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									Regional
Trauma
Services
    ANNUAL REPORT

 April 1, 2006 - March 31, 2007
Regional
Trauma
Services
ANNUAL REPORT

April 1, 2006 - March 31, 2007
Regional Trauma Services                                                              2006/2007




                              Special Acknowledgement To:

Many professionals have made significant contributions over the year to the information,
data, and documents contained in this report.

Dr. Ian Anderson                Trauma Surgeon
Ms. Alma Badnjevic              Regional Trauma Services Data Analyst
Ms. Dianne Dyer                 Regional Trauma Services Manager
Ms. Christi Findlay             Regional Trauma Services Data Analyst
Ms. Natalie Hohman              Regional Trauma Services Administrative Assistant
Dr. Vincent Grant               Pediatric Trauma Medical Director
Dr. Andrew Kirkpatrick          Regional Trauma Services Medical Director
Ms. Leanne Kmet                 Regional Trauma Research Coordinator
Dr. Rohan Lall                  Trauma Surgeon
Ms. Joyce Mammel                Orthopedic Trauma Clinical Nurse Specialist
Ms. Barbara Matiakis            Regional Trauma Services Nurse Clinician Specialist
Ms. Sherry MacGillivray         Regional Pediatric Trauma Coordinator
Ms. Michelle Mercado            Regional Trauma Services Data Analyst
Ms. Maria Vivas                 Regional Trauma Services Data Analyst

Note:
•  The Regional Trauma Services Project Leads and/or authors will be acknowledged
   on the specific reports.
•  The author(s) of external submissions representing other departments or
   organizations will be specifically acknowledged on the report as per their direction.


    Special Acknowledgment:

    Natalie Hohman, Administrative Assistant, for compilation and formatting of the
    Trauma Services Annual Report (2006/2007).
                                       Calgary Health Region
                          Annual Regional Trauma Services Report 2006-2007


                                                         Table of Contents


Organization Structure................................................................................................................. i

Vision, Mission, Values, Roles .................................................................................................... ii

Medical Director’s Message ........................................................................................................ iii

Executive Summary..................................................................................................................... 1

Regional Trauma Services Activities ........................................................................................... 11

Regional Trauma & Injury Statistics Summary............................................................................ 25

Major Trauma Statistics & Outcome Data: Foothills Medical Centre .......................................... 29

Performance Indicators: Foothills Medical Centre...................................................................... 48

ACH Pediatric Trauma Program Report ……………………………………………………………..72

Trauma Statistics & Performance/Outcome Data: Peter Lougheed Centre............................... 128

Trauma Statistics & Performance/Outcome Data: Rockyview General Hospital…………………138

An Imperative for Injury Prevention ............................................................................................. 150

City of Calgary Emergency Medical Services (EMS) Annual Report .......................................... 161

Shock Trauma Air Rescue Society (STARS) Report .................................................................. 172

Office of the Chief Medical Examiner Report ............................................................................. 178

Regional Department of Emergency Medicine Report ................................................................ 186

P.A.R.T.Y. Program Report ......................................................................................................... 195

Calgary Firefighters Burn Treatment Centre Report ................................................................... 199

Tertiary Neurorehabilitation Program Reports
        Traumatic Brain Injury Population...................................................................................... 206
        Traumatic Spinal Cord Injury Population ........................................................................... 214

Appendices
        Appendix A: Trauma Research Publications .................................................................... 222
        Appendix B: Trauma Research Funding Summary………………………………………….227
        Appendix C: Profile of Injuries in the Calgary Health Region Report ............................... 233
Regional Trauma Services                                                           2006/2007




ORGANIZATIONAL STRUCTURE (April 1st, 2006-March 31st, 2007)

Regional Trauma Services personnel include:
Southwest Community Portfolio/Regional Trauma Services:
Ms. Tracey Wasylak, Vice President, Southwest Community Portfolio
Dr. James Silvias, Executive Medical Director, Southwest Community Portfolio
Ms. Marg Semel, Director, Inpatient Surgical Services & Trauma Services
Dr. Andrew Kirkpatrick, Regional Trauma Services Medical Director
Ms. Dianne Dyer, Regional Trauma Services Manager
Ms. Natalie Hohman, Regional Trauma Services Administrative Assistant
Dr. Kent Ranson, Regional Trauma Services Research Coordinator
Ms. Barbara Matiakis, Regional Adult Clinical Nurse Specialist
Ms. Sherry MacGillivray, Regional Paediatric Trauma Coordinator
Ms. Christi Findlay, Regional Trauma Services Data Analyst
Ms. Maria Vivas, Regional Trauma Services Data Analyst
Ms. Sukhi Lally, Regional Trauma Services Data Analyst
Ms. Michelle Mercado, Regional Trauma Services Data Analyst
Ms Alma Badnjevic, Temporary Regional Trauma Services Data Analyst

Child & Women’s Health Portfolio: Alberta Children’s Hospital Site (ACH):
Ms. Brenda Fischer, Vice President, Child & Women’s Health
Dr. Brian Stewart, Executive Medical Director, Child & Women’s Health
Ms. Toni MacDonald, Director, Child Health Programs, Child & Women’s Health
Dr. Vincent Grant, Pediatric Medical Director
Ms. Sherry MacGillivray, Regional Paediatric Trauma Coordinator
Ms. Maria Vivas, Regional Trauma Services Data Analyst

Adult Trauma/ Clinical Safety Committee Chairpersons:
Dr. Andrew Kirkpatrick: FMC Adult Trauma Care Committee
Dr. Bruce Rothwell: Peter Lougheed Centre (PLC) Trauma Committee
Dr. Nancy Zuzic: Rockyview General Hospital (RGH) Trauma Committee

Paediatric Trauma/ Clinical Safety Committee Chairperson:
Dr. Vincent Grant, ACH Trauma Committee


 Acknowledgment of former personnel:
 Dr. Robert Abernethy, Executive Medical Director, Southwest Community Portfolio
 Ms. Monica Rodriguez-Galvez, Administrative Assistant, Regional Trauma Services
 Ms. Stacey Litvinchuk, Regional Adult Clinical Nurse Specialist (0.6 FTE)
 Ms. Joanne Bouma, Regional Adult Clinical Nurse Specialist (0.6 FTE)
 Mr. Laurie Leckie, Regional Paediatric Trauma Coordinator

 Welcome to New Personnel:
 Ms. Natalie Hohman, Regional Trauma Services Administrative Assistant
 Ms. Sherry MacGillivray, Regional Paediatric Trauma Coordinator
 Ms. Barbara Matiakis, Regional Adult Clinical Nurse Specialist (1.0 FTE)
 Ms. Alma Badnjevic, Regional Trauma Services Data Analyst
 Ms. Michelle Mercado, Regional Trauma Services Data Analyst




                                                   - i-
Regional Trauma Services                                                                    2006/2007




                                     REGIONAL TRAUMA SERVICES

                           http://www.calgaryhealthregion.ca/clin/rts/index.htm


                                         Calgary Health Region

Vision: Healthy Communities
Mission: Leaders in Health – a partner in Care
Values: Caring, respectful relationships, quality and safety, accountability

                                       Regional Trauma Services

Vision: Excellence in trauma service delivery based on adequate financial and human resources,
research-based quality improvement and education within a community that values integration,
comprehensive rehabilitation and prevention.

