Trauma 

Trauma refers to a serious injury and possibly life threatening that is caused by an external force .

Maior trauma: defined as injury or a combination of injuries that are life threatening and could be
life changing because it may result in permanent disability.

Minor trauma: a result of an injury and while you need medical attention, you may not require a
visit to the emergency room' Common minor trauma injuries include Lacerations (cuts) in your skin that may require sutures (stitches) lnjuries involving the feet, ankles, lower legs, and  knees.

The goal of pathway 

To provide proper pathway of Trauma Management in order to promote timely and efficient
management mitigating trauma injury that can cause permanent disability nor mortality from the
start of Pre-Hospital Care, Primary Survey to Trauma Code activation, definitive treatments until
acute or long-term rehabilitation leading to successful discharge of every patient

Trauma assessment 

  Pre-Hospital trauma triage toots: used to identify trauma patients that are generally based on a
scoring system which leads to the transport of the patient toward the best treatment solution. (i.e.
Patients with major trauma should be transported to a high-level facility for trauma care

Primary Suruey is the assessment of patients presenting with trauma. This consist of identification of life-threatening injuries and resuscitation. problems are addressed accordingly through the following

Airway maintenance

 Breathing andventilation

Circulation with bleeding control

Disabilityand NeurologicAssessment

Exposure and Environmental control

Secondory Suruey is a complete evaluation of the trauma patient, including a complete

history and physical examination, reassessment of all vital signs and diagnostic

examinations.

Tertiory Suruey is the careful and complete examination followed by serial assessments that

help recognize missed injuries and related problems, allowing a definitive care management.

Patient segmentation 

Level III Patients who needs Emergency specialist, General Surgery

Level II Patients who needs General surgery, Neurosurgery, Orthopedic, Urology

Level I Patients who needs Vascular , Cardiothoracic Surgery, interventional Radiology, Pediatric Surgery , 0bstetric and Gynecology.  

Trauma lnjury Severity Score Criteria (TRISS)

•  Patient age in years - Age lndex (as risk factors for adverse outcome), where patients under
  55 are awarded 0 in the formula and patients of 55 and above are awarded 1
•  Revised Trauma Score (RTS)

1. Glasgow Coma Scale
2. Systolic blood pressure (Bp)
3. Respiratory Rate

• lnjury Severity Score (lSS) Each of the injuries present is classified as minor, moderate, serious,
  severe, critical, or maximal (un-survivable)

1.  Head and neck injury includes injuries to cervical spine
2.  Face injuries include facial skeleton, nose, mouth, eyes, and ears
3. Thorax iniury includes chest injuries to rib cage, thoracic spine, and diaphragm.
4. Abdomen injury includes abdominal organs and lumbar spine
5.  Extremities injury including pelvic skeleton injuries, extremity injuries, sprains,
   fractures, and dislocations.
6.  External lnjury includes injuries such as lacerations, contusions, burns or
   hypothermia.

The Scope of Management of Trauma cases:

Adult Trauma patients

Level 1 - patients are brought directly to Buridah Central Hospital (BCH) and King

Fahad Specialty Hospital (KFSH) - Buraydah. These patients require higher center services i.e' Vascular, Cardiothoracic Surgery, interventional Radiology, pediatric Surgery, 0bstetric and Gynecology

Level 2 - patients are brought directly to King Saud Hospital (KSH), and Al Rass General Hospital (RGH). These patients only require General surgery, Neurosurgery,Orthopedic, and Urology

 Level 3 - Patients that comes from a peripheral Hospitals and are referred to designated Level 2 Hospitals. These patients only require Emergency specialist and General Surgery

King Fahad Specialty Hospital

Buraidah Central Hospital.

Qusaiba General Hospital.

Al Asyah General Hospital.

 Al Quwarah General Hospital.

Uyan Aljiwa General Hospital.

 Qbah General Hospital.

King Saud Hospital.

 Riyadh Alkhabra Hospital.

 Al Badayea General Hospital.

 Al Mithnab General Hospital.

 Al Bukayriyah General Hospital.

 Al Rass General Hospital

 Al Nabhanyeh Hospital.

Dariyah Hospital.

 Uglat Alsugoor Hospital

Pediatric Trauma patient:

Patients coming from all Hospitals through EMS are brought to either Maternt and Children's Hospital in Buraidah (MCH) or in King Saud Hospital (KSH) or to the nearest Hospital.

lab request 

 Laboratory lnvestigations (CBC, Chemistry, PT/PTT, Urinalysis,blood glucose & lactate)

Rediology examination 

x-rays

CT scan

Trauma KPIS:

• Average transfer time (Time from request of transfer to arrival at receiving hospital) < 4 hours
• % Trauma severity assessment > 90 %
• Mortality Rate (Severity adjusted)< 5%