Dr. Cryer is Professor of Surgery and Chief of Trauma, Acute Care Surgery, and Surgical Critical Care at Ronald Regan UCLA Medical Center. He is a past president of the American Association for the Surgery of Trauma and a past member of the Executive Committee of the American College of Surgeons Committee on Trauma where he was Chair of the Performance Improvement and Patient Safety Committee and the Trauma Quality Improvement Project (TQIP). His research interests include shock and resuscitation, multiple organ failure, management of the unstable trauma patient, trauma systems and quality improvement.

Trauma systems were developed to increase survival and outcomes in patients with traumatic injuries.  This presentation will explore three complex trauma cases from their pre-hospital care through rehabilitation.  Resuscitative and intra-operative strategies including use of field providers and their extrication tools in the hospital environment will be shared. Successful critical care and acute nursing interventions will be discussed.  The trauma network survivors program will be emphasized.

A short series of lectures describing the evolution of the advanced practitioner in the trauma/critical care practice and their assistance with, or performance of, procedures in the critical care setting, addressing such issues as delineation of privileges, credentialing, and skills maintenance for advanced practitioners. These topics will reference databank templates that are being developed by the EAST Advanced Practitioners Section.

Older patients experiencing trauma are often admitted with baseline cognitive impairment, chronic conditions or increased level of frailty. Palliative care is a process that focuses on quality of life by aligning goals of care, pain relief, and psychological/spiritual needs. A screening tool was designed for the bedside nurse to assess the need for early palliative care consultation; the use of this screening tool in collaboration with multidisciplinary rounds improved palliative consultation rates in the trauma unit.

After attending this session, participants will be able to compare and contrast the new oral anticoagulant medications, including apixaban, dabigatran, edoxaban, and rivaroxaban; evaluate therapeutic options for traumatically injured patients who require emergent reversal of a new oral anticoagulant; and review the budgetary impact of the various emergent reversal options for new oral anticoagulants.

Forty percent of trauma patients will exceed age 65 by 2050. That number has already been  surpassed in the presenting organization’s Level I designated trauma center. These statistics prompted geriatric specific education for trauma nurses through Nurses Improving Care for Healthsystem Elders (NICHE), and the development of multiple geriatric focused process improvement initiatives that focused on the unique needs of the geriatric trauma patient, in an effort to improve outcomes, reduce hospital complications, and reduce healthcare costs for this high risk population.

Following this session, attendees will be able to apply knowledge about physiologic responses to tissue trauma and shock to guide assessment and utilize emerging interventions to mitigate inflammation. Pathophysiologic responses of the GI tract and strategies for optimizing immunocompetence will be discussed.

The top three submissions in the Evidence-Based Practice category are presented at this session. This is an opportunity to review EBP projects from a variety of trauma centers.

Improving Care by Imbedding a Trauma Hospitalist onto the Trauma Service
Deborah Hassler, ACNP-BC; Joan Pirrung, ACNS-BC; Mark Cipolle, MD, PhD

Designing Technology to Reduce Pain in Pediatric Trauma Patients
Jillian Swearer BSN, RN, CCRN Susan Matthews BSN, RN, CCRN

Implementation and Evaluation of a Team Simulation Training Program
Yvonne Rice, APRN DNP, Cynthia Talley, MD, Lisa Fryman, RN DNP, and Mary DeLetter, PhD, RN

The session will consist of a short series of lectures highlighting various anticoagulants and their respective mechanisms of action. Coagulation studies (PT, PTT, INR, and thromboelastography) and reversal strategies will also be discussed for the various classes of agents.

The new ANA Code of Ethics will be reviewed with specific examples applied to trauma nursing practice along with strategies to empower nurses to advocate for themselves and others.

By understanding our brain when it is stressed, we can outsmart the negative intrusive thoughts that keep us in a fatigued state of mind.

