Traumacast

In this episode of Traumacast, we hosted an EAST roundtable discussion on firearms policy and firearm-related injury prevention. The discussion centered around the recently released EAST literature review and Practice Management Guideline on the efficacy of restrictive licensing and concealed carry laws for preventing firearm-related injuries, as well as the recent efforts of the Committee on Trauma to promote open discussion and consensus buidling to tackle this challenging problem. The panelists included Marie Crandall and Alex Eastman (co-authors of the EAST PMG), Ronny Stewart (Chair, COT), Nicole Stassen (EAST President), and Kevin Schuster (Chair, EAST Manuscript and Literature Review Committee). This interview was recorded live at the 2016 AAST Annual Meeting in Waikaloa, Hawaii.Supplemental Materials:EAST Practice Management Guideline: Prevention of Firearm-Related Injuries with Restrictive Licensing and Concealed Carry Laws Firearm Injury Prevention: A Consensus Approach to Reducing Preventable Deaths

In this episode we discuss two issues highlighted in the August 2016 EAST Literature review concerning Pediatric Trauma: the meaning and definition of pediatric traumatic coagulopathy and what to do with an injured child with a tender c-spine and negative imaging. Drs. Barbara Gaines, David Mooney, and John Petty joing moderators Dave Morris and Matt Martin for a thought-provoking discussion that will be interesting to anyone who cares for injured children -- even providers who don't normally treat pediatric patients.Supplemental MaterialsAcute traumatic coagulopathy in a critically injured pediatric population: Definition, trend over time, and outcomes.Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma.

Election season is upon us…Drs. Schuster and Stassen (EAST president) face off with Drs. Patel and Skinner!  The experts debate the merits of cervical spine collar clearance based on CT alone in the obtunded patient.   This debate is based on the EAST 2015 PMG (link below).  Audience members called in and pressed our experts for answers to difficult questions.  Who won the debate…click “PLAY” and find out.  Stay tuned for the next Traumacast!Drs. Kevin Pei and Matthew Martin served as moderators for this debate.Supplemental MaterialsEAST PMG - Cervial Spine Collar Clearance in the Obtunded Adult Blunt Trauma Patient

IMPORTANT NOTE: This podcast is a lead-in to an EAST Master Class online webinar on REBOA that will be held on October 6, 2016 at 5pm (Eastern Standard Time). See the link below to register. After that date, the webinar will be available on the EAST website to viewIn this episode of Traumacast, we interview Dr. Laura Moore and Dr. Elizabeth Benjamin on one of the current “hot topics” in trauma care and resuscitation, resuscitative endovascular balloon occlusion of the aorta (REBOA). These techniques and devices offer a new therapeutic option for the patient with significant non-compressible truncal hemorrhage, and can serve as a resuscitative bridge to provide additional time to get the patient to the operating room or angiography suite. Dr. Moore and Dr. Benjamin share their experience and insights as two early adopters of REBOA at their Level 1 trauma centers. This interview was recorded live at the 2016 AAST Annual Meeting in Waikaloa, Hawaii.Supplemental Materials:Collection of major REBOA studies and abstractsRegister for the October 6, 2016 EAST “Master Class” Live Webinar on REBOA with Dr. Laura Moore and Dr. Elizabeth Benjamin

At the 2016 annual meeting of the Military Health System Research Symposium, the US military Joint Trauma System (JTS) held the inaugural session of a new educational program called "Case Records of the Joint Trauma System". This is the first in a planned series of presentations where an expert panel is presented with interesting and challenging battlefield trauma cases drawn from the Department of Defense Trauma Registry. This registry has captured data on all wounded patients treated at forward military medical treatment facilities during combat and post-combat operations in Iraq and Afghanistan. This program has been spearheaded by Lieutenant Colonel Jennifer Gurney, an Army trauma surgeon and the current Chief of Trauma Systems Development with the JTS. This challenging and entertaining session featured an expert panel representing multiple military services and several allied nations, and was co-moderated by Dr. Gurney and Dr. John Holcomb.Panelists:Colonel Ray Fang, US Air ForceColonel (retired) Don Jenkins, US Air ForceMajor Valerie Sams, US Air ForceColonel Matthew Martin, US ArmySurgeon Captain Rory Rickard, Royal NavyLieutenant Colonel Avi Yitzhak, Israeli Defense ForcesSupplemental Materials:Joint Trauma System WebsiteFor any questions about this program, suggestions for future venues or cases, and to submit any cases or case material, please email Dr. Jen Gurney.

