trauma in nether land
Post on 10-Apr-2018
219 Views
Preview:
TRANSCRIPT
-
8/8/2019 Trauma in Nether Land
1/34
Organization of Trauma Care in the Netherlands
Christian van der Werken
Paris, May 30st, 2008
-
8/8/2019 Trauma in Nether Land
2/34
-
8/8/2019 Trauma in Nether Land
3/34
GNP Euro p.c.
x 1000COUNTRY
France
Netherlands
Austria
Germany
Switzerland
United Kingdom
United States
22,8
23,3
23,5
22,0
34,9
23,9
27,8
Healthcare Spen-
dings Euro p.c.
1460
1400
1330
1720
2480
1080
3805
Physicians
p. 1000 c.
3,37
3,15
3,38
3,37
3,61
2,30
2,56
Life
expectancy
80,6
79,1
79,2
78,9
80,6
78,7
78,0
Differences between countries
-
8/8/2019 Trauma in Nether Land
4/34
The Netherlands in the 1980s
Lack of organized trauma care
No centralized care for the multiple injured patient
Dutch Trauma Society stipulated repeatedly the need for action
Simultaneously major incidents attracted the political arenato improve the organization of trauma care
-
8/8/2019 Trauma in Nether Land
5/34
Basic Concepts Reorganization Trauma Care
Regionalization and concentration of trauma care
(Inclusive trauma system)
Ambulance services
Inception of geographically dispersed Trauma Centers
Backup helicopter service for a nationwide network ofmobile medical teams
National Trauma registry
Education ATLS (Advanced Trauma Life Support)
PHTLS (Pre Hospital Trauma Life Support)
MIMMS (Major Incident Medical Management Support)
-
8/8/2019 Trauma in Nether Land
6/34
Geography and Demography
Over 100 hospitals
All have an Emergency Service taking care for injured patients
Virtually all have ATLS trained doctors and nurses Physical distance is never a problem
Ambulance time is < 15 minutes and is everywhere reached
Except: - West - Frisian islands
- Urban conglomerations (traffic congestion)
-
8/8/2019 Trauma in Nether Land
7/34
Prehospital Care
Principally provided by ambulance personnel
Crew:
Specifically trained driver
PHTLS trained paramedic (90 % is ICU or anesthesiology trained)
Resuscitation of severe trauma and cardiac arrest:
Hard neck collar
Spine board Coniotomy
Chest needle decompression
Intubation (without muscle relax.)
Defibrillation
No permission to perform full anesthesia
Generally accepted national standard protocols
-
8/8/2019 Trauma in Nether Land
8/34
Emergency Response System
Early on 80 (!) different ambulance care providers
Now 26 regions with
- Central control room (dispatch or CPA)
- Full ambulance service
- Training and evaluation responsibility
Contact by European emergency number: 112
Coordination by CPA
Legal obligation to reach the victim within 15 minutes after first call
-
8/8/2019 Trauma in Nether Land
9/34
Ambulance
SPREAD OVER THE COUNTRY:
202 ambulance stands
-
8/8/2019 Trauma in Nether Land
10/34
Ambulance Service
Responsibility qualification based
(nurse is sole responsible for all the actions taken) Registration through Individual Health Professions Act (BIG)
Professional has to be authorized to perform medical actions
Functionally independent Overall responsibility lays with the medical officer of the
ambulance service
-
8/8/2019 Trauma in Nether Land
11/34
On site care
Basic emergency care by paramedics
Evolving knowledge shows the efficacy of SCOOP AND RUN
In complicated cases or need for prolonged anesthesia, support
can be called in from a designated Mobile Medical Team
10 MMTs by car / special minibus
-
8/8/2019 Trauma in Nether Land
12/34
On site care
Basic emergency care by paramedics
Evolving knowledge shows the efficacy of SCOOP AND RUN
In complicated cases or need for prolonged anesthesia, supportcan be called in from a designated Mobile Medical Team
10 MMTs by car / special minibus
4 MMTs by helicopter
-
8/8/2019 Trauma in Nether Land
13/34
Mobile Medical Team
Four hospitals are providing a helicopter backup facility
Trained medical specialist (anesthesiologist or trauma surgeon)
Paramedic with special training
Until the beginning of 2006 flying time was between 7 am and 7 pm
-
8/8/2019 Trauma in Nether Land
14/34
Mobile Medical Team
Four hospitals are providing a helicopter backup facility
Trained medical specialist (anesthesiologist or trauma surgeon)
Paramedic with special training
Until the beginning of 2006 flying time was between 7 am and 7 pm
Recently one night helicopter service was started as pilot study
-
8/8/2019 Trauma in Nether Land
15/34
Mobile Medical Team doctor training
Anesthesiology training (for surgeons)
Surgical training (for anesthesiologists)
ICET training Media training
ATLS
ACLS
APLS
Toxicology training
Crew resource management
Flight safety training Line check JAR-OPS
Helicopter training
-
8/8/2019 Trauma in Nether Land
16/34
Trauma Centers
Since 1999 designation of 10 (later11) Trauma Centers
8 University hospitals
3 General teaching hospitals with neurosurgical facilities
Adequate care for every trauma patient in the most suitable hospital Centralization of the care for the polytrauma patient for the best care
Decision made by the ambulance or MMT crew
Protocols and direction on which patients belong in which facility
are in place and are working well
-
8/8/2019 Trauma in Nether Land
17/34
Exclusive Trauma System
patients
ISS > 16 p.
