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.