Trauma: early assessmentCharles Perrotta, M.D.

With thanks to Mike McBride, M.D. who provided many of the slides

Landstuhl Regional Medical Center

• Treats all patients evacuated from both combat theaters

• The only ACS trauma center outside the US• 65,000 patients evacuated from U.S.

CENTCOM (from 45 coalition nations)• 12,000 combat casualties (2004-2010)• Responsible for treatment of 245,000 U.S.

military personnel and families within Europe

Landstuhl Regional Medical Center

• Fully accredited (JCAHO, ACS, etc)• Staffing: 2,837 including 1,161 Army, 309 Air

Force, 304 Navy, 12 Marines, 1,279 civilians and 4 VA civilians

• 149 inpatient beds• 218 beds in its Medical Transient Detachment

USAR mobilizations

• Oct –Dec 2003 at LRMC• Mar- May 2006 at LRMC• Mar- May 2008 at Vilseck : working with

families and with the WTU (Warrior Transition Unit)

Redeployment Rounds

• Priority #1: OIF/OEF patients with blast injuries.

• Priority #2: OIF/OEF patients with non-blast injuries.

• Goal: Every patient receives a triage assessment and psychological first aid.

Assessment

• Introduction “I’m a psychiatrist working with your medical team. Every patient gets ‘top to bottom care.’”

• Pain assessment– 1) pain level using the pain scale 1-10.– 2) “At what level do you call the nurse for help?”– 3) Catching the pain early can reduce the amount

of pain medication required.

Soldiers need to take charge of their medical care by knowing all

they need to know about their injury and treatment.

Soldiers need to learn how ask for help;“The more comfortable you are the

sooner you will heal.”

Comfort Measures

• Room temperature• Hydration• Nutrition• Sunlight• Privacy

“Tell me about your injury”

• Knowledge of medical information• The trauma story.

– Filling in the missing pieces.– Post trauma symptom assessment.– PTSD education

Post Trauma Assessment

• Quantity and quality of:– IED attacks– Small arms fire– Mortar attacks– Suicide bombers– Exposure to dead bodies – Returning fire

PTSD Education

• Normalize the response to trauma as universal, using the metaphor of tissue injury.

• Healing of the mind requires a mastery of the event.

• Dreams, flashbacks, emotional flooding are normal psychological reactions to trauma.

Identifying Survivors Guilt

• A common reaction to trauma especially if others have been killed or wounded.

• The belief they have let their unit down.• Treatment approach includes getting the facts

of the incident, reviewing their role and response, arranging communication with unit downrange.

• After Action Report model

Preparation for Transfer

• A common anxiety is when they will fly and where they will be transferred to.

• Reinforce soldier’s ability to communicate needs (pain, comfort, anxiety, etc.)

• Follow up e-mail or phone call to CONUS for those patients demonstrating Acute Stress Disorder symptoms.

Special thanks to Mike McBride, M.D. (USAR and Milwaukee VA)

Landstuhl Regional Medical Center