RELEVANT EDUCATION IN VISCERAL TRAUMA
As mentioned in the Introduction, surgeons and surgical education in Europe is challenged by predominantly blunt trauma increasingly managed non-operatively, work hour restrictions, and few well developed trauma systems centralizing the most severely injured to well defined and dedicated trauma centres, most surgeons will feel uncomfortable with critically ill trauma patients. Let’s face it, the surgical responsibility for the critically injured trauma patient from the acute phase in the ED through hospital definitive treatment and ICU stay is not adequately covered in our surgical education. Every surgeon is responsible for his/her own competency in this field. With this chapter, the VTS seeks to point out what educational elements are necessary to reach a minimum competency in trauma care, and then provide a list of courses available within each of these areas. The VTS is not aiming at devloping new course concepts where there are relevant, high quality courses available. However, the VTS is open to taking on the challenge of developing educational concepts where deemed necessary.
The four main areas every surgeon should have additional education in order to be able to function in a team or as a trauma team leader and trauma surgeon are:
Similar courses for nursing staff like ATCN and TNCC should be promoted
European Trauma Course – ETC
Based on the same ABCDE principles as ATLS but has the teamwork aspect added (CRM)
DSTC is a 3 day course with practical training as well as interactive discussions and robust training in surgical decision-making based on physiology. DSTC is currently organized in 29 countries; in Europe: France, Italy, Portugal, Greece, Netherlands, Denmark, Sweden, Norway, Germany, Austria.. In several countries the course is being organized as a team course with anaesthesia (DATC)
One day didactic course owned by the ACS. Trains mainly vascular access in cadavers, but with some focus on decision-making. We suggest it as an add-on to DSTC or equivalent.
One-day course focusing on trauma surgical technical skills. We suggest it to be used as refresher course after DSTC or combined with decision-making training.
TREATMENT GUIDELINES IN VISECERAL TRAUMA
Trauma care has to be systematic and simple. The treatment of most injuries can be protocolized and is so in well-developed trauma systems. Protocols and guidelines are helpful in stressful situation were quick decisions has to be taken by less experienced physicians.
Development of robust guidelines is a resource-intensive task and relevant and updated guidelines have been developed and cover most existing trauma settings and injuries. No guideline will be of global relevance, since trauma care has to take into account the setting and resources in which the patient is being treated. Even within Europe, the health care systems and resource situations vary. The VTS committee has therefore decided that we don’t need to reinvent the wheel where there is a functional one already existing. We have therefore decided to provide links to relevant webpages where updated protocols and guidelines can be found for the fields of trauma we aim to cover.
If you, as a member of VTS or interested reader discover fields that are not adequately covered or update is due, we trust you to be active and let us know, so that we can consider the topic for development of a new guideline.
Initial trauma assessment
Specific injury treatment guidelines
Critical care in the trauma patient
Trauma system development and quality improvement programs
WHY A VISCERAL TRAUMA SECTION?
First of all, what is visceral trauma? According to MedicineNet, visceral is referring to the viscera, the internal organs of the body, specifically those within the chest (as the heart or lungs) and abdomen (as the liver, pancreas or intestines). In addition to torso organ injuries, we have chosen to include all non-orthopaedic trauma in the scope of the visceral trauma section. This includes initial work-up of any potentially severely injured patient (including prehospital), as well as intracranial injuries and critical care for the trauma patient. The trauma patient has to be managed as potentially severely injured and with limited information.
Why is there a need for a visceral trauma section in ESTES? Following traumatic brain injury, torso trauma and especially the critically injured patients with ongoing bleeding, represent the major cause of preventable deaths. The surgical landscape is changing rapidly worldwide, with better diagnostic tools and advancements in surgical instruments such as laparoscopic and robotic surgery. This has led to increasing sub-specialization in most surgical fields in Europe. These changes have led to a generation of more super-specialized surgeons with specific expertise in a narrower field of surgery. Adding to these changes, work hour regulations, more non-operative management of blunt trauma, few well developed trauma systems directing severely injured patients to dedicated trauma centers, has led to most surgeons are uncomfortable managing critically ill trauma patients.
The Visceral Trauma Section’s aim is to increase the interest and spread the knowledge to improve the care of the critically injured torso trauma patient, including the whole chain of survival.
Dear visitor if you have any questions in regard to our section, we gladly invite you to contact us on the following e-mail addresses:
Macsim / MRMI: www.macsim.se
MRMI: Several dedicated international disaster courses are organized across Europe by our members.
