Create a trauma team at the Ravenna hospital that can intervene in the most serious cases currently normally diverted to the trauma center of the Bufalini hospital in Cesena. Lista per Ravenna, with the support of Forza Italia and Lega, returns to propose an expansion of the Santa Maria delle Croci after last year the Romagna Local Health Authority, and consequently the city council, rejected the proposal to organize a second trauma center in the city Romagna, as it was considered a useless duplicate of the one already operational at Bufalini.
THE PROPOSAL:
“In Italy, serious trauma or polytrauma, due to road accidents, disastrous falls, burns, gunshot wounds, collisions with equipment, etc., represents the third cause of death, the largest one for young people. The USL business district of the Ravenna area is afflicted by a high accident rate, statistically the highest in the Romagna area. Conspicuous sources of accidents and accidents are, on the one hand, the relevant industrial (chemical, metalworking, etc.) and port settlements, and on the other, inadequate primary roads.
The first peak of mortality, in cases of accidental trauma, occurs a few seconds or minutes after the event, when the injuries are not compatible with life. The second occurs in a period that can range from a few minutes to a few hours, as the person has suffered potentially lethal damage, such as haemorrhagic or neurological lesions, but which can be controlled with timely, as well as appropriate and effective, treatment. In these cases, the urgency of the interventions therefore plays a fundamental role not only in saving lives, but in reducing complications that can produce invalidity or disability.
For minor traumas – as required by DGR 1267/2002 – each Spoke hospital belonging to the Trauma Network must formalize operational instructions (already existing in practice) making use of a multidisciplinary team capable of dealing with clinical problems of not high complexity, on the basis of a exhaustive approach which, to be completed on an operational level, must lead to the integration of all the various healthcare functions envisaged: Emergency-Urgency, Anesthesia, General Surgery, Radiology and, clearly, Orthopedics (as well as the on-call managers of the Clinical Pathology and the Transfusion Service ).
For highly complex traumas, the need for concentration at the relevant Trauma Center is highlighted, in the logic of volumes-outcomes (whereby a high concentration corresponds to lower mortality), as well as for the presence of rare specialties at the Hub and complex ones such as Neurosurgery and Maxillofacial Surgery.
The polytrauma doctor must however carry out the following tasks:
requests for tests;
overall assessment of the patient;
communication with colleagues;
family management;
contacts with the regional Trauma Center.
This series of tasks involves seeking contact with a variety of specialists and explaining the patient’s clinical case and urgent needs to each one.
According to the guidelines of the main international health associations in the sector (“Advanced Trauma Life Support”, “Academy of Emergency Medicine”, etc.), the management of polytraumas requires, for the purposes of correct and quicker treatment of the patient, that taken care of by a Trauma Team, a multidisciplinary group made up of professional figures from the following specialties, all present in the civil hospital of Ravenna:
Emergency Medicine;
intensive care;
surgery;
pediatrics and obstetrics, where appropriate;
orthopedics;
nursing;
as needed, other medical support professionals (ENT, vascular surgery, urology, ophthalmology, neurology) and non-medical support (OS, Coordination of stretcher bearers).
Primary objectives are to quickly resuscitate and stabilize the patient, set priorities, determine the nature and extent of injuries, prepare the patient for transport to the regional Trauma Center which will provide definitive care.
According to the above guidelines, the Trauma Team is equipped with organizational lines, in which the following roles are predefined, supported by the corresponding nursing figures:
Team Leader;
Support Team Leader;
Airway doctor;
Procedure doctor (excluding those of the aforementioned airways);
Technical evaluation doctor.
Following a single call, the presence of all team members in the emergency room is required already in the reception phase and then in the patient’s resuscitation phase, each called to carry out the series of key tasks for which they are responsible. The Team Leader guarantees good team interrelationships and contacts with the regional Trauma Center at all times.
The Trauma Team facilitates the handover of deliveries to each of the specialists, speeds up and optimizes, furthermore, by communicating synergistically with the reference Trauma Center to which the polytrauma patient will have to be transferred, it can, if necessary, refer to his subsequent taking charge for definitive care ;
In this regard, considering that it is useful, as stated above, to make a request to the general director of the Romagna AUSL, through the Mayor of Ravenna, also in his capacity as president of the territorial socio-health conference of the AUSL itself, to verify the opportunity to formalize, through specific “organizational instructions”, the procedures through which the Trauma Team, active at the Civil Hospital of Ravenna, takes charge, making use of internal human and technological resources, of the primary management of patients affected by minor trauma, which, upon closer examination at your emergency room, turns out to be a major trauma.”
