In an article recently published in the World Journal of Surgery, Hadassah University Medical Center trauma specialists shared their finding: introducing an intensified, high-level supervision approach to trauma care decreases the percent of fatalities.
The article entitled Trauma Care and Case Fatality during a Period of Frequent, Violent Terror Attacks and Thereafter, brought out that in Hadassah Hospital's Shock Trauma Unit (HHSTU), close supervision by senior staff of pre-hospital triage, transport, and all surgical procedures, as well as longer hospital stays led to increased survival. Emphasis was on the on-site presence, hands-on close supervision, and direct involvement in case management by senior attending trauma surgeons in all specialties, such as orthopedics, neurosurgery, and anesthesiology.
"Furthermore," the authors relate, "in almost every trauma case, and consistently in mass casualty situations, the head of the Department of General Surgery is present to provide advanced knowledge, experience at the hands-on level, and supervision to each trauma patient to optimize the level of care and to minimize errors in diagnosis and management."
Hadassah's protocols were derived from the models of care developed at the Maryland Institute of Emergency Medical Services System (MIEMSS), where senior surgeons play a pivotal role in trauma care and disaster management through their constant direct supervision.
Case Fatality rates (CFRs) were tracked in 8,127 patients. The results over a five-year span (1999-2003) revealed CFRs of 2.62 percent—less than half that in 51 Level 1 United States trauma centers. As the decade progressed, the percent continued to decline so that by 2010, the CFRs were 1.9 percent. The Hadassah team, headed by Prof. Avraham Rivkind, head of the Trauma Unit, explains that previous data had shown large differences in CFRs in trauma centers that had similar resources.
Therefore, it highlighted the importance of replicating structures and processes of those centers with superior survival results. "Despite the oft-mentioned increased financial burden of increased length of hospitalization," the authors conclude, "extended in-hospital care of trauma victims improved the outcome of trauma patients admitted to our ICU (Intensive Care Unit), and its value should be taken into consideration for seriously injured cases." The article was published online in the May 17, 2012 edition of World Journal of Surgery.