The courses are all based on the MRMI (Medical response to major Incidents and Disasters) format, a teaching format introduced by prof Sten Lennquist. Many members have contributed in the development of this format and the subsequent courses. Courses have been given in Kroatia, Netherlands, Madeira, Milaan, Slovenia, Stockholm
Information of the MRMI can be found on: www.macsim.se
Active centers with annual courses are:
Karolinska University Hospital, Stockholm Sweden ; Contact: Sten Lennquist (firstname.lastname@example.org)
Colegio Dos Jesuitas, Funchal, Madeira; Contact: Pedro Ramos (email@example.com)
San Raffaele Hospital in Milan, Italy; Contact: Roberto Faccincani (firstname.lastname@example.org)
Surgical training for austere environments: Interactive 5 dag course to prepare the candidate for austere conditions. www.rcseng.ac.uk/courses/course-search/surgical-training-for-austere-environments
As stated in the introduction the section strives to expand its knowledge and expertise. On this page the currently active projects of members are mentioned briefly.
Threats: The THREATS project aims to increase the resilience of EU hospitals as critical infrastructure by improving their protection capability and security awareness against terrorist attacks. It’s aims are:
To develop a reliable method for assessing the risks and vulnerabilities of major EU health infrastructures to terrorist attacks; To prepare specific security and threat assessment models and tools applicable to the Health sector using other EU projects; To challenge these tools through application to the San Raffaele Hospital in Milan; To disseminate guidelines designed to optimize the preparedness of hospitals’ healthcare infrastructures against terrorist attacks. For more information mail: email@example.com
MSF: The section is in negotiation with MSF (Médicine Sans Frontière) in Brussels in regard to provide specialists from our members to assist in medical relief in a broad sense and specifically in regard to disasters.
Many members are enthusiastic for this project. Currently we are negotiating the conditions in regard to insurance etc. If after reading this you would like to apply for this project then mail: firstname.lastname@example.org
The Disaster and Military section proudly announces that they strive to annually procure a plaquette, to an individual or institution, in recognition of extraordinary achievements in the field of Disaster and Military medicine. Every member of the section may nominate a person or institute for this prize. Certain rules are applicable, these can be read by pressing this.
The first to receive this prize is prof Sten Lennquist. (2015) He was one of the Founders of ESTES and is considered the godfather of this section. He has an impressive track record of achievements in Disaster medicine, eg. the founder of Macsim® and Editor/ author of Medical Response to major Incidents and Disasters. A milestone in the literature concerning disaster care.
2015: Prof. Sten Lennquist, Sweden
2016: Dr. Gino Strada, Italy
The Section has 193 individual members and we are happy to see that the numbers are gradually increasing.
The following counties are listed: Austria, Belgium, Brazil, Bulgaria, China, Croatia, Denmark, Dominican republic, Egypt, Finland, France, Georgia, Germany, Greece, Hungary, India, Ireland, Israel, Italy, Japan, Kazakhstan, Korea, Latvia, Lebanon, Liberia, Malta, Mexico, Netherlands, Nigeria, Norway, Portugal, Romania, Russia, Saudi Arabia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Arab Emirates, United Kingdom, USA. The Netherlands , Germany and Great Britain, are the top 3 providers of members. We are honored to see that our European society even is growing roots in countries far beyond the European community.
The board of the section is chosen by the members of the section for a term period of 2 yrs and with a possibility for prolongation with another 2 yrs.
Mike Bemelman, trauma surgeon, St. Elisabeth hospital Tilburg, The Netherlands. (April 2013 – April 2017)
He is currently working in a non academic level 1 trauma center. He has special interest in
disaster and military medicine. Prior to the St Elisabeth he has worked for 6 years in the
UMC Utrecht and was involved with activities in the Disaster hospital of the UMC Utrecht,
since 2009 he is a MRMI instructor and has been course director of several courses.
Pedro Ramos, Surgeon, Madeira (April 2016 – April 2018)
Chair of Trauma Section of Portuguese Surgical Society since 2012 working at Nelio Mendonça Hospital in Madeira . Special interest in Trauma, Emergency andCatastrophe, European Instructor for ATLS, DSTC, ETC, TEAM, MRMI and leading Portuguese MRMI Project since 2010, where has been Course Director of several courses .
The ESTES (European Society for Trauma and Emergency Surgery) was founded in 2007 after a merger between EATES (European Association for Trauma & Emergency Surgery) and ETS (European trauma Society). Within the EATES a Disaster and Military section already existed since 2006 and was founded by Sten Lennquist. Subsequently and after the formation of ESTES the disaster and military section was the first to be re-installed in 2008 with Sten Lennquist as past president of ESTES and chair of the Disaster and Military section.
In 2010 the first Vice Chair was installed within the section with Fernando Turegano.
Together with the founding of ESTES a merging was realized between the EJTES (European Journal of Trauma and Emergency Surgery) and the International Journal of Disaster Medicine. The latter being under the guidance of Sten Lennquist as Editor.
In 2012 Sten Lennquist past on the Chairmanship of our Section.
The Disaster and Military section is one of the 5 sections of the ESTES, The section has a board which is directly under the executive board of the ESTES and represents approximately 190 individual members from many countries. The section has the ambition to be active within the disaster and military field. Several initiatives have been made to provide disaster courses. During the ECTES congresses we strive to provide interesting topics and talks with renown speakers and experts from all over the world. Currently new initiatives are explored in expanding our knowledge and expertise. For more details we invite you to look at the “Projects” and “Courses” page.
