Archive for September, 2010

San Diego Trauma Surgeon Urges Civilian Establishment to Adopt Military Trauma System

Tuesday, September 14th, 2010

In an August article in the Journal of the American College of Surgeons, Dr. Brent A. Eastman, a general, vascular and trauma surgeon in San Diego, urges medical and political institutions in the United States to make advances in our civilian trauma system adopted from current military practice.

The U.S. military has successfully reduced the death rate from combat trauma due to emergency treatment on the battlefield, rapid transport to a field hospital and then to a better equipped hospital in-country, and finally, evacuation to hospitals in Germany or the United States. “It’s all about getting the right patient to the right hospital at the right time,” Eastman says in the article. Eastman notes that there is a direct relationship between high rates of death and a scarcity of trauma surgeons in specific areas of the U.S., most notably in rural areas.

Eastman points out that trauma is the number one killer of youth and people younger than 45. “The people who are injured from trauma are our youth, our children, our future.”

Read the full article in the Los Angeles Times.

NTI to Participate in Combined Federal Campaign

Wednesday, September 8th, 2010

The National Trauma Institute will be one of many non-profit organizations to which federal employees can donate through the San Antonio area Combined Federal Campaign this fall. The campaign runs from September 1 through December 15. To direct a CFC donation to NTI, use NTI’s campaign code number: 94298.

The Combined Federal Campaign (CFC) was established by President Kennedy to provide a convenient way for federal employees–including military, civilian and US Postal Service personnel–to give to the charities of their choice. It is the largest single fundraising effort in the world, comprised of 340 individual campaigns throughout the United States.

2010 Symposium Highlight–Advanced Airway Workshop Offers Opportunity for Practice

Thursday, September 2nd, 2010

Antonio Hernandez, MD, and Stephen Venticinque, MD, both of the University of Texas Health Science Center San Antonio, led the Symposium’s Advanced Airway Workshop on Tuesday, a hands-on learning opportunity where participants practiced multiple ways to manage the difficult airway using a variety of devices and approaches, from optical stylets to supraglottic airway devices to video laryngoscopes and more.

“It’s a bad idea to stick things blindly into the airway and think good things are going to happen,” warned Dr. Jay Ellis of Tejas Anesthesia, as he directed participants in the correct placement and tracking of the optical stylet at Station 1. “These are motor skills. You need to do this several times a month in order to stay current.”

At Station 4, Dr. Thomas Grissom, an associate professor at the University of Maryland School of Medicine, talked a young medic through the process of using a video laryngoscope to open the airway, reminding him to keep it midline for best results. “The young guys [who are used to video games and other simulations] are better at this than the older guys are,” he said.

Pig tracheas were used at Stations 5 and 8 so that Dr. Kurt Grathwohl (Brooke Army Medical Center) and Dr. Joseph Brennan (Wilford Hall Medical Center) could realistically demonstrate different approaches to performing a cricothyroidotomy. Dr. Brennan urged participants to learn the technique by feel. “If there’s blood everywhere, you’re not going to be able to see anything, so really use that index finger so you know exactly where you are,” he said.

The room swirled with activity throughout the three-hour-long workshop, as participants rotated through the 12 demonstration stations and two bonus tables.

2010 Symposium Highlight–Post-Traumatic Stress Disorder

Thursday, September 2nd, 2010

In one of the Annual Trauma Symposium’s mental health sessions, Randy Strong, PhD, professor of pharmacology at the University of Texas Health Science Center San Antonio, discussed the role of early life stressors in later development of PTSD.

Dr. Strong pointed out that the majority of warriors exposed to traumatic events do not develop PTSD. He said a potential mechanism that explains vulnerability to PTSD is exposure to traumatic stress in early life. His research group is looking at several questions surrounding the effects of early stress on susceptibility to PTSD, as well as whether the “programming” that may be the result of early stress can be reversed.

In animal fear conditioning and extinction studies, Strong’s group found that prenatal stress programs adult sensitatization to fear and resistance to fear extinction, as indicated by chemical changes in the brain and automated measures of animal responses.

Following Dr. Strong’s presentation, Sheila Rausch, PhD, a clinical research psychologist with the VA Ann Arbor Healthcare System, reported on a study of a new PTSD treatment under review in a DoD primary care setting.

The treatment under study follows the Stepped Care Model, where, at lower levels, interventions such as self-help materials and web-based CBT and phone support are made available. Higher levels of care include primary care intervention (currently there are few, if any, specific PTSD programs at this level with a therapeutic component), specialty mental health care, and finally, inpatient programs.

The primary care PTSD treatment approach under study involves four to six 30-minute visits, a self-report assessment, education on the normal recovery curve and exposure-based treatments and discussion of primary and specialty care options. Participants advance though a workbook, answer emotional processing questions and complete homework. Preliminary data on the 15 participants who completed the study showed a signficant reduction in PTSD symptoms.

Despite the small study size, Rausch believes that primary care PTSD treatment can reduce PTSD and depression over four weeks, and it can be a critical component of a stepped care model of PTSD treatment.