European Trauma Course Research Articles

Blunt Trauma Neck with Thyroid Cartilage Subluxation with no External Sign

Trauma to the neck can produce catastrophic results as neck houses plethora of vital structures and is relatively an unprotected anatomical territory. Blunt trauma to the neck, excluding cervical spine injuries, represents only 5% of all neck trauma, but can be very challenging to assess since its presentation is often delayed. Penetrating injuries, on the other hand, are more common, and even when they seem to be only superficial and minor, always need thorough investigation and observation. Primary stabilization of the patient followed by an extensive evaluation needs to be done in all cases of neck trauma. CECT neck and thorax along with fibreoptic laryngoscopy remain the main modalities of diagnosis following a neck trauma. The initial approach to any kind of neck injury, whether penetrating or blunt, is performed according current Advanced Trauma Life Support (ATLS) or European Trauma Course (ETC) protocols, which both use the structured ‘ABCD’ approach. A motor vehicle accident (MVA) remains the most common cause of blunt neck injury, causing direct pressure to the anterior neck from the dashboard, steering wheel or airbag deployment. Direct pressure to the neck is transduced to the trachea and causes compression of the oesophagus against the cervical spine. Laryngotracheal trauma continues to be a rare entity and is the second most common cause of death in patients with head and neck trauma after intracranial injury. Only 0.5% of multiple trauma patients were reported to have injury to the airway at any level. Stabilize the airway first. Immediate surgical airway procedure can be necessary in less familiar circumstances and environments. If possible, define landmarks before the procedure. Defining anatomical zones is useful in penetrating injuries, although these do not guide diagnostic or therapeutic management completely. In unstable patients, elective surgical exploration is recommended instead of extensive diagnostic work-up. Unstable patients still need immediate exploration, whereas all stable patients will first be assessed with clinical examination and CT angiography and fibreoptic laryngoscopy. Thus the take home message is to consider all neck injuries an emergency and proceed with the diagnosis and management without delay.

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BackgroundThis experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.MethodsIn a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.ResultsNinety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann–Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).ConclusionsThe integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.Trial registration: University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

Does participation in the European Trauma Course lead to new behaviours and organisational change? A Portuguese experience

BackgroundMedical educational courses can be successful from an immediate feedback perspective but not lead to new behaviour or organisational changes in the workplace. The aim of this study was to assess the self-perceived impact of the European Trauma Course (ETC) on Reanima trainees’ behaviour and organisational change.MethodsA 40-item questionnaire based on Holton's evaluation model was used to evaluate the candidate's perceptions. The results were analysed with descriptive and inferential statistical analysis using nonparametric tests with α = 0.05.ResultsOut of 295 participants, 126 responded to the survey. Of these, 94% affirmed that the ETC modified their approach to trauma patients, and 71.4% described a change in their behaviour. Postcourse responders changed their behaviour in their initial approach to trauma care in the nontechnical skills of communication, prioritisation and teamwork. Being an ETC instructor strongly influenced the acquisition of new material, and this group was able to implement changes in attitudes. Individuals with no previous trauma course experience identified lack of self-efficacy as a significant obstacle to introducing new work-based learning. In contrast, responders with ATLS training noted a lack of ETC colleagues as the main impediment for moving from conceptualisation to experimentation in the workplace.ConclusionsParticipation in the ETC led to behavioural changes in the workplace. However, the ability to influence others and bring about wider organisational changes was more difficult to achieve. Major factors were the status of the person, their experience and self-efficacy. National organisational impact was obtained, which went far beyond our aspirations in acknowledging change in individual daily practice.Future research studies will include the effect of implementing the ETC methodology on the outcome of trauma patients.

Worldwide snapshot of trauma team structure and training: an international survey.

Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.

ACTUALIZACIÓN DEL MANEJO PREHOSPITALARIO DEL PACIENTE CON TRAUMA GRAVE

INTRODUCTION The goals of pre-hospital care for severe trauma are the detection of lifethreatening injuries, the early application of therapeutic measures and the timely transfer to an appropriate hospital centre. The response of the emergency services to major trauma incidents involves different responders with specific functions and in a variety of often challenging contexts. Therefore, a common language, preparation and coordination are essential to ensure compliance with the goals and quality of care. OBJECTIVE To carry out an update on the management of the adult trauma patient based on new evidence and practices. METHODS Literature review search mainly through PubMed. A secondary search on UptoDate and the latest editions of reference books on prehospital and advanced major trauma, and in reference organizations such as Difficult Airway Society, Advanced Trauma Life Support, European Trauma Course, and Anaesthesia, Trauma and Critical Care Course (ATACC). A tertiary search through the references in the UpToDate guidelines to identify new sources. Search terms included: prehospital care, major trauma, difficult airway, permissive hypotension, immobilization, both in Spanish and English. RESULTS The management of catastrophic bleeding is the first step in the primary assessment, because it can cause death even before an obstructed airway. Airway management and ventilation remain a priority. Permissive hypotension is increasingly accepted in the management of major trauma with hypovolemic shock except in the case of patients with head trauma. Prevention and control of the deadly triad (acidosis, hypoxia and hypothermia) improve the prognosis. An “excessive stabilization” approach should be avoided, so that access to definitive treatment is not delayed. CONCLUSIONS Prehospital trauma care is necessarily multidisciplinary, requiring coordination and communication between teams to ensure quality of care.

