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Department of Emergency Medicine

Matthew Levine, MD
Trauma Education Director

Education: Trauma

The ED continues to be busy caring for trauma patients in FY 2011. In addition to the consistent flow of minor injuries and consultations to the trauma service, there were 813 trauma “activations” (major traumas that require mobilizing all trauma resources for severe injury scenarios) in 2010. 218 of these were penetrating injuries and 595 were blunt trauma, which is consistent with blunt/penetrating ratios at peer trauma centers.

Trauma education continues to evolve and make great progress. Through coordinated advance planning, our monthly Trauma Case Conference is now a true Interdisciplinary Conference, well attended by Emergency Medicine, General Surgery, Nursing, and other services.  The monthly trauma lecture series has continued with guest speakers from various surgical subspecialties inside and outside of NMH.  The Trauma Simulator Case Conferences, led by Dr. David Salzman, have also blossomed into a great team training activity with general surgery.  Residents from both services come together to form the trauma team that cares for the simulated patient.  The scenario is broadcast live to the rest of the residency and surgical housestaff in attendance, and there is a group discussion with Surgery and EM faculty afterwards. 

Nursing education continues to evolve as well. The staff educators utilize Cosmo in the SIM lab for trauma case scenarios. Scenarios include both assistants and nurses, and together the team demonstrates critical thinking and hands on skills.

The Trauma Nurse Mentoring Program has been developed by our Trauma Coordinator and ED Educators and has been a great success. The program was implemented in June and is an orientation specific to caring for the trauma patient. It is designed to prepare nurses who have not spent time in the trauma bay through a multifaceted teaching approach. Through lecture, hands-on demonstrations, patient scenarios and mentoring, the participants have expressed that they are able to confidently and competently care for this patient population.

In FY11, eight Emergency Department nurses have obtained their CEN (Certification for Emergency Nursing), a voluntary credentialing process that elevates professional standards and enhances individual performance.  Two nurses obtained their TNS (Trauma Nurse Specialist) certification. 

January 2011 was an exciting month in orthopedic education as we accomplished one of the major goals for this year. We implemented the “orthopedics module”, in which the theme for resident education for the month was orthopedics. This included protected lecture time, online “asynchronous” learning, small group physical exam teaching, journal club, and night sessions. The highlight was the unveiling of the next version of a great orthopedic teaching resource, the Orthopedic Teaching File.  This is available online for independent study and during shifts for patient management.  Residents Dr. Luke Rosiere and Dr. Heather Leonard worked with Dr. Levine to update the original version and elevate it to a new level of quality.  The site was recently cited at the national EM Council of Residency Directors meeting as a favorite online site for asynchronous learning.  It can be accessed through the ED Resource page or at http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/index.html. 

Program Highlights

• In April 2011, the IDPH reviewed NMH for our Adult Level 1 Trauma Center re-designation.  The IDPH trauma site surveyors were very complimentary of our center on several dimensions, including but not limited to our physical layout, CT proximity to trauma resuscitation area, flow from ED to OR to ICU, and our robust quality management program.  At the conclusion of their visit, we were informed that they would be recommending us for official re-designation.
  
• Trauma education in the NMH ED also participated in community service.  The ED continued to volunteer in a program called Illinois National Guard Trauma Observer-ships. Medics in training for the Illinois National Guard were matched with an EM resident for 6 hour sessions that included teaching and direct observation of ED teamwork, procedures, and resuscitations. This occurred for three nights per week over three separate weeks. This was an extremely rewarding experience for both residents and trainees alike.
  
•  In February 2011, the trauma team was excited to complete a roles and positioning review to enhance our current practice.  This included clearly defining all roles and responsibilities of trauma team members, personnel positioning at the patient bedside and universal precaution measures.  The much-needed review was well received by all physicians, nurses and staff.      
  
• In November 2010, NMH launched a partnership with CeaseFire to improve patient outcomes and prevent retaliation by intervening with violently injured patients at the bedside using Violence Interrupters. CeaseFire is an organization with a public health approach to reduce violence using prevention, intervention, and community-mobilization strategies. The Violence Interrupters respond to the hospital then back to the street to offer non-violent alternatives to gang leaders, victim’s friends, and relatives in attempt to interrupt the cycle of retaliatory violence.
  
• In May 2010, we also welcomed a new Trauma Coordinator, Jennifer Mullen, RN, TNS, CEN. Her energy and creativity has been a great asset.  In a short time she has already enacted changes that have improved trauma bay organization, trauma team role definition, and documentation. Knowing Jennifer, more improvements are certainly on the way!

Emergency Medicine has been an active participant in the recruitment process for trauma surgery faculty, and in the last year we were happy to recruit Dr. Mamta Swaroop.  She has been a great advocate for team training and has been a key player in the advancement of many of our resident education initiatives.  Another surgeon has recently accepted a faculty position with the Trauma Service starting Summer 2011.

FY12 Goals

• Continue great progress with multidisciplinary trauma team training in both conference and simulation settings.
  
• Achieve trauma center re-designation during scheduled IDPH site survey.
  
• Continue to support community service and violence prevention efforts.
  
• Integrate new trauma faculty into trauma care at NMH.
  
• Continue to enhance orthopedics teaching file.