Mission: To provide and support a comprehensive, integrated and optimal system for the
prevention, treatment and rehabilitation of injury focusing on the individual, family and community.

Values:
•  Respect: non-judgmental acknowledgment of the unique contributions, dignity and worth of
   individuals, being able to disagree, value diversity.
•  Caring: sensitivity to and support for the well being of all.
•  Accountability: willing to give an account of/be responsible for ones autonomy (where
   autonomy = actions/decisions taken within ones area/scope of responsibility).
•  Teamwork: a commitment to work together towards common goals through effective
   communication, collaboration and tolerance for differences.
•  Growth: personal and organization commitment to lifelong learning; continuous improvement;
   mentoring and sharing.
•  Quality/excellence: in care and practice/work; clear standards; continuous improvement.

Roles:
•  Provide care to those affected by trauma within Region 3, Southern Alberta, Southeast British
   Columbia, and Southwestern Saskatchewan.
•  Develop/advance clinical services, education and research at Regional, Provincial and
   Federal levels.
•  Act as a clinical/education resource for rural & other urban communities.
•  Provide acute care services including emergency care, diagnostic imaging, operative &
   critical care, ongoing surgical management & rehabilitation.
•  Link to, and support disaster planning services, prevention programs, pre-hospital care,
   rehabilitation & other trauma programs.
•  Maintain the trauma registry database and report on patients with ISS > 12 (Foothills Medical
   Centre (FMC) and Alberta Children’s Hospital (ACH).
•  Review/report on injury discharge data and emergency transfers, and maintain the trauma
   registry database data and report on patients with ISS > 12 at Rockyview General Hospital
   (RGH) and Peter Lougheed Centre (PLC).
•  Assume a leadership role & active partnership in provincial and federal trauma services
   planning.
•  Facilitate quality monitoring & improvement activities including the review & development of
   clinical practice guidelines, research initiatives, and the acquisition of applicable educational
   resources.
•  Support the Trauma Association of Canada (TAC) as the TAC Central Office.



                                                   - ii -
Regional Trauma Services                                                                   2006/2007




INTRODUCTION

Medical Director’s Message

The Calgary Health Region continues to provide comprehensive medical care to one of the most
dynamic and rapidly growing populations in Canada. I believe the multi-disciplinary teams we
have created in the Calgary Health Region, cross-cutting across professions, disciplines, and
sites, have risen to this challenge despite present resource challenges. The Calgary Health
Region continues to be a National Leader in both clinical trauma care as well as the systems
required to successfully regionalize and rationalize trauma care. This year’s annual report
continues to reflect the scale and significance of these activities. The broad coalition of health
providers required to provide comprehensive injury control and advance the knowledge of injury
is immediately apparent within. The strength of the Calgary Health Region’s Trauma Service
delivery of care model is reflected in the continuing dedication to good clinical care measured by
accepted benchmarks, complemented by an ever-increasing number of publications and research
dollars earned.

The Calgary Health Region Trauma System continues to lead the country in reporting and
benchmarking. Calgary’s recognized strengths include comprehensive and coordinated pre-
hospital ground and air ambulance services, single coordinated regional Emergency Department
and Critical Care Departments, specialized surgical services including the dedicated Trauma
Service and leadership in Spine, Orthopaedic, Reconstructive, Neurosurgical, Rehabilitative, and
Vascular Surgery services. It is not surprising that the Trauma Association of Canada reflects
these strengths in the high accreditation standing as a trauma system. Thus, a notable highlight
of trauma care this year included the inaugural meting of the Provincial Trauma Committee. It is
hoped that increased province wide communication and the development of improved and
comprehensive data collection and analysis will serve to further understand the challenges and
priorities for trauma care across the Province. As always the goal is improved patient outcomes.

Consistent with the goal of facilitating province and nation-wide communication, the Calgary
Health Region continues to be the only region in Canada which strives to display transparency to
the Public by publishing comprehensive performance indicators in the public domain. In doing so,
we publicly commit to providing a high clinical standard and challenge other trauma care systems
to do the same. This is not meant to be competitive or adversarial, only to stimulate good clinical
care across the country.

The challenge for the future continues to be the need to preserve these successes and to
continue to provide excellent care across the clinical continuum for all Albertans despite the
continuing systemic stresses accompanying rapid growth. We also hope to increase the already
good research and teaching productivity across the multiple-disciplines involved in the delivery of
regional trauma care. The Calgary Health Region is of necessity, pursuing an ambitious plan of
expansion across the Region, most notable for the construction of the South Hospital. Regional
Trauma Services has been actively involved in these discussions focused towards creating the
footprint and future staffing to allow this resource to assume an appropriate role in the Regional
Trauma Plan.




Andrew W Kirkpatrick CD MD MHSc FACS FRCSC
Calgary Health Region



                                               - iii -
Regional
Trauma
Services
EXECUTIVE SUMMARY
Compiled By:
• Ms. Dianne Dyer, Manager
     Regional Trauma Services
Regional Trauma Services                                                                     2006/2007




EXECUTIVE SUMMARY
The Regional Trauma Services Program is dedicated to supporting and evaluating the provision
of optimal trauma care to individuals and families affected by traumatic injury across southern
Alberta, southeastern British Columbia and southwestern Saskatchewan. Services provided by
the program include the provision, ongoing development and advancement of clinical care,
education and research pertaining to the trauma continuum from pre-hospital to discharge to the
community. The Regional Trauma Services team continues to collaborate with partners and
stakeholders, within and external to the trauma system, to address needs, issues and to ensure
an efficient, effective integrated system of care.

The annual report is a comprehensive summary of team activities, trauma statistics, quality
performance measures, trauma research publication information and various interrelated reports
from system partners. This report is focused on April 1, 2006 through to March 31, 2007; one
exception being the City of Calgary Emergency Medical Services (EMS) report, which is based on
their reporting year from January 2006 through to December 2006.

Some of the unique features of the report this year include new designs and innovative
submissions on the Alberta Children’s Hospital Regional Pediatric Trauma Program; an Injury
Prevention and Control report entitled “The Imperative for Injury Prevention”; the City of Calgary
Emergency Medical Services (EMS) report; the Shock Trauma Air Rescue Society (STARS)
report; and comprehensive reports on the trauma care at the Peter Lougheed Centre and the
Rockyview Hospital.