Primary Management of Polytrauma

The management of polytrauma patients is a challenging and dynamic process for the whole multidisciplinary team in the emergency department. Decisions made and measures taken during primary management have the ultimate effect on the prognosis of multiple injured patients. Trauma team leaders and team members benefit from a structured approach to such a complex situation. Hospital-specific interdisciplinary consensus on the workflow can help to optimize the management of trauma patients. All medical specialties involved should therefore have a basic understanding of each other’s approaches and the treatment options of the most important injury patterns. Primary Management of Polytrauma aims to provide a systematic and comprehensive guide on how to identify treatment options of potentially life-threatening injuries. The editors, all 3 themselves experienced surgeons from the Republic of South Korea, gathered authors from several surgical disciplines to cover sections on injuries of all major body regions. These specific sections are preceded by 2 sections on “Initial Assessment and Management” and the “Management of Shock,” which are authored by an emergency physician and 2 acute care surgeons. The book ends with 2 chapters on the role of radiology and a section on when and how to transfer trauma patients from your hospital. Within its 183 pages, the book provides a lot of detailed surgical information on how to diagnose and to classify individual injuries and gives insights into the regional approach of the management of trauma patients. Unfortunately, these sections do not intersect with each other, and there exists no overriding framework. Therefore, the book falls short to be a structured step-to-step guide to the management of polytrauma patients. Especially during the primary management of multiple injured patients, anticipation of injury mechanisms, pathophysiology of injury-related diseases (ie, trauma-associated coagulopathy), and critical injury constellations are crucial points. Unfortunately, none of these problems are substantially discussed in the book. The authors do not mention internationally accepted course concepts like the European Trauma Course (ETC) or Advanced Trauma Life Support (ATLS), both of which offer possibilities to learn trauma management in a structured manner. The views of international guidelines are rarely reflected in the book. In the chapter “Management of Shock,” recommendations on hemostatic resuscitation include the immediate transfusion of packed red blood cells; fresh-frozen plasma; platelets; and the correction of the lethal triad of coagulopathy, hypothermia, and acidosis. Lots of such improvident advice can be found throughout the first 2 chapters. For massive transfusion situations, for example, it is stated that (Chapter 2, page 14) “Current data support a target ratio of plasma:red blood cell:platelet transfusions of 1:1:1.” No advice on how to adjust transfusion on laboratory measures or the potential problems that come with transfusing large amounts of plasma is mentioned. The “current data” cited in the reference list, however, were published between 1982 and 2010, although more recent and high-quality evidence would have been available in most cases.1 Cited references in the short section discussing coagulopathy even go back to 1982–1989 (Chapter 2, page 14). More importantly, the book is lacking high-evidence recommendations from international consensus guidelines, like the early application of tranexamic acid to the bleeding trauma patient to treat or prevent hyperfibrinolysis.2 Specific chapters provide more detailed information on the classification and the surgical approach to the respective injuries. Radiological images and the discussion of relevant clinical scoring systems (as can be found in Chapter 4, “Spinal Injuries”) can support the physician’s individual decision-making. However, in most cases, these decisions would not be made by the leader or a member of the trauma team during the initial management of the patient. This is rather a surgical specialist’s task. In summary, this book allows for detailed insight into parts of the surgical decision-making and the approach to specific injuries and injury patterns of the polytraumatized patient. This can be interesting additional information for the advanced trauma leader or interested members of the trauma team. Due to lack of evidence-based information and missing recommendations from current guidelines, we cannot recommend the book as a guide or a reference for studying the primary management of polytrauma patients. Nils Kunze-Szikszay, MDKonrad Meissner, MDKlinik für AnästhesiologieUniversitätsmedizin GöttingenGöttingen, Germany[email protected]

ACTES 2019 - Abstracts Book; The 3rd Albanian Congress of Trauma and Emergency Surgery

This event reflects the author's involvement in internationally recognized education and training models, as ATLS, ETC, and DSTC, and UEMS Boards of Emergency SurgeryDo different countries need very different things? I don’t think so, for the simple reason that in Europe and about the challenges we face, with regard to trauma and other medical and surgical emergencies, similarities are much greater than differences.• We all agree on the need for a trauma system “to assure that patients (…) seamlessly receive the proper care, in the proper locations, with proper interventions and, if necessary, transfer to a hospital able to provide the best and most appropriate care” (www.aast.org).• We all agree that teamwork is necessary for prehospital care, transportation, emergency room care, intensive care, surgery, and in/post-hospital rehabilitation.• We all agree on the need for trauma registries with, as much as possible, global follow-up of patient's course.• And finally, we all agree that it is necessary to educate, how to prevent and how to treat.This is also apparent from the recommendations of the European Trauma Course Organization (ETCO) about equipment and facilities: complete trauma team, trauma admission bay close to the ambulance entrance, enough space and adequate lighting, the adjacent operating room to allow emergency procedures, standardequipment for the initial management of major trauma, immediate availability of additional equipment as difficult airway equipment, X-ray, ultrasound machine, surgical instruments, readily available bloodproducts and massive transfusion equipment, co-located CT scanner to allow immediately imaging and access to angiography and interventional radiology, 24 hours a day within 30-60 minutes of request.

