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INTRODUCTION TO TRAUMA
MANAGEMENT

EMERGENCY MEDICAL TECHNICIAN - BASIC


Trauma
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 Seventh leading cause of death in Indonesia for all


age groups is traffic accidents
Trauma
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 ADB (Asian Data Bank) estimated 30,464 deaths


from traffic accidents in 2004
 ADB estimated 2,550,000 injuries related to traffic
accidents in 2004
 Annual economic loss of 2.91 % of the GDP, or 6,032
million US dollars related to traffic accidents
 The police under report the actual numbers of
accidents and injuries

www.adb.org
Trauma
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2004
Trauma
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This is the number of DALY’s/1000 capita per year, meaning


the number of “disease associated life years” per 1000 people
every year affected by these injuries.
World’s lowest rate Indonesia’s rate World’s highest rate

For every 1,000,000 people in Indonesia, 3300 years


of life will be lost to traffic accidents every year, 6600
due to other injuries. Many of these life years could
be saved with rapid response and treatment.
(population in Indonesia in 2007 was 234,693,997)
Trauma
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One-fifth to one-third of
all deaths may be
preventable
Research Spending
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$15,000,000

$550,000,000 Cancer
Heart Disease
Trauma
$1,000,000,000

“Trauma: The Neglected Disease of Modern Society”


Time to Care vs Survival
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Evacuation Mortality
Conflict Time (hrs) Rate (%)
World War I 18 18.0

World War II 4-6 3.3

Korea 2-4 2.4

Vietnam 1-2 1.8

What do these numbers suggest about trauma care strategies?


When Trauma Deaths Occur

<1 hour 1-3 hours 4 to 6 weeks

“The Trimodal Distribution” 9


Immediate Deaths(<1 hour)
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 Loss of Airway
 Brain Stem Laceration
 High C-Spine Lesion
 Aortic/Heart Rupture

What can be done about these deaths?

What role does EMS play?


Early Deaths (1-3 hours)
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 Epidural Hematoma
 Subdural Hematoma Why do these
 Hemo/Pneumothorax patients die?
 Intra-abdominal Bleeding
 Pelvic Fractures
 Femur Fractures
 Multiple Long Bone Fractures
Late (2-4 weeks)
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 Sepsis
 Multiple Organ System Failure

How can these deaths be


avoided?
Trauma Care Conclusions
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 Definitive Trauma Care = Surgeon’s Knife


 Short time to surgery = Improved survival
 EMS improves survival by:
 Recognizing critical trauma
 Supporting oxygenation, ventilation, perfusion

 Transporting rapidly to definitive care


Where should the patient go?
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The most
appropriate
facility Not
necessarily the
closest one!

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