1. Regional Trauma Services Activities

     1.1 Clinical
     The core component of the trauma service is the clinical role to provide, facilitate and
     evaluate clinical services. The goal is to improve and maintain the highest standard of trauma
     care through inter-disciplinary team collaboration, education and research. To support this
     goal clinical practice is enhanced through the development, implementation and evaluation of
     clinical practice guidelines, technology, quality assurance and clinical collaborative projects.

     Note: Current protocols and practice guidelines are available to clinical providers on the
     Regional Trauma Services internal website and the Trauma Orientation Manuals. The
     external website includes information on programs, services, related links and copies of the
     annual reports.

     Some of the clinical activities this year included: implementing a protocol focused on the
     management of blunt vascular trauma to the neck; the development of a Family Support
     pamphlet; implementation of a Blunt Traumatic Aortic Arch protocol; preparing a proposal to
     improve and support the care of the paediatric trauma patient (age < 14; evaluating the
     Paediatric Hypothermia protocol; revising the Trauma Team Activation paging process;
     updating the Regional Trauma Transfer policy; and piloting a Brief Intervention protocol
     focused on patients involved in alcohol related trauma or with potential alcohol related risk
     behaviours.

     1.2 Education

     An effective accredited trauma program must promote educational opportunities for clinical
     providers, managers, support staff and patients. Educational activities this ear included
     weekly and monthly Trauma Rounds, as well as, various team orientation sessions for new
     trauma nurses, residents and physicians. The monthly regional adult Grand Trauma Rounds
     were presented via Telehealth to various rural centres upon request. Monthly Trauma
     Rounds at ACH were well attended and addressed various topics pertinent to the unique
     needs of the pediatric trauma population. Some members of the Regional Trauma Services

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Regional Trauma Services                                                                      2006/2007




     team participated in and/or presented at the Trauma Association of Canada Scientific
     meeting held in Ottawa. Others presented at various international conferences throughout the
     year. Some team members presented at the P.A.R.T.Y. (Prevention of Alcohol Related
     Trauma in Youth) program. Trauma Services continued to support the Advance Trauma Life
     Support (ATLS) program and other surgical teaching programs (e.g. Advanced Trauma
     Operative Management (ATOM)) offered across North America.

     1.3 Quality Improvement
     The measurement and evaluation of various components of the adult and paediatric trauma
     system is an important focus of the work of Trauma Services. Throughout the year trauma
     care providers made referrals to Trauma Services with specific concerns for follow-up. The
     ACH and FMC trauma and Trauma Clinical Safety committees conducted quarterly and ad
     hoc reviews of Trauma Registry statistics, performance indicators and audit filters. The PLC
     and RGH site trauma committees conducted quarterly and ad hoc case reviews and reviews
     of major trauma charts/reports using Trauma Registry data. Performance indicators and audit
     filters were reviewed and updated by the Trauma Clinical Safety Committees. Some new
     clinical practice guidelines and protocols were implemented; updated as appropriate and
     posted on the Trauma Services internal web site for timely access for providers.

     1.4 Research
     Trauma research and evidence based practice is an essential focus of Trauma Services and
     an effective trauma system. A fulltime Trauma Research Coordinator was hired in October
     2006 to support this important work. This new role provided leadership, consultation and
     support for research initiatives within the Regional Trauma Services Program as well as
     projects that related to trauma care across the region and the system. Meetings occurred to
     support several joint projects with the Vancouver research group, with the Clinical Trauma
     Trials Collaborative and with various members of the Trauma Association of Canada. This
     past year Regional Trauma Services became actively involved with Telesat Canada and the
     Canadian Space Agency in a project that looked at remote telesonography and applications
     to trauma care. The ultimate goal was to test the technology and assess the future potential
     benefits to clinical care and providers in Canada’s remote communities in the far north. Work
     is underway to move the project forward with a target date commencing in July 2007, Images
     will be transmitted to test the technology from Banff, Alberta to Calgary, Alberta. More
     detailed information will be provided in the next annual report. Total funds dedicated and
     received to support trauma related research: $12,369,090.26

          A comprehensive list of research publications, projects, funding sources and related
               information are included in the appendices section of this annual report.

     1.5 Administration
     Administrative support is essential to the co-ordination and achievement of the various
     trauma services activities. This year administrative activities included work to implement the
     Provincial Trauma System proposal. The proposal was approved by Alberta Health and
     Wellness in February 2007 to a total of 2 million. The goal was an integrated provincial
     system for trauma in Alberta, aiming to get the injured trauma patient to the right location, the
     right provider and the right services in a timely manner. Regional Trauma Services worked
     closely with Capital Health Region Trauma Services and the Alberta Centre for Injury Control
     and Research (ACICR) over several years to bring the proposal to the attention of
     government and administrators at the proposed District Centres. Plans are underway for the
     first inaugural meeting of the Provincial Trauma Committee. Ongoing links were maintained
     with the Trauma Association of Canada (TAC) including management and coordination of the
     TAC Central Office and web master of the TAC web site. Funds were acquired to support
     weekly and monthly Trauma Rounds, the Trauma Nurses Journal Club, educational
     opportunities for staff and staff resources. External and operational funding was acquired to
     send team members to the Trauma Association of Canada (TAC) Scientific meeting held in


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Regional Trauma Services                                                                    2006/2007




     Ottawa, Ontario. Trauma Services participated in the planning for the Simulator Education
     Centre and will be a partner in this Centre in the future. A proposal was submitted to
     Administration in June 2007 and again in November 2007 to seek funds to improve and
     support the care of the paediatric trauma patient (age < 14). Support was received and
     awaiting next steps. A team retreat was planned for June 2007 to provide an opportunity for
     team building, visioning and planning for the future. Regional Trauma Services moved to their
     new location at FMC in November 2006. The new location is on the 7th floor of the FMC, next
     door to PCU 71 (the Trauma Unit).

     1.6 Data Management
     A trauma registry is a requirement of TAC guidelines for an accredited trauma centre. FMC,
     ACH, PLC and RGH have stand-alone trauma registries. To qualify for the trauma registry a
     patient must have an ISS > 12 and be admitted to the trauma centre or die in the emergency
     department of the trauma centre. ISS is an anatomical scoring tool that provides an overall
     score for patients with single system or multiple system injuries. The higher the ISS, the more
     severe the patient’s injuries. To ensure all appropriate patients are included into the trauma
     registry, all injury admissions, discharges and emergency department resuscitations are
     reviewed at FMC and ACH. This fiscal year, 4139 (3870: 2005/2006) FMC patient records
     and 760 (798: 2006/2007) ACH patient records were reviewed to determine eligibility for the
     trauma registry. At the PLC and RGH, patients are selected for review based on discharge
     diagnosis. More information on these two sites is included in the new comprehensive reports
     in this report. The Health Information Act (HIA), section 27(1) (g), outlines clearly the
     parameters whereby Trauma Services is authorized to collect this data. Up to 1300 data
     elements may be collected for each patient. The performance of the overall trauma system is
     measured in various ways. One way in the Calgary Health Region is by collection,
     documentation and review of 42 performance indicators. Thirteen of these are related to
     patient flow and outcome and twenty-nine to clinical benchmarks. Inclusion or exclusion
     criteria are clearly defined for each of the individual performance indicators. Other measures
     of performance include applications of the data to internal quality and safety initiatives,
     research, resource utilization, education and injury prevention initiatives, and outcome
     studies. The Trauma Registry supports unique projects by providing the ability to customize
     the registry and to write queries and reports. Regional Trauma Services worked this past year
     closely with colleagues in Edmonton to develop and maintain a consistent provincial data
     dictionary ensuring a comprehensive and comparative data set.