During this presentation, we will discuss unique issues surrounding the pediatric patient with multisystem injuries. Current literature on pediatric development, as well as considerations when dealing with a traumatically injured child, will be reviewed, while utilizing case studies to illustrate these points. The role of multiservice team approach and family centered care will be discussed.

Brain injuries cause a significant number of deaths each year, and those who are treated leave the hospital with some disability, that may or may not improve over time and with therapy. Despite progress in the management of TBI patients, controversy remains regarding the best use of data obtained from monitoring tools and how to treat elevated intracranial pressure. The goal of this session is for participants to understand the pathophysiology and research behind management of severe traumatic brain injury.

The top three submissions in the Research category are presented at this session. This is an opportunity to review Research projects from a variety of trauma centers.

The Relationship of Compassion Fatigue, Burnout and Unprofessional Behavior in a Level 1 Urban Trauma Center
Paul Thurman, MS, CCNS, CRNP, CCRN; Kathryn VonRueden, MS, CNSBC, FCCM; Michelle Bardakh, BSN, RN; Kendall Gelston, BSN, RN, CNOR

Diaphragm Pacing Can Decrease Wean Time from Mechanical Ventilation
Mary Jo Elmo, MSN, RN, CNP;Cynthia Kaplan, MSN; Raymond P. Onders MD, FACS

Comprehensive Geriatric Assessment for Trauma: Operationalizing the TQIP Directive
Stephanie Devore, RN; Carol Wright, RN; Andrew Bernard, MD

The use of Advanced Practice Providers in direct trauma care has emerged as a valuable resource for trauma programs. While the majority of Advanced Practice Providers are utilized mainly in direct patient care, their unique practice perspective as a blend of nursing and medical care proves to be an invaluable resource for insight in to trauma care and system evaluation. Identifying way to engage Advanced Practice Providers in all aspects of trauma program activities will assist in robust program enhancement and essential quality improvement. This session will explore opportunities for incorporation of Advanced Practice Providers, as an optimum resource, for trauma program development and enhancing trauma quality improvement throughout the continuum of care.

Older patients experiencing trauma are often admitted with baseline cognitive impairment, chronic conditions or increased level of frailty. Palliative care is a process that focuses on quality of life by aligning goals of care, pain relief, and psychological/spiritual needs. A screening tool was designed for the bedside nurse to assess the need for early palliative care consultation; the use of this screening tool in collaboration with multidisciplinary rounds improved palliative consultation rates in the trauma unit.

This session describes how to take our consultative review, the weaknesses and deficiencies identified, and developing multiple performance improvement projects. Items that will be included are our activation criteria and our PIPS process. A multi-disciplinary task force was formed. We will demonstrate how to leverage key resources, define ownership of each process and determine leadership roles for each issue.

This presentation will illustrate the shocking prevalence, clinical manifestations and diagnosis of physical abuse in children. Injuries involving the skin, skeletal system, abdomen and head will be discussed and examined with multiple photos. Case studies will encourage active participation and application to practice as well as demonstrate the devastation of misdiagnosis and abusive head trauma. We will use an objective and systematic approach to identifying child abuse in its early stages by applying a Non-Accidental Trauma (NAT) protocol to case studies.

This session will highlight key components of trauma assessment and interventions across the continuum of patient care. Mechanism of injury will be analyzed in detail. This presentation will explore elements of traumatic brain injury, multi-system trauma, and spinal injury. In addition, special patient populations (elderly, pregnant, and bariatric) will be addressed. Learning will occur in a fun and interactive way using the format of the popular game show “Who Wants To Be A Millionaire?”

In 2014, the American College of Surgeons released a new version of the Resources for Optimal Care of the Injured Patient manual. This manual details the requirements for all ACS surveyed Trauma Centers and is mirrored by numerous states and other verifying agencies. The release of new and expanded guidelines has created a knowledge gap as trauma centers have not experienced reviews using the new guidelines.

