Showing posts with label Dr. Andrea Doud. Show all posts
Showing posts with label Dr. Andrea Doud. Show all posts

Wednesday, November 19, 2014

Kids and Cars by Dr. Meredith


Motor vehicle crashes are the number one cause of death from injury in children. It’s more than 50 percent of all pediatric trauma injuries, according to the Centers for Disease Control and Prevention.

The number of deaths spike sharply as kids approach getting their driver's license. There's a great deal we can do in terms of preventing deaths and injuries. Those prevention strategies include driver's license strategies, drinking and driving strategies, automobile design and safety strategies, all of which have been effective and need to significant resources investments to continue and improve.

It is safer on our highways than it's ever been before. Per vehicle mile driven there are fewer deaths both in children and in everyone else. Nonetheless, it will be a long, long time before we eliminate motor vehicle crashes as a cause of injury or a cause of death.

Until that time occurs, another strategy that needs to be implemented is the development of trauma systems so that kids who are injured in crashes can be identified. Researchers are working on automatic crash notification systems that will identify if people are likely to have significant injuries in them and notify the system automatically.

You think about commercials of cars that look for the crash potentials, automatically slow down and proactively help the driver. It is equally possible for a car to sense how severe a crash is and automatically notify folks, from notification through the response. Once EMS is notified, they need to have localized people who can get to crashes quickly. When they arrive they need to have the training, expertise and equipment that is necessary to recognize and treat the injuries. 

In addition to funding crash notification research, the Childress Institute is committed to developing and providing training programs for all health care professionals. Surgeons, who treat mostly adults, need extra help in knowing how to treat kids. It's not as common and it's so emotionally charged which makes it difficult. The same thing is true for paramedics. They need that training and we're committed to developing it and disseminating educational programs for first responders. 

When an injury occurs, we need a good trauma system that can recognize kids with triage protocols. Responders need to comprehend who has injuries that require trauma center care and have ready access to get to trauma centers.

There are not enough trauma centers or pediatric trauma centers in our country. There's not enough coordination of the children's hospitals with the trauma centers and the trauma systems in our country. The Childress institute is working very hard to foster the development of more children's hospitals becoming trauma centers. We have worked very hard to support the Pediatric Trauma Society, which is a group of professionals whose goal is to further the knowledge and develop trauma systems and improve trauma centers.

The last piece of the puzzle is the actual care of injury victims and understanding more. So much of the treatment for these high energy crashes and the injuries that occur in them comes from extrapolation of injuries that occur in adults and the way we treat them. The research that is necessary to figure out the best way to treat specific injuries in children has not yet been done. And it must be.

The Childress Institute has already funded research investigating the relationship of shock and head injury, which are the top two causes of death from trauma in children from car crashes. The outcomes of this research could be revolutionary for the treatment of injured children. It's full impact and how generalizable that is, needs further research. We need to be at the forefront of helping get that done and we need funding to help us make that kind of research a reality. Then after we develop new knowledge, we need better tools to disseminate that knowledge to the caregivers in our country.

Currently it takes sometimes ten years for new knowledge to become the standard of care widely used. We need to shorten that cycle time. Can you imagine the cycle time of learning to develop a new way of setting up the shock absorbers for a certain race track? If that took ten years, many teams would be extinct. You have to make these turnarounds at least every week. Health care needs to get there and trauma leaders need to forge the path.

Wednesday, June 18, 2014

The Right Place at the Right Time – Crash Notification Research



Trauma remains the leading cause of death and disability for children in the United States. Motor vehicle crashes contribute to a huge portion of such traumatic injuries in children, and cause over 50 percent of traumatic injury deaths of children. While most research regarding children in motor vehicle crashes focuses on preventing injuries, my research group recognizes that prevention is not 100 percent effective. Therefore, we chose to focus our efforts on the treatment of children injured in motor vehicle crashes when prevention fails.

One of the most important factors in the treatment of injured children is the process of trauma triage. Triage is the process of transporting the “right patient to the right place at the right time.” The “right place” depends on the severity of the child’s injuries.  For severely injured patients, the right place is usually a specialized trauma center, where doctors specialized in the treatment of traumatic injuries are on-call 24 hours a day.  Failure to identify these children in need of treatment at a trauma center can result in disability and death. However, it is not practical to send every child to a trauma center.  This would put an undue strain on the trauma system’s resources and may thus impair care of those more seriously injured patients. 

Currently, most triage systems rely on assessment of the child after Emergency Medical Technicians (EMTs) have already arrived on the scene. EMTs assess the child, determine the severity of the injuries and decide whether or not they need to be transported to a trauma center. This is problematic for several reasons. First, the assessment and determination of whether or not a child needs transport to a trauma center may be highly subjective. Second, it may be impossible to determine, based on the limited diagnostic tools available in the field, the specific injuries a child has sustained and thus how severe they actually are. Third, this process may be long and arduous for children in rural areas who often live long distances from trauma centers. Such children would require transport by helicopter to the nearest trauma center. By the time the EMT team arrives on the scene, determines helicopter transport is necessary and sends for such transport, critical time is wasted that is best spent treating injuries.

For these reasons, some began to wonder if it would be possible to determine which children injured in motor vehicle crashes were likely to need treatment at a trauma center with a systematic approach even before EMTs arrived at the scene. Such a system could eliminate some of the bias of the current subjective triage process and could save precious time for children living in rural areas. This could be accomplished through an Advanced Automotive Crash Notification (AACN) system. While AACN systems have been developed for adults, no such systems have been developed specifically for children.

Our research is focused on creating an AACN system that will help EMTs decide which children need treatment at a trauma center after a motor vehicle crash. AACN systems use information recorded in a vehicle at the time of the crash, such as speed and direction of impact. They can then use this information to predict the severity of the injuries occupants in the vehicle are likely to have sustained. This information can be transported from the vehicle’s black box to EMTs so that the appropriate resources can be immediately utilized. AACN will not replace the ability of EMTs to assess and treat children but will improve the ability with which they can do so quickly and correctly. 

We hope that our AACN system can help improve the care of children injured in motor vehicle crashes throughout the U.S., making it possible to get many more of them to the right place at the right time, no matter where they are injured.

Dr. Andrea Doud, Wake Forest University School of Medicine and CIPT Scholar

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