2.0 Trauma Statistics & Outcome Indicators (FMC & ACH)

     2.1 Major Trauma Totals
     The inclusion criteria for major trauma is that the patient must have an Injury Severity Score
     (ISS) > 12, be admitted to hospital or die in the Emergency Department. The FMC total major
     trauma patients was 1094 (969: 2005/2006). This was a 12.9% increase in one year. The
     ACH total major trauma patients was 91 (87: 2005/2006). This was a 4.6% increase over last
     year. Adding the PLC and RGH major trauma numbers (PLC: 22; RGH: 23) the overall total
     major trauma patients was 1230 (1109: 2005/2006). The overall total numbers of traumatic
     injury inpatients was 7631 (7829: 2005/2006). The number of patients with an ISS> 16 was
     886 for FMC (805: 2005/2006) and this represents a 41.3% increase over five years
     (2002/2003: 627). The number of patients with an ISS > 16 at ACH for 2006/2007 was 83 or
     91% of the total.

     2.2 Mechanism of Injury/Type of Injury
     As in previous years the mechanism of injury (MOI) or cause of injury was reported using four
     broad categories: Transportation, Falls, Violence and Other. Transportation continued to be
     the “number one” MOI for FMC and ACH; 47.1% (42.7%: 2005/2006) and 48% (47%:
     2005/2006) respectively. Violent cause of injury comprised 13% (10.2%: 2005/2006) at FMC
     and 3% (1.1%: 2005/2006) at ACH. There has been an increase in adult incidents of violence



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Regional Trauma Services                                                                    2006/2007




     and a downward trend in pediatric cases from 2002/2003. Blunt trauma continues to be the
     highest percentage for the type of injury in adults (92.7%) and pediatrics (85%).

     2.3 Transports/Transfers
     76% of the adult patients were transported by ground ambulance to FMC (67.3%:
     2005/2006). 59.3% of the pediatric patients were transported by ground ambulance, a 35%
     increase over 2005/2006. The ACH Pediatric Trauma report includes new graphs and
     information on Emergency Department arrival by month, the day of week and time of arrival.

     2.4 Physician Services/Surgical Procedures
     The majority of adult trauma patients were admitted to General Surgery (529), followed by
     ICU (220), Neurosurgery (206) and Orthopedics (56). The majority of pediatric patients were
     admitted to the ICU (53), followed by Pediatrics (16) and Pediatric Surgery (14).

     Orthopedic procedures continued to be the highest number of procedures at FMC (41.7%;
     39.2%: 2005/2006). Neurosurgery was the highest number of procedures at ACH followed by
     plastic surgery. The ACH Pediatric Trauma report includes graphs and information on various
     non-operative procedures, including procedures performed by Diagnostic Imaging. Five year
     comparisons are included in some graphs.

    2.5 Length of Stay (LOS)
    The median LOS for adult patients was 8 days; the median for pediatric patients was 5 days.
    The median LOS for FMC ICU admissions was 5.5 days; the median LOS for ACH ICU
    admissions was 2 days.

    2.6 Outcomes
    The annual report provides graphs and details on outcomes by age group including
    deaths and outcomes by ISS. In both adults and pediatrics the majority of survivors
    were in the 16-25 ISS range. Mortality was highest in the same range for adults; in
    the 26-35 range for pediatrics. In adults there were 18 survivors in the ISS range of
    46-75; in pediatrics there was one survivor in the range of 46-75 and 100% non-
    survivors in the range beyond ISS 55. The majority of survivors in both populations
    were discharged home.

    2.7 ISS > 16 Major Trauma Population
    In 1992, the inclusion criterion for the Trauma Registry was an ISS > 16. In 1993, this was to
    an ISS > 12. At FMC, this year the number of major trauma patients with an ISS > 16 was
    805. This represents a 42.2% increase in the number of patients with an ISS > 16 over the
    last 5 years (2001/2002: 648 patients). The rise in major trauma cases at FMC has resulted in
    increased pressures on acute care and community resources, with demands for
    improvements in access to services, performance, technology and efficiency measures.

3.0 Trauma Statistics (PLC & RGH)
The major trauma population at RGH and PLC was captured by a review of the monthly injury
discharges prepared by Quality Safety Health Information (QSHI). Trauma patients with an ISS
>12 are identified through chart audits. In 2006/2007, 22 patients were identifies at PLC
(20:2005/2006) and 23 patients were identified at RGH (33:2005/2006). This does not represent
patients that arrived to the Emergency Department and were transferred to Trauma centres. The
PLC and RGH reports this year includes a detailed presentation of quality performance
measures.

4.0 Regional Trauma Statistics Injury Statistics
The total number of traumatic injury admissions (any ISS) for the four urban centres for adults
was 6480 for 2006/2007. The number for pediatrics at ACH was 705. There was no clear
evidence of a peak in admissions in any one month for adults; a peak for pediatrics occurred in
August. There was a total, from all four urban sites of 1230 major trauma admissions (ISS > 12)


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Regional Trauma Services                                                                     2006/2007




or deaths in the Emergency department in 2006/2007. This was a 10.9% increase in overall
numbers from 2005/2006 (1109).

5.0 Performance Indicators
As part of the Regional Trauma Services quality improvement process, several indicators were
monitored on a regular basis as a measure of performance throughout the continuum of care.
The following is a summary of these indicators at Foothills Medical Centre and the Alberta
Children’s Hospital for patients who met the inclusion criteria for the Alberta Trauma Registry
(patients with an ISS > 12 and who were admitted to the hospital or died in the ED). Detailed
information on the performance indicators at PLC and RGH is included in their reports for this
year.

     5.1 Foothills Medical Centre
     Each performance indicator number was applied to a total population of 1094; at time of
     publication. The FMC Quality Improvement/Quality Assurance Committee and Trauma
     Services reviewed the data and charts, and addressed identified issues as appropriate.

          5.1.1 Transports/Transfers
          The number of patients transferred from PLC to FMC increased this year from 25 to 40;
          number from RGH decreased from 37 to 27. Only one patient was transferred from ACH
          to FMC. The number of out of province transfers to FMC increased from 72 to 84; 60.2%
          of the patients transferred from hospitals in British Columbia. The number of patients
          transferred from a rural District Centre (i.e. Provincial Trauma System) increased from 95
          to 105 in this past year.