Trauma Centers are familiar with the prior requirements and have limited experience with the new guidelines.

Upon completion of this activity, participants will have increased knowledge about the ACS review process, expected changes related to the release of new rules, experiences from trauma program leaders who have been reviewed under the new rules and informed expectations when preparing for their own verification visits.

These sessions will give you a chance to network with colleagues and meet with some of the speakers and trauma leaders. Feel free to bring your thoughts, ideas or questions for discussion. Please reference the program syllabus onsite, for available topics.

Table# Topic – Moderator
1. ATCN: Initiation/Issues/Etc. – Jan Howard, MSN, RN; David Meysenburg, BSN, RN; Mike Glenn, RN

2. Performance Improvement at Level I & II’s – Judy Mikhail, PhD, MBA, RN

3. Performance Improvement at Level III’s & IV’s – Jane Kilgore, MSN,RN,CEN

4. Advanced Practice in Trauma– Jonathan Messing, MSN, CCRN, ACNP-BC and A. Britton Christmas, MD, FACS

5. Work with the JTN Editor – Kathryn Schroeter, BSN, MS, MA, PhD, RN, CNOR, CNE

6. TCRN Certification Course – Melissa Harte, MS, RN

7. Piecing Together the Education Puzzle: Nursing & Beyond – Erin Moorcones, MSN, RN, CNSPNP

8. Leadership SIG – Sarah Mattocks, MSN, FNP-C

9. Injury Prevention – Steven Woods, RN

10. Geriatric SIG – Kai Bortz, MSN, RN-BC, CMSRN, CNL

11. Membership SIG – Nathan Christopherson, MSN, MBA, RN, CEN, CPEN, NREMT-P

The session will review how to create and implement a guideline and how to put it together working through an actual example of the process from a leading institution.

The critical care phase of trauma care can be challenging and fraught with pitfalls. During the critical care phase patients can experience minor or major complications, and many trauma related deaths occur in the critical care unit. In this plenary session the discussants will present challenging cases and situations which occur during the critical care phase of management for trauma patients.

• Finding Serious Surprises AFTER the Initial Excitement is Over

Daniel L. Gross, DNSc, RN, is the Executive Vice President for Sharp HealthCare. He oversees four acute-care hospitals, three specialty hospitals, government relations and clinical effectiveness at Sharp HealthCare. Dr. Gross began his career at Sharp in 1979 as a clinical nurse at Sharp Memorial Hospital. Over the years, he served as Clinical Nurse IV, Director of Patient Care Services, Regional Director of Critical Care, Regional Director of Patient Care Services and System Vice President of Clinical Services. Prior to his role as Executive Vice President, Gross was Chief Executive Officer of the Sharp Metropolitan Medical Campus for 11 years, where he had oversight of three hospitals, an outpatient surgery center, home care services and two senior centers.

A review of the quality of trauma care in the world, particularly in low and middle income countries. The initiatives of the World Trauma Congress will be highlighted.

This session will be presented from the perspective of the patient who has been admitted to a trauma center.

TOPIC focuses on skill development for trauma program staff who are involved in the ongoing evaluation of trauma care across the continuum. It offers concrete strategies for the monitoring of trauma care, loop closure, and patient outcomes. The course provides practical lessons for all levels of trauma centers, from entry level to those who have achieved a mature phase of program development. It consists of 12 modules in PI and outcomes assessment, and includes over 50 case study examples, sample documents, and templates. TOPIC can now be co-taught by both nurse and physician faculty.

The American College of Surgeons Committee on Trauma (ACS-COT) and the Society of Trauma Nurses (STN) have partnered to develop the Optimal Trauma Center Organization & Management Course. Both physicians and nurses teach this collaborative course. Its goal is to enhance trauma center performance and to improve patient care through implementation of the ACS COT Trauma Center Standards.