Optimal practice for emergency ‘front-of-neck’ airway in trauma setting: Words of European Trauma Course Austria instructors

Purpose of the study: The essence of trauma airway management is to establish and/or maintain adequate oxygenation, ventilation, and airway protection. Unanticipated difficult airway (DA), accompanied with cervical immobility, represents a major challenge in trauma emergencies, and may result in significant morbidity and mortality. Therefore, all trauma personnel must be familiar with well-established framework for unanticipated DA management. Emergency ‘front-of-neck’ airway (FONA) represents ‘end-of-algorithm’ following ‘can’t intubate, can’t oxygenate’ (CICO) rescue scenario. For the purposes of these, the 2015 Difficult Airway Society (DAS) guidelines propose ‘scalpel-bougie’ (SB) technique. However, recent scientific evidence, depending on individual experience, training, and comfort of use, advocate other techniques, such as needle cricothyroidotomy (CCT). In our study we aimed to investigate European Trauma Course (ETC) instructors’ optimal practice for emergency FONA.

What is our motivation for teaching on European Trauma Course (ETC)? Results from a survey of active ETC instructors in Austria

What is our motivation for teaching on European Trauma Course (ETC)? Results from a survey of active ETC instructors in Austria

Challenges instructors meet while teaching on European Trauma Course (ETC)

Challenges instructors meet while teaching on European Trauma Course (ETC)

The development of the European Trauma Course in Austria: Data on 30 courses

The development of the European Trauma Course in Austria: Data on 30 courses

The European Trauma Course development from 2006 to 2015

The European Trauma Course development from 2006 to 2015

The use of cricoid pressure during rapid sequence induction in trauma patients – UK and European practice compared

IntroductionThere is ongoing debate and conflicting evidence surrounding the place of cricoid pressure (CP) as part of a rapid sequence induction (RSI) of anaesthesia. This study investigated the current use of CP during trauma RSI and compared reported practice in the UK with the rest of Europe.MethodsAn anonymised, web-based survey was sent to all clinicians registered as European Trauma Course instructors.ResultsCP use was reported by 83.1% of UK respondents and 39.4% from the rest of Europe, with an overall reported use of 49.8%. Anaesthetists use CP less commonly (35.6%) than clinicians from other specialties (63.6%). The most common reason given for not using CP (76.7%) was a perceived lack of evidence of effectiveness.ConclusionGenerally the use of CP appears to be in decline with only half of all clinicians reporting to use it; however it remains much more commonly used in the UK than the rest of Europe.

Utilization of social media platforms among instructors of European Trauma Course in Austria

Utilization of social media platforms among instructors of European Trauma Course in Austria

Finding the fifth intercostal space for chest drain insertion: guidelines and ultrasound

ObjectivesInternational guidelines exist for chest drain insertion and recommend identifying the fifth intercostal space or above, around the midaxillary line. In a recent study, applying these guidelines in cadavers risked...

Detection of haemorrhagic shock: Are vital signs obsolete? A commentary by Dr M. Luginbühl

Detection of haemorrhagic shock: Are vital signs obsolete? A commentary by Dr M. Luginbühl

Guidelines for chest drain insertion may not prevent damage to abdominal viscera

ObjectivesGuidelines to improve the ease and safety of chest drain insertion recommend using the fifth intercostal space, around the midaxillary line (MAL). This study aimed to assess whether compliance with...

The European trauma course: trauma teaching goes European.

The European trauma course: trauma teaching goes European.

Notfälle im Krankenhaus - Ausbildungskonzepte für innerklinische Notfallsituationen

In this manuscript training concepts, which help us to manage in-hospital emergency situations adequately, are described. International courses such as the Basic Life Support Course and the Advanced Life Support Course of the ERC are introduced. Recently the European Trauma Course has been established; technical and non-technical skills, which are necessary to treat traumatised patients, are taught in this course. The quality of the medical emergency team in the hospital should be monitored to find deficits and to improve teaching. The use of the new in-hospital emergency chart and participation in the new emergency register of the DGAI may be helpful.

Guidelines for chest drain insertion do not protect relevant anatomical structures

We have reported the risk of chest drain insertion inferior to the diaphragm when using current international guidelines [1]. Another complication is damage to significant peripheral nerves, such as the long thoracic nerve causing winging of the scapula [2]. We assessed these risks using: the European Trauma Course method, a patient's handbreadth below their axilla just anterior to the midaxillary line; the British Thoracic Society safe triangle [3]; and the Advanced Trauma Life Support (ATLS) course guidance [4].