          5.1.2 Pre-Hospital Phase
          In 2006/2007, the indicator focused on airway interventions for patients with a first
          recorded scene GCS ≤ 8, was expanded to include laryngeal mask airways and oral and
          nasopharyngeal airways. This demonstrated an increase from 41.7% compliance to
          60.8% compliance for 2006/2007. This indicator was and is under review at the Trauma
          Clinical Safety Committee meetings.

          5.1.3 Resuscitative Phase
          The Trauma Team Leader (TTL) response time was ≤ 20 minutes 97.1% of the time. Of
          the 336 patients that met the criteria for Trauma Team activation, activation was initiated
          in 57.4% (193) of the cases. If a case met the criteria and a trauma team activation was
          not called, the cases are flagged for quality review by Trauma Services. If the Trauma
          Team was not activated, trauma was consulted in 44% of the cases. This will continue to
          be an on-going item for careful review and follow-up in 2007/2008.

          5.1.4 Definitive Phase
          In 2006/2007 the joint relocation indicator was revised to include “attempts at relocation”
          of the joint within one hour. There was compliance 62.1% of the time (41.2%: 2005/2006).
          Follow-up of these cases include Emergency and Orthopaedics. Patients with a GCS <
          13 had a CT of the head performed within 4 hours, 97.7% of the time. For 2007/2008 the
          time frame for this indicator will be reduced to “within one hour” of arrival. 93.0% of
          patients with femur fractures received operative management within 24 hours (87.3%:
          2005/2006). 76.2% of the patients with open long bone fractures had operative
          management within the defined time frame (6 hours: Grade 3, 12 hours: Grade 12)
          compared to 62.8% in 2005/2006.

          There was a delayed diagnosis or missed injury in 1.3% of the major trauma patients
          (2.5%:2005/2006). There were no missed c-spine injuries in 2006/2007. 97.7% of the
          patients were admitted to a surgeon or intensivist. There were no missed c-spine injuries
          in 2006/2007.



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Regional Trauma Services                                                                      2006/2007




          35% of the admissions to ICU were unplanned with most due to respiratory compromise.
          5% of the patients had unplanned ICU re-admissions.

          95.5% of the patients received operative management of facial fractures within 7 days of
          injury (91.5%: 2005/2006). 94.2% of the patients received operative management of
          spinal fracture within 7 days of injury (90.2%: 2005/2006).

          71.4% of the patients were Category 1 status (hemorrhagic shock) had a laparotomy
          within one hour of arrival (42.9%: 2005/2006). The median time to laparotomy was 38.5
          minutes (59 minutes: 2005/2006). Use of Angiography and the options for
          angioembolization play a major role in decisions to take the patient to the OR in these
          cases.

         5.1.5 Outcomes
         56.4% of all deaths took place within 24 hours of arrival (44.1%: 2005/2006). 10.1% of all
         patients died in 2006/2007 (13.1%: 2005/2006). For 1995-2007, there were 1.58 more
         survivors per 100 than would have been expected from the major trauma study. 3.7% of
         the patients with a probability of survival of 20% died at the FMC (6.1%; 2005/2006).

     5.2 Alberta Children’s Hospital
     Each performance indicator was applied to a total population of 91 patients for the 2006/2007
     year. All cases flagged by a performance indicator or an audit filter were reviewed by the ACH
     Trauma Clinical Safety Committee and Trauma Services to determine appropriateness of
     care. If the ACH Trauma Clinical Safety Committee identified cases where there were trends
     or issues, the committee initiated the appropriate follow up on those cases.

         5.2.1 Pre-ACH Care
         80% of the pediatric patients with a GCS ≤ 8 did not receive a mechanical airway at the
         scene prior to transport. This is considered the ‘best practice” in pediatric care; rather
         than delaying care/transfer with attempts at intubation.

         42% of pediatric patients spent > 2 hours at a rural site prior to transfer and 46.4% of
         patients arrived at the trauma centre ≤ 4 hours from the time of injury. If the LOS or delay
         is not acceptable the Clinical Safety Committee will address the situation via a letter to the
         rural site or hospital. 18.6% of the patients were transported to ACH via the ACH
         Transport Team.

         5.2.2 Resuscitative Phase
         The criteria for Trauma Team Activation will be revised in 2007/2008 with links to a more
         detailed reporting system in the future. 11% of patients were admitted directly (bypassing
         ED) in 2006/2007. A new policy was written in February 2007 whereby all referred
         patients are to be assessed in the Emergency Department before admission.

         A new Trauma ED Record is being developed to improve documentation issues. Trauma
         Packs, which include Neurological Vital Sign sheets, were located in the ACH Trauma
         Room.

         100% of the patients with a GCS < 12 received a CT of the head within 4 hours of arrival
         at the ACH.

         86.7% of the patients had an ED length of stay ≤ 4 hours. 80% of the patients were
         admitted to a surgeon or intensivist.




                                               -6-
Regional Trauma Services                                                                   2006/2007




         5.2.3 Definitive Phase
         80% of the patients had operative repair of their femur <24 hours from arrival.

         There were no missed injuries identified after 48 hours and no missed c-spine injuries.
         2.2% of the patients had an unplanned admission to ICU (n=2) and 1.8% had an
         unplanned re-admission to ICU (n=1).
         5.2.4 Outcomes
         57.1% of patients died within 24 hours of arrival. 7.7% of the patients died at ACH.
         According to TRISS (Trauma Injury Severity Score) methodology there were no
         unexpected deaths or unexpected survivors in all age categories at ACH.

6.0 Reports

A number of reports were submitted this year from various trauma system partners for inclusion in
the annual report. The reports include:
    • City of Calgary Emergency Medical Services (EMS) Annual Report
    • Shock Trauma Air Transport Society (STARS) Report
    • The Office of the Chief Medical Examiner’s Report
    • The Regional Department of Emergency Medicine Report
    • The P.A.R.T.Y. Program Report
    • The Calgary Firefighters Burn Treatment Centre Report
    • Two Tertiary Neuro-rehabilitation Program Reports
    • An Imperative for Injury Prevention
    • Profile of Injuries in the Calgary Health Region

These reports are an important addition to the annual report and demonstrate and support the
complexity and magnitude of the integrated Calgary Health Region trauma system.