What does the Polytrauma section represent?
Patients with multiple severe injuries encounter a larger range of complications and a more complex clinical stay than those with severe isolated injuries, e.g. “polytrauma is more difficult to treat than the sum of the isolated injuries”.
The treatment requires knowledge of the complex interplay between several cascade systems that are activated by the injury, the hemorrhage, the ensuing coagulopathy and the activation of inflammation (four vicious cycles). The avoidance of complications through knowledge can save lives.
Therefore, it is necessary that this important subtopic is covered within a society that focuses on the treatment of acute injuries.
What is the aim of the Polytrauma section
The Polytrauma section aims at teaching members of ESTES, visitors of the Annual meeting and readers of scientific Journals the issues of pathophysiology, scientific findings and invovations in treatment of polytrauma patients. .
Board members (Polytrauma section and steering board)
Hans-Christoph Pape, Section chair
Aitor Andaluce, Section cochair
Steering Board Members:
Luca Fattori, Rebecca Hasler, Gleb Korobushkin, Aitor Landaluce-Olavarria, Radko Komadina, Diego Mariani, Thomas Müller, Hans-Jörg Oestern, Hans-Christoph Pape, Roman Pfeifer, Ruben Peralta, François Pitance , Hans-Peter Simmen
Definition of Polytrauma
An evidence based Definition of Polytrauma was developed by members of the Polytrauma section as follows:
The term ‘polytrauma’ was first used by Tscherne et al. in 1966 for patients that demonstrated a combination of at least 2 ‘severe injuries of the head, chest or abdomen’ or ‘one of them in association with an extremity injury’ In 1975, Border et al. defined the ‘polytrauma’ patient “as any patient with two or more significant injuries”. Oestern et al. then distinguished the entity ‘polytrauma’ as ‘a patient with two or more injuries, one of them being potentially life threatening’ from `isolated, but potentially life threatening injuries`, for which he coined the term ‘barytrauma’.
To address the lack of an evidence based definition, a group of experts met in a series of scientific sessions and meetings. These were held under the auspices of several societies; European Society for Trauma and Emergency Surgery (ESTES), German Trauma Society (DGU), British Trauma Society (BTS), American Association for the Surgery of Trauma (AAST), New Zealand Association for the Surgery of Trauma (ANZAST) The consensus was reached following a number of quality management measures, such as a preparative literature review, multiple in person meetings, and evaluation of data using data from 28.211 polytraumatized patients. The ensuing parameters consisted of five pathologic conditions and ancillary parameters to describe a multiply injured patient.
The definition of polytrauma revisited: An international consensus process and proposal of the new ‘Berlin definition’ Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, Lichte P, Josten C, Bouillon B, Schmucker U, Stahel P, Giannoudis P, Balogh Z. J Trauma Acute Care Surg. 2014 Nov;77(5):780-786.
The hallmark of the Polytrauma section is represented by the Polytrauma course, which is structured as a 2 day course. www-polytraumacourse.com
It is guided by a Polytrauma course steering board
Survey: What is new and what is true in Polytrauma
Definition of the major fracture
Initiative: DCO indications, an expert opinion and systematic review (EJOT 2020)
Polytrauma courses with ESTES, Steering board meetings
Standards in Trauma Management
Polytrauma courses with ESTES, Steering board meetings
S3 guideline and others for trauma
Polytrauma courses with ESTES, Steering board meetings
Indications and interventions of damage control orthopedic surgeries: an expert opinion survey_2020
The definition of polytrauma revisited: An international consensusprocess and proposal of the new ‘Berlin definition’_2014
Documentation of Blunt Trauma in Europe_2000
Free Polytrauma APP
The APP has been developed in 2016 and is available for Android and IOS. It is free and demonstrates all relevant scoring systems to be used in the emergency room and thereafter. It
– summarizes all relevant information
– includes clinically relevant scores
– includes clinically relevant flow charts
– helps with clinical decision making
The Emergency Surgery Section concentrates on the management of non-trauma emergency surgical patients. In addition to diagnosis and therapeutic intervention (radiological, endoscopic, laparoscopic and open surgery), surgical critical care forms an important part of the section’s work.
The Emergency Surgery Section has been instrumental in publishing the ESTES guidelines on Acute Mesenteric Ischaemia.
The current section chair and vice-chair can be seen in the board overview.
Emergency Surgery Course
February 1-2, 2019
Dear visitor, welcome to the webpage of the Disaster & military section, a section of the ESTES. The section is an enthusiastic group of the ESTES Community. It consists of world class specialists who are devoted in improving care and sharing knowledge in regard to disaster and military medicine. Feel free to surf through the different items depicted by the headers on the left of this page. If you have specific questions we invite you to contact the members as stated in “talking with us“.
The ESTES Skeletal Trauma & Sports Medicine section is happy to publish recommendations on hip fractures: