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REGISTRATION FORM

Trauma STAT 2015Registration fee includes: Valet Parking, Breakfast, Lunch,

Lectures and Certificate of Attendance

Amount Enclosed: $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Make check payable to: Halifax Health

Cancellation PolicyRefunds will not be granted after September 20, 2015 or for no-show registrations.

Detach and return registration form and check to:Halifax Healthc/o Continuing Medical Education303 N. Clyde Morris Blvd.Daytona Beach, FL 32114

Name

Address

City State Zip

Phone #

Email

Employer Title

License#

Halifax Health Employee I.D. # (5 digits)

Friday, September 25 o $75.00Saturday, September 26 o $75.00Friday & Saturday o $125.00Friday, Networking Reception o $15.00

Registration at the door, space permitting.Payroll deduct available for Halifax Health Team Members. (up to 3 installments for one day,4 installments for two days.)Only checks accepted on day of event; cash, debit or credit not accepted.

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AMERICANS WITH DISABILITIES ACTIf you need assistance as identified in the Americans with Disabilities Act, please call Kevin Captain at 386.239.2358 at least five business days prior to the program.

CONTINUING EDUCATION CREDITSParticipants must attend the full day to obtain the certificate of attendance.Partial continuing education credit will not be awarded.Halifax Health is accredited by the Florida Medical Association to providecontinuing medical education for physicians. Halifax Health designates this liveactivity for a maximum of 7 AMA PRA Category 1 Credit(s) on Day 1 (Friday).Halifax Health designates this live activity for a maximum of 6 AMA PRA Category1 Credit(s) on Day 2 (Saturday). Physicians should claim only the creditcommensurate with the extent of their participation in the activity.

Nurses & Respiratory Therapists: Halifax Health is an approved provider ofcontinuing education. This program has been approved for 7 contact hours onDay 1 (Friday) and 6 contact hours on Day 2 (Saturday). CE Broker Provider #50-851

Paramedics & EMT: This program has been approved for 7 contact hours on Day 1 (Friday) and 6 contact hours on Day 2 (Saturday) by the EMS MedicalDirector of Volusia County. Paramedics and EMTs may submit Certificates ofAttendance to their boards following the program.

Radiography Professionals: Applied for 7 continuing education hours on Day 1(Friday) and 6 continuing education hours on Day 2 (Saturday) for radiologictechnologists from the Florida Department of Health, Bureau of Radiation Control.

Nutritionists/Dieticians: Applied for 7 continuing education hours on Day 1(Friday) and 6 continuing education hours on Day 2 (Saturday) with the FloridaCouncil of Dietetics and Nutrition.

To register for this event, please contact:Halifax Health Medical Librarymedical.library@halifax.org386.254.4051

100 North Atlantic AvenueDaytona Beach, FL 32118From I-95, take exit 261, International Speedway Boulevard (ISB), goeast and cross the ISB Bridge to Atlantic Avenue (A1A). Head north(left turn) toward the Hilton; please use north entrance. Valet parking is included for the symposium only; vouchers will be provided at registration on the day of the symposium. A block of rooms are available at a discounted rate of $99.00 plustaxes and fees for September 24-26, 2015. The deadline for reserving the discounted room rate isAugust 14, 2015. Valet parking is not included with the rooms. Please mention "Halifax HealthTrauma" when booking your room. Call 800.HILTONS to make reservations.

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AGENDA

FRIDAY, SEPTEMBER 25, 2015Agenda is subject to change; times are approximate.

7:30 am Registration, Breakfast, Vendor Exhibits

7:55 Welcome, Purpose & ObjectivesKevin Captain, RN, NREMT-P

8:00 Challenges while caring for Panhandlers,Transients and the HomelessKen Bouvier, NREMT-P

9:05 Medicolegal Considerations in Trauma CareMarie A. Hermann, MD

10:10 Clinical Considerations for Injuries Relatedto Violent CrimeMichael A. Fabian, MD, FACS

11:15 Head Injury: Achieving Better Outcomes Through Proper CareFederico C. Vinas, MD

12:20 pm Lunch / Vendor Exhibits

1:25 The Hidden Dangers of Emergency ResponseTrauma STAT Public Safety Collaborative

2:30 Neighborhood Violence Leads to ER VisitsKen Bouvier, NREMT-P

3:35 Alcohol Emergencies: The Intoxicated PatientWilliam D. Hampton, DO, FACOEP

4:35 Wrap Up & EvaluationsKevin Captain, RN, NREMT-P

TRAUMA STAT 2015AUDIENCEPhysicians, nurses, paramedics and EMTs, respiratory therapists,radiologytechnologists, and other clinical providers involved in trauma care.

OBJECTIVESAt the conclusion of this program, participants will be able to identify theimportance of personal safety during the assessment of the trauma patient;recognize the perils and relationships with narcotics in the trauma patient;and discuss evidence-based fundamentals for the optimization in thedelivery of trauma care.

SYMPOSIUM DESCRIPTIONHalifax Health is excited to present Trauma STAT 2015, a comprehensivetwo-day symposium featuring fundamental concepts of trauma care andscenario-based activities, all targeted to optimize the continuum of care forthe severely injured patient. This year’s faculty comprises many of HalifaxHealth’s key trauma providers to include the coordinated participation ofmyriad public safety agencies from Volusia County, Florida. Guest facultyincludes: Deputy Chief, Ken Bouvier from New Orleans, Louisiana, and Dr.William Hampton from Manitowoc, Wisconsin.

SYMPOSIUM FACULTY

Trauma STAT Public Safety Collaborative

Volusia County Department of Public Protection:Beach SafetyMichael Berard, CaptainBrian Dean, OfficerChris Dembinsky, Accreditation ManagerRay Manchester, CaptainMark Swanson, Director

Volusia County Department of Public Protection:EVAC AmbulanceMichael Semple, Operations ManagerLisa Smith, Quality Improvement CoordinatorJeff VanDoorn, Lieutenant & Chief CinematographerMichael Vincent, Clinical Operations Manager

Volusia County Sheriff’s OfficeBrian Henderson, Lieutenant,Assistant Commander – Criminal Investigations

Daytona Beach Fire DepartmentDavid Newell, Clinical Education

Daytona Beach Police DepartmentLance Blanchette, Captain

Daytona State CollegeGeorgia Jenkins, School of Emergency Services

Halifax HealthKevin A. Captain, Trauma Program Manager / EMS LiaisonAshley Fisher, Coordinator - Emergency PreparednessMark T. Jones, Chief - Safety & SecurityGary T. McElroy, Captain - Safety & SecurityPeter C. Springer, MD, FACEP - Administrator,Emergency/Trauma/Hospitalist ServicesAndy Dennison, ROT – Manager, Orthopaedic Technology

Lana M. Bouchard, CSTRVendor Coordinator, Trauma Registry Coordinator, Halifax Health

Kenneth J. Bouvier, NREMT-PDeputy Chief of Operations,City of New Orleans EMS

Kevin A. Captain, RN, NREMT-PTrauma Program Manager / EMS LiaisonHalifax Health

Michael A. Fabian, MD, FACSMedical Director,Halifax Health - Trauma ServicesDirector, Halifax Health - General SurgeryResidency Program

Rakesh Gupta, MDCritical Care Medicine, Halifax Health

William D. Hampton, DO, FACOEPEmergency PhysicianHoly Family Memorial Hospital, Manitowoc, WI Assistant Clinical Professor of Emergency Medicine,Midwestern University, Downers Grove, IL

Marie A. Hermann, MDChief Medical ExaminerVolusia County District Medical Examiner Office

Gregory M. Kirkwood, MS-HASMedical Librarian, CME Coordinator Halifax Health

Peter C. Springer, MD, FACEPAdministrator, Emergency/Trauma Services, Halifax HealthMedical Director, Volusia County EMS

Megan G. Sherod, Ph.D.Clinical NeuropsychologistHalifax Health | Brooks Rehabilitation - Center for Inpatient Rehabilitation

Federico C. Vinas, MDNeurosurgeon, Center for Neurosciences,Halifax Health

AGENDA

SATURDAY, SEPTEMBER 26, 2015Agenda is subject to change; times are approximate.

7:30 am Registration, Breakfast, Vendor Exhibits

7:55 Welcome, Purpose & ObjectivesKevin Captain, RN, NREMT-P

8:00 Meth & ViolenceKen Bouvier, NREMT-P

9:05 Treatment of Coagulopathy in the Setting of Traumatic Brain InjuryRakesh Gupta, MD

10:10 This is your brain on drugs: Any Questions?Megan Sherod, Ph.D.

11:15 Introduction to ToxicologyWilliam D. Hampton, DO, FACOEP

12:20 pm Lunch / Vendor Exhibits

1:25 The Narcotics Conundrum of TraumaTrauma STAT Public Safety Collaborative

2:30 9½ Things You’d Do Differently ifDisney Ran Your HospitalWilliam D. Hampton, DO, FACOEP

3:35 Wrap Up & EvaluationsKevin Captain, RN, NREMT-P

4:45 - 6:30 Friday Night

Networking ReceptionHilton North Deck

$15 per person as separate registration.Hors d’oeuvres & non-alcoholic beverages included.

Cash bar available.

To register for this event, please call:

386.254.4051