7.0 Future Directions

These are just a few of the Regional Trauma Services projects planned for the next year:
   • A team retreat will be scheduled for June 2008. The focus will be three of the Regional
   Trauma Services top priorities:
           o Pediatric Trauma Program Enhancement
           o Provincial Trauma System Work
           o Injury Prevention: Brief Intervention for alcohol related trauma
   • The development of a process for statistical / data management on PCU 71 (the Trauma
   Unit) at FMC.
   • Explore new ways to track Mortality and Morbidity data through SCM.
   • Explore new ways to initiate Clinical Nurse Specialist referrals through SCM.
   • Acquisition of external funding for staff education and Trauma Rounds.
   • Further development of the trauma research program with the new leadership role.
   • Establishment of the fulltime Nurse Practitioner role to support clinical practice and quality
   assurance on the Trauma Unit.
   • Re-development of the Trauma Services internal and external website, including both
   Adult and Pediatric protocols, projects and new initiatives.
   • Participation and leadership in the new integrated Provincial Trauma System.
   • Establishment of the Brief Intervention for alcohol related trauma project on PCU 71.
   • Continued support for the enhancement of the Pediatric Trauma Program (more details in
   the ACH Trauma Program Report).
   • Continued work on the application of Trauma Registry to the data collection and case
   review processes at PLC and RGH.
   • Explore new data management strategies that gather both retrospective and prospective
   data to support timely quality improvement and clinical care initiatives.
   • Continued updates and revisions to Trauma Orientation Manuals for FMC and ACH.

                                              -7-
Regional Trauma Services                                                                2006/2007




     • Begin discussions and work towards Trauma Accreditation in 2010 with the new June
     2007 TAC Accreditation Guidelines.
     • Participation in the planning process for the new South Health Campus.
     • Seek opportunities to benchmark trauma care with national and international groups.
     • Continue active participation in the Trauma Association of Canada committees,
     accreditation processes, research and support for the TAC central office.

Regional Trauma Services will continue to promote the integrated Provincial Trauma System and
support system performance through data management and quality improvement projects and
initiatives based on current trauma research, clinical evidence and measurement of performance.


Note: For additional detailed information on Future Directions for pediatric care please see the
ACH Trauma Program report.

For more information on the work of Regional Trauma Services visit our web site at:


                                            Trauma Services

                           http://www.calgaryhealthregion.ca/clin/rts/index.htm




                                                 -8-
Regional
Trauma
Services
ACTIVITIES
Project Lead:
•     Ms. Dianne Dyer, Manager
     Regional Trauma Services
Regional Trauma Services                                                                       2006/2007



REGIONAL TRAUMA SERVICES ACTIVITIES

Regional Trauma Service continues to provide support for trauma care in the following areas:

1.   Clinical

A primary role of the trauma service is to support, facilitate and evaluate the clinical services provided for
trauma patients. The goal is to improve and maintain the highest standard of trauma care through inter-
disciplinary team collaboration, education and research. To support this goal, clinical practice is enhanced
through the development, implementation and evaluation of clinical practice guidelines, technology,
quality assurance activities, and collaborative projects with other services and departments.

Note: Current protocols and practice guidelines are available to clinical providers on the Trauma Services
internal website and in the Adult Trauma Orientation Manual. The Pediatric Trauma Orientation Manual is
currently under review.

Clinical activities this year included:
• Facilitation of on-going trauma/ clinical safety committee meetings at all sites with the intent to
    support the work of the committees, facilitate communication across the system and encourage input
    and feedback on trauma patient care issues and protocols.
• Collaboration with Surgical Services, Vascular Services, Cardiovascular Services and Diagnostic
    Imaging to support and evaluate the implementation of a Blunt Traumatic Aortic Arch protocol for
    trauma patients. The equipment to support the process at FMC was purchased. The protocol
    supports arch injury medical interventions at the FMC site and is posted on the website.
• Collaboration with multiple partners at the ACH and FMC site to prepare a proposal to
     improve and support the care of the paediatric trauma patient (age < 14). The proposal was
    submitted to Administration in June 2007 for funding approval and again in November 2007.
• Working to revise the FMC Trauma Resident orientation manual. The goal was to distribute the
    manual to the residents prior to arrival for a rotation so that they have information regarding their role
    and expectations of the rotation. Monthly resident orientation was presented. Work is ongoing on this
    project.
• Working to revise the Trauma Team Activation process to include a single alphanumeric page for all
     responders with a text message containing pertinent patient information. The project was evaluated
    on an on-going basis with introduction of a new activation call-out sheet based on the Emergency
    Unit Clerk and trauma surgeon input.
• Working to continue to evaluate the FMC Trauma Team Activations for major trauma patients as part
    of the ongoing quality assurance reviews. If a case met the criteria for activation and the team was
    not called the case was flagged in Trauma Registry and reviewed. Patterns were identified and
    recommendations were proposed for action at the Trauma Clinical Safety meetings.
• Facilitation of the review of patient issues through M+M (Morbidity and Mortality) rounds as
     required and in conjunction with Friday noon teaching rounds. Exploring options for recording M&M
    information in the SCM system.
• Working with Neurosurgery and other stakeholders to finalize the “Guidelines for Neurosurgical
    Consults”. The guidelines were designed to provide information and support to Emergency
    Physicians and others related to assessment, monitoring and appropriate interventions / referrals/
    consults for patients with head injuries. The guidelines were posted on the website and monitored
    and evaluated through the quality assurance reviews at the various trauma / clinical safety
    committee meetings.
• Working to complete a literature review and to develop a guideline for patients flying via
     Medivac or commercial airline following chest tube removal. Many patients are from out of town, out
     of province or out of country. Once they are stabilized and able to receive the required healthcare in
     the area of residence, they are transferred closer, or discharged, to home. This project is ongoing.
• Working with regional partners, stakeholders and administration to update the Regional Trauma
     Transfer policy. The revision was approved at the Regional Trauma Advisory meeting and sent to the
     Surgical Executive. The process is ongoing and the policy will be posted on the Regional web site
     once finalized.
• Collaborating with Social Work and Addictions Services to implement a project focused on screening

                                                - 11 -
Regional Trauma Services                                                                    2006/2007



      patients involved in alcohol related trauma or potential alcohol related risk behaviours. This was a
      new initiative with the hope that clinical providers could make a difference and potentially prevent
      alcohol related trauma in the future. The intervention was called “Alcohol Screening and Brief
      Intervention”, from the National Institute on Alcohol Abuse and Alcoholism, USA. The interview tool
      was designed to help patients relate alcohol use to the trauma event they have experienced in the
      hope that this insight might prevent future alcohol related traumatic events. Other benefits might
      include provision of support for those seeking to address their abuse of alcohol. This project was
      submitted for funding in November 2007, however funding sources must be found. This is a criterion
      for a Level 1 Trauma Centre as per the Trauma Association of Canada Guidelines revised June
      2007.
•     Working in partnership with Diagnostic Imaging to refine the day to day processes for timely spinal
      clearance and reporting. A Regional spinal clearance guideline was finalized and was posted on the
      website. This continues to be an on-going project.
•     Meetings underway to explore opportunities for angio-embolization in the FMC Trauma OR (i.e.
      logistics, funding and support)
•     Meetings underway to explore opportunities for establishment of arterial lines in FMC ED (i.e.
      logistics, training, competencies and support)

Note: For detailed information on the Alberta Children’s Hospital Pediatric Trauma Program
clinical activities please see the ACH Trauma Program report.