Viscoelastic assays for assessing the coagulation system have been around for decades, but have recently seen a surge in interest and research in the trauma community. Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM) provide a real-time assessment of multiple aspects and factors involved in clot initiation, development and maturation, and then breakdown or lysis. Many trauma centers have begun incorporating viscoelastic testing in the initial evaluation of injured patients, particularly among those with known or suspected active bleeding. Although TEG/ROTEM have many theoretical advantes compared to standard or conventional coagulation assays, there have been no prospective controlled trials comparing them head to head until now. We interviewed Dr. Gene Moore, the senior author and principal investigator on a recently published prospective randomized trial comparing the utility and associated outcomes of massive transfusions guided by TEG versus those guided by conventional coagulation assays. This is a must-read paper for all trauma providers, and Dr. Moore provides some great additional insights into the study design, results, and interpretation.Supplemental Materials:Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays Annals of Surgery: June 2016 - Volume 263 - Issue 6 - p 1051–1059EAST Online Education Activity  - TEG/ROTEM Testing in Trauma & Transfusion Management

In this episode, we discuss an interesting study which was recently published in the Journal of Trauma and Acute Care Surgery (see link below) with the study’s lead author, Dr. Matthew Carrick, and the senior author, Dr. Kenneth Mattox.  Drs. Carrick and Mattox describe the extension of the hypotensive resuscitation paradigm beyond the trauma bay and into the operating room, as well as some details about how they were able to accomplish this prospective, randomized trial with exception from informed consent.  In characteristic form, Dr. Mattox also challenges the audience to take on more areas of untested dogma — what he calls the “sacred cows” of patient care — and to make an impact in clinical science research.Article ReferencedCarrick MM, Morrison CA, Tapia NM, Leonard J, Suliburk JW, Norman MA, Welsh FJ, Scott BG, Liscum KR, Raty SR, Wall MJ Jr, Mattox KL. Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective clinical trial. J Trauma Acute Care Surg. 2016 Jun;80(6):886-96.http://www.ncbi.nlm.nih.gov/pubmed/27015578

Whole blood transfusion, once the norm, is once again rising to the forefront of hemorrhage resuscitation science.  In this podcast, Drs. Philip Spinella and Alan Murdock share their expert thoughts and opinions regarding the rationale for whole blood transfusion.  After listening, you just may want to start using whole blood in your hospital.Articles Referenced:Cotton BA, Podbielski J, Camp E, Welch T, del Junco D, Bai Y, Hobbs R, Scroggins J, Hartwell B, Kozar RA, Wade CE, Holcomb JB; Early Whole Blood Investigators. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2013 Oct;258(4):527-32; discussion 532-3Spinella PC, Pidcoke HF, Strandenes G, Hervig T, Fisher A, Jenkins D, Yazer M, Stubbs J, Murdock A, Sailliol A, Ness PM, Cap AP. Whole blood for hemostatic resuscitation of major bleeding. Transfusion. 2016 Apr;56 Suppl 2:S190-202.Blumberg BS, Kuvin SF, Robinson JC, Teitelbaum JM, Contacos PG.  Alterations in Haptoglobin Levels. JAMA. 1963;184(13):1021-1023Nessen SC, Eastridge BJ, Cronk D, Craig RM, Berséus O, Ellison R, Remick K, Seery J, Shah A, Spinella PC. Fresh whole blood use by forward surgical teams in  Afghanistan is associated with improved survival compared to component therapy without platelets. Transfusion. 2013 Jan;53 Suppl 1:107S-113S.Strandenes G, Berséus O, Cap AP, Hervig T, Reade M, Prat N, Sailliol A, Gonzales R, Simon CD, Ness P, Doughty HA, Spinella PC, Kristoffersen EK. Low titer group O whole blood in emergency  situations. Shock. 2014 May;41 Suppl 1:70-5Strandenes G, De Pasquale M, Cap AP, Hervig TA, Kristoffersen EK, Hickey M, Cordova C, Berseus O, Eliassen HS, Fisher L, Williams S, Spinella PC. Emergency whole-blood use in the field: a simplified protocol for collection and transfusion. Shock. 2014 May;41 Suppl 1:76-83.http://rdcr.org/wp-content/uploads/2015/06/2013-williams-blood-transfusion-on-cruise-ships.pdfhttp://rdcr.org/wp-content/uploads/2015/06/2013-williams-blood-transfusion-on-cruise-ships.pdf

In this traumacast, Dr. Howard Champion, EAST Founding Member and 1991 EAST President, and surgical simulation expert shares his experience and vision for simulation in surgery training.  Dr. Champion is a seasoned surgical educator, serving as Chief of Trauma at Washington Hospital Center for many years.  In 2001, he founded SimQuest, a leading simulation platform provider.  Dr. Champion not only discusses his views on the utility of simulation in competency based assessment, but also offers encouragement for those interested in a career in simulation-based surgical education.  Drs. Kevin Pei and Matt Martin serve as co-moderators.Supplemental MaterialsMinimizing Surgical Error by Incorporating Objective Assessment into Surgical EducationSimQuest Website

The 29th EAST Annual Scientific Assembly took place January 12-16, 2016 in San Antonio, Texas. The meeting once again had record attendance, and boasted a wide array of educational, scientific, career development, and social programs. And of course - dodgeball! The EAST Traumacast was there to cover it all and bring you highlights, interviews, and summaries from this great meeting. This traumacast starts out with an interview with the 29th EAST President,  Dr. Stan Kurek, then covers the highlights from the entire meeting, and closes with an interview with the 30th EAST President, Dr. Nicole Stassen.Supplemental MaterialsSummary and downloads from the 29th EAST Annual Scientific AssemblyMake your plans now for the 30th EAST Annual Scientific Assembly - January 10-14, 2017Video highlights and interviews from the 29th EAST Annual Scientific Assembly - See what it is all about!