-
8/8/2019 Trauma in Nether Land
18/34
Dutch Trauma Centres
-
8/8/2019 Trauma in Nether Land
19/34
Dutch Trauma Centers
-
8/8/2019 Trauma in Nether Land
20/34
Burn care in The Netherlands
Three major Burn Centers (Rotterdam, Beverwijk and Groningen)
Patients
Burn body surface area of > 20 %
(children > 15 %)
Burn in special areas
Combined trauma and burn
No relation with a university hospital
*
*
*
-
8/8/2019 Trauma in Nether Land
21/34
Hospital Care in The Netherlands
High standard of care
Well trained specialists (ATLS generally accepted)
Advanced
TraumaLife
Support
Categorized care- Trauma Centers (10%): highest level of care: polytrauma
- Large general hospitals (30%) without neurosurgery:
major trauma
- Restricted capacity for trauma care (60%): isolated injuries
Care is well distributed over these facilities
-
8/8/2019 Trauma in Nether Land
22/34
In Hospital Care in The Netherlands
Alert before patient arrives by the CPA
Internet transfer patients data and parameters
Emergency room:
Surgeon is in charge
Team approach: surgeon (ATLS+), anesthesiologist (ATLS+),neurologist, radiologist supported with trained emergency carenurses
Team on site when patient arrives
Additional services available on demand
-
8/8/2019 Trauma in Nether Land
23/34
In Hospital Care in The Netherlands
Alert before patient arrives through the CPA
Internet transfer data
Emergency room:
Surgeon is in charge
Team approach: surgeon (ATLS+), anesthesiologist (ATLS+),neurologist, radiologist supported with trained emergency carenurses
Team on site when patient arrives
Additional services available on demand
Crucial is the ongoing lack of ICU beds for trauma
-
8/8/2019 Trauma in Nether Land
24/34
Trauma Care in The Netherlands
Mainly provided by general surgeons
80 % of skeletal trauma is treated by (trained) general surgeons
20 % and most spine injuries are treated by orthopedic surgeons
Training of general surgeons:
Designated trauma rotation in last year of training
Two years fellowship after registration as a general surgeon
-
8/8/2019 Trauma in Nether Land
25/34
Trauma Care in The Netherlands
Mainly provided by general surgeons
80% of skeletal trauma is treated by (trained) general surgeons
20 % and most of spine trauma is in the hands of orthopedicsurgeons
Training of general surgeons:
Designated trauma rotation in last year of training Two years fellowship after registration as a general surgeon
Care funding through statewide obligatory insurance/social security
Trauma Centers are funded through a special program
(0,5 million Euro per year) for organizational en logistic functions
Helicopter Centers have additional funds for their service
-
8/8/2019 Trauma in Nether Land
26/34
2500 - 4000 polytrauma patients (ISS > 16) / year
20 % helicopter MMT intervention
11Traumacenters 180 - 300 polytrauma patients per center / year
20 % in hospital mortality
Polytrauma Care in The Netherlands
-
8/8/2019 Trauma in Nether Land
27/34
Wishes for the future
- Increase helicopter MMT services 4 6
- All helicopter MMTeams 24 x 7 operational
- Increase national ICU capacity
Halve the number of trauma centers
-
8/8/2019 Trauma in Nether Land
28/34
-
8/8/2019 Trauma in Nether Land
29/34
-
8/8/2019 Trauma in Nether Land
30/34
-
8/8/2019 Trauma in Nether Land
31/34
-
8/8/2019 Trauma in Nether Land
32/34
-
8/8/2019 Trauma in Nether Land
33/34
547.000 square kilometers
64.5 million inhabitants
-
8/8/2019 Trauma in Nether Land
34/34
Response time to victim
top related