2.    Education

Educational activities included:
• Trauma Rounds on a weekly basis at FMC and on a monthly basis at both FMC and ACH. Rounds
   were well attended and included internal and external speakers on a variety of pertinent topics. The
   adult monthly trauma rounds were presented via Telehealth to all acute care sites and rural sites
   (upon request).
• Team member attendance at the 2007 Trauma Association of Canada Scientific Meeting held in
   Ottawa. External sources and minimal operations funding was used to support this. Some team
   members presented papers and posters at the meeting. Regional Trauma Services helped to plan the
   concurrent Canadian Forces program at the event in conjunction with various members of the
   Canadian Forces.
• Leadership and clinical guidance for clinical clerks, residents and Fellows during their trauma surgery
   rotations. The students were from Calgary, other provinces and other countries.
• Working closely with the coordinator of the PARTY program to provide instructor support and
   advisory support for the program.

ATLS®

    Student Provider Courses:   2006: April 20-22, May 25-27, June 1-3, June 8-10, October 19-21

                                2007: January 18-20, February 8-10, March 8-10

    Instructor Courses:         2007: January 13

Dr. Richard Simons, in BC, is the Region Chief, ATLS®. Dr. Mary van Wijngaarden-Stephens is the
Provincial Chair for Alberta. Trauma Surgeon Course leaders include: Dr. Michael Dunham, Dr. John
Kortbeek, Dr. Bruce Rothwell, Dr. Jim Nixon, Dr. Jeff Way, Dr. Ian Anderson, Dr. Andrew Kirkpatrick and
Dr. Rohan Lall.

There are 54 instructors in good standing: Anaesthesia (3), Emergency Department (10), General
Surgery (26), Critical Care (2), Orthopaedic Surgery (4), Neurosurgery (1), Family Medicine (3), P.C. (4).
ATLS® Coordinators in Calgary: Nancy Biegler RN MN (started in 2004), Sandra Dowkes (started in
1998). Natalie Hohman provided administrative support for the program through the Regional Trauma
Services office. The program moved under the leadership of the Department of Surgery, Calgary Health
Region, in January 2006. Information provided by: Sandra Dowkes.
                                               - 12 -
Regional Trauma Services                                                                2006/2007



                                   Trauma Education Rounds

SPONSOR ACKNOWLEDGEMENTS:

SonoSite sponsored monthly FMC Grand Trauma Rounds. Wyeth sponsor external speaker costs for
some of the rounds.

                   Trauma Grand Rounds, FMC Auditorium, 0730-0830 (Adult Program)


                                                2006
 April 28       Cancelled
 May 26         “Orthopaedic Plates for Fixation of Fractures, Past Experience has Led to
                Marvellous New Technology” – Dr. Richard Buckley
 Sept. 22       Cancelled
 Oct. 27        “The Role of Interventional Radiology in Trauma” – Dr. Jason Wong
 Nov. 24        “Management of Intracranial Hypertension in Severe Traumatic Brain Injury:
                Hypothermia and Decompressive Craniectomy” –
                Dr. Walter Hader, Dr. David Zygun, Dr. Ian Parney

                                                2007
 Jan 26         “Hot Zone Kandahar: How the Medical Lessons of War can be Applied to
                Calgary” – Dr. Ian Anderson
 Feb 23         “Fatigue Management and Patient Safety: Issues for the Trauma Team” –
                Professor Drew Dawson
 Mar 23         Cancelled

NOTE: The Paediatric Monthly Rounds are discussed in the Paediatric Trauma Report in this
document.




                                              - 13 -
Regional Trauma Services                                                                     2006/2007



SPONSOR ACKNOWLEDGEMENTS:
Thank you to Novo Nordisk, SonoSite, Wyeth and KCI for sponsoring FMC weekly rounds.

                           FMC Trauma Friday Noon Conference Rounds, 1200-1300

                                                    2006
 Date        Presenter                            Topic
 April
 7           Dr. Peter Lewkonia                   The Role of the IVC Filter in High Risk Trauma Patient
 14          CANCELLED
 21          Pediatric & Adult Residents          Pediatric Hypothermia
 28          Dr. Bruce Rothwell                   M&M Rounds
 May
 5           Dr. David Zygun                      The NABISH Study
 12          Dr. Steve Johnson                    Troponins in Trauma
 19          CANCELLED
 26          Catherine O’Brien (Clinical Clerk)   Animal Bites in Trauma
 June
 2           CANCELLED
 9           Dr. Marcello Venditti                An Interesting Case Report in Trauma
 16          Dr. Rohan Lall                       M&M Rounds
 23          CANCELLED
 30          Dr. Jeff Davies                      TBA
 July
 7           Summer Session - CANCELLED
 14          Summer Session - CANCELLED
 21          Summer Session - CANCELLED
 28          Summer Session - CANCELLED
 August
 4           Summer Session - CANCELLED
 11          Summer Session - CANCELLED
 18          Summer Session - CANCELLED
 25      Summer Session - CANCELLED
 September
 1       CANCELLED
 8       CANCELLED
 15      Dr. Leanne Irvine                        Radiographic Findings of the Hip, Shoulder & Ankle
 22      Dr. Ryan McColl                          Blunt Cardiac Trauma
 29      Dr. Emmanuel Illical                     Trauma Case
 October
 6       CANCELLED
 13      Dr. Sandy Widder                         Trauma & Pregnancy
 20      Dr. Andrew Kirkpatrick                   F7 Trauma – Protocol in Severely Injured Trauma
                                                  Patients
 27     Dr. Andrew Kirkpatrick                    M&M Rounds
 November
 3      CANCELLED
 10     Dr. Vanda Phillips                        Mild Traumatic Brain Injury
 17     Dr. Chad Ball                             Pulmonary Trauma
 24     CANCELLED
 December
 1      Dr. Mini George                           Eye Injuries
 8      CANCELLED
 15     CANCELLED
 22     CANCELLED
 29     CANCELLED


                                                   - 14 -
Regional Trauma Services                                                                   2006/2007




                                                   2007
 Date      Presenter                             Topic
 January
 5      Dr. Nathan Deis                        Incomplete Spinal Cord Injury
 12     Dr. Matthew Kaminsky                   Neck Trauma
 19     Dr. James Huffman                      Lactate and Base Deficit in the Trauma Patient
 26     Dr. Justin LeBlanc                     Fat Embolism
 February
 2      CANCELLED
 9      Dr. Andrew Howard                      The Global Burden of Disease Due to Injury – A Neglected
                                               Pandemic
 16        Luke Szobota – Medical Student      Angio-embolization in Splenic Injuries: A Case
                                               Presentation
 23        Dr. Dallas Pearson                  C-Spine Clearance
 March
 2         Dr. Bahpreet Brar                   Coagulopathy in the Trauma Patient
 9         Ms. Lisette Lockyer                 Chest Tube Jeopardy
 16        Dr. Eldridge Batuyong               The Role of CT Imaging in a Polytrauma Patient
 23        Dr. Herman Johal – Clinical Clerk   Pelvic Fractures: Assessment & Management
 30        CANCELLED

 Teaching Opportunities
 University of Calgary weekly Trauma Conference Noon Rounds         Calgary          Continuous
 – Trauma Services
 University of Calgary Undergraduate Trauma Seminars                Calgary          Continuous
 – Trauma Services
 University of Calgary Critical Care City-wide Rounds               Calgary          Continuous
 University of Calgary Academic Half-Day Presentations              Calgary          Continuous
 Critical Care Resident Presentations                               Calgary          Continuous

3. Quality Improvement

The measurement and evaluation of various components of the adult and paediatric trauma
system is an important focus of the work of Regional Trauma Services.