Whether yours is a mature verified center or a hospital preparing for designation, this course is designed to help participants develop strategies, processes, and operations to support trauma systems, based on their unique environments. It is designed to help you take your trauma center to the next level, beyond verification or designation. The nuances of implementing or improving upon trauma center criteria within the structure of your specific facility will be reviewed in an interactive forum.

The ATCN Faculty Course is a two-day course designed to prepare students to become ATCN Faculty. This course will be held offsite.

Prerequisites:

• A student in the ATCN Faculty Course must be a licensed registered nurse who has successfully completed the ATCN Student Course.
• The successful completion of a Student Course must be current and within 4 years.
• Written recommendation from the Course Director of the ATCN student course they attended, or documentation verifying ATCN Instructor Potential.

The ATS Injury Prevention Couse was developed in collaboration with members of the Trauma Prevention Coalition (Including, the Society of Trauma Nurses (STN), American College of Surgeons – Committee on Trauma (ACS-COT), Eastern Association for the Surgery of Trauma (EAST), Trauma Center Association of America (TCAA) and American Association for the Surgery of Trauma (AAST). This 2-day course was developed by seasoned injury prevention professionals across the country and is designed to cover 14 chapters related to establishing and expanding a comprehensive Injury Prevention Program within hospitals and trauma centers. This course is designed for individuals and organizations actively engaged in developing and implementing policies or programs that primarily target or secondarily impact the prevention of injury.

Throughout the United States, unintentional injury continues to be a leading cause of death and disability for all age groups. Hundreds of thousands of individuals are affected by injury or injury-related deaths each year. Evidence shows that effective prevention programs and strategies work to reduce these statistics. The ATS Injury Prevention Coordinator’s Course is geared towards establishing and developing a formal hospital based, multi-faceted injury prevention program. This 2-day course was developed by seasoned injury prevention professionals across the country and is designed to cover 14 chapters on injury and data analysis, education, program development, advocacy, promotion, and more!

Course Objectives:

• Learn how injury prevention fits into the trauma care system.
• Discuss trauma mechanisms of injury, and connect injuries with safety interventions for a full understanding of how interventions impact injuries.
• Discuss the social and financial impact of traumatic injuries. Explore the psychological effects of traumatic injury and how peer support groups can impact recovery.
• Define public and population health, and learn how injury prevention initiatives impact communities.
• Describe the difference between primary and secondary data. Learn about the strengths and weaknesses of injury prevention data and trauma scores.
• Understand how epidemiology relates to injury prevention. Learn how to identify determinants of injury, modifiable risk factors, and different applications of standard epidemiologic techniques to quantify risk in injury prevention.
• Learn about injury prevention program development and the tools necessary for designing interventions.
• Identify community stakeholders to help develop unique ways to promote and facilitate community-based programs.
• Discuss initiating, developing, and advancing community partnerships.
• Learn about the role Advocacy plays in injury prevention, and how to develop relationships to promote advocacy.
• Identify various media options available to augment injury prevention initiatives and learn the various steps involved in interfacing with the media.
• Identify generational differences in internet and social media usage and how these differences related to media messaging.
• Learn about opportunities for programmatic funding and ways to financially build and sustain injury prevention programs.
• Discuss research and its role in injury prevention programs, describe the phases of research, explain study design, understand the role of published research to inform injury prevention practice and discuss important recent injury prevention research.
• Demonstrate the importance of program evaluation. Learn about unique evaluation techniques to ways to use outcomes in program development.
• Discuss the development of strategic plans to advance injury prevention programs and discuss the need for business planning to ensure program growth.

The ATS’s new Injury Prevention Couse was developed in collaboration with members of the Trauma Prevention Coalition (Including, the Society of Trauma Nurses (STN), American College of Surgeons – Committee on Trauma (ACSCOT), Eastern Association for the Surgery of Trauma (EAST), Trauma Center Association of America (TCAA) and American Association for the Surgery of Trauma (AAST).