of ATLS are fourfold:
1.A rapid, accurate and physiologic assessment of the trauma patient.
2.Resuscitate, stabilize and monitor by priority.
3.Prepare for transfer to definitive care.
4.Teamwork for optimal, safe patient care.
The objectives of the TEAM program and ATLS in general are to describe the fundamental principles of initial assessment and management, identify the correct sequence of management priorities and to describe the appropriate techniques of resuscitation. The objectives also include the value of the patient’s history, an understanding of the mechanism of injury and identifying the concepts of teamwork in caring for the injured patient.
Trauma is the leading cause of death for ages 1-44, 150,000 deaths per year in the USA are the result of trauma. Disabilities exceed death by a ratio of 3:1 and results in an expenditure of over $400 billion dollars yearly and accounts for 33% of hospital admissions. 70% of these trauma patients are victims of a motor vehicle related accident. Where can we make a difference? Studies suggest that there remains a lack of awareness of injury prevention but we are well aware of the end result of spilling hot coffee on your lap from Mc Donald’s. Trauma strikes down our youngest and potentially most productive citizens. It is for this reason that communities have a Regional Trauma Program.
Hopefully, the studies, evidence, results of outcomes and education to prevent injury will change these statistics.
As we look to the future we will observe the current trends in accident victims and prepare ourselves to be the providers that can change the M&M figures and learn the concepts that the program offers. This education requires teamwork, diligence and a desire to excel and make a difference.
 Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
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