Quality improvement activities throughout the year included:
• Daily case reviews on the nursing units and timely reporting and follow-up.
• The quarterly and ad hoc review of FMC and ACH Trauma Registry statistics and the revision
   of performance indicators and audit filters at trauma and Clinical Safety committees. This
   applied to the major trauma population only.
• A specific trauma registry data set was selected for PLC and RGH (Level IV trauma centers)
   and entry into the registry. Quarterly and ad hoc quality assurance case reviews were done at
   the PLC and RGH site trauma/ clinical safety committee meetings.
• The review of standards and benchmarks applied to other trauma programs in Canada and
   internationally.
• The facilitation of Morbidity & Mortality (M&M) discussions at the weekly Friday noon rounds.
   The process for M & M reviews, recording of issues, complications, and deaths is under
   review and discussions are underway to look at how this process relates to the SCM system.
• Reviewing, critiquing and creating reports, documents and policies from a trauma service
   perspective.
• On-going review of all deaths and all laparotomy cases through the chart audit processes.
• The participation by some team members as national accreditors for the Trauma Association


                                               - 15 -
Regional Trauma Services                                                                      2006/2007




     of Canada.
•    The posting of new or revised protocols and guidelines on the internal web site for application
     to practice.
•    The posting of the Trauma Services Annual Report on the internal and external website and
     the Trauma Association of Canada website.
•    Working with Capital Health Region to finalize a provincial Data Dictionary for Trauma
     Registry and with national partners to finalize a national Data Dictionary.
•    Two members of the Trauma Services team presented a poster at the Trauma Association of
     Canada conference in Ottawa. The topic was Trauma Registry: A data source for economic
     and resource predictions.

4.   Research

Trauma research and evidence based practice is an essential focus of Regional Trauma
Services.

Research activities this year included:
• The hiring of a fulltime Trauma Research Coordinator in October 2006. This new role will
   provided leadership, consultation and support for research initiatives within the Regional
   Trauma Services Program as well as projects that relate to trauma across the region and the
   system.
• A Trauma Nurses Journal Club continued to meet however; interest diminished throughout
   the year. There are plans to continue with the Journal Club in 2008 and seek ways to
   stimulate interest in the next year.
• Members of the Regional Trauma Services team continued to participate in the Regional
   Nursing Research Committee, various interdisciplinary research projects and attend
   research courses and workshops.
   Meetings have occurred to support several joint projects with the Vancouver research group,
   with the Clinical Trauma Trials Collaborative and with various members of the Trauma
   Association of Canada.
• This past year Regional Trauma Services has become actively involved with Telesat Canada
   and the Canadian Space Agency in a project that looks at remote telesonography and
   applications to trauma care. The ultimate goal was to test the technology and assess the
   future potential benefits to clinical care and providers in Canada’s remote communities in the
   far north. Wok is underway to move the project forward with a target dare commencing in July
   2007. Images will be transmitted to test the technology from Banff, Alberta to Calgary,
   Alberta. More detailed information will be provided in the next annual report.

      $12,369,090.26 total funding was received to support trauma related research projects.

A comprehensive list of research publications, projects, funding sources and related information
are included in the appendices section of this annual report.

5.   Administration

Administrative support is essential to the co-ordination and achievement of the various trauma
services activities.

This year the administrative support activities included:
• The Provincial Trauma Proposal was approved by Alberta Health and Wellness in February
    2007 to a total of 2 million. The goal was an integrated provincial system for trauma in
    Alberta, which aims to get the injured trauma patient to the right location, the right provider
    and the right services in a timely manner. Regional Trauma Services worked closely with
    Capital Health Region Trauma Services and the Alberta Centre for Injury Control and
    Research (ACICR) to bring the proposal to the attention of government and administrators at


                                                - 15 -
                                                - 16 -
Regional Trauma Services                                                                     2006/2007




    the proposed District Centres. These centres included Lethbridge Regional Hospital, Red
    Deer Regional Hospital, Medicine Hat Regional Hospital, Queen Elizabeth II Hospital in
    Grand Prairie and the Northern Lights Regional Hospital in Fort McMurray. The proposal was
    revised in November 2005 to include a detailed budget, updated references and action plans.
•   Maintaining ongoing links with the Trauma Association of Canada (TAC). Ms. Christi Findlay,
    Data Analyst, sat on the National Executive for the Trauma Registry Information Specialists of
    Canada (TRISC). Ms. Dianne Dyer sat on the TAC Executive representing the TAC Central
    Office and as Vice Chairperson for the Canadian Forces Medical Liaison/Disaster Committee.
    Dr. John Kortbeek, Medical Director for the TAC central office and Dr. Andrew Kirkpatrick
    (TAC President-Elect) sat on the TAC Executive. Ms. Natalie Hohman, Trauma Services
    Administrative Assistant, assumed the role of the office coordinator for the TAC Central
    Office, located as part of the Calgary Regional Trauma Services Office. Ms. Michelle
    Mercado assumed the position as webmaster for the Trauma Association of Canada and
    revised the TAC website.
•   Acquisition of funding to support weekly and monthly Trauma Rounds, the Trauma Nurses
    Journal Club, educational opportunities for staff and staff resources. External and operational
    funding was acquired to send team members to the Trauma Association of Canada (TAC)
    Scientific meeting held in Ottawa, Ontario.
•   Acquisition of funding from the Trauma Association of Canada (TAC) to support the TAC
    central office coordinator role and webmaster within Regional Trauma Services.
•   Acquisition of funding from Advanced Trauma Life Support (ATLS®) to support the ATLS®
    secretarial support role within Regional Trauma Services.
•   Submission of annual reports to Province Wide Services (PWS) and continued meeting with
    the Regional PWS representative to ensure input into PWS funding allocations.
•   Participation in the FMC and Regional Disaster planning meetings to ensure input from
    Trauma Services and access to updates on new developments. Regional Trauma Services
    participated actively in the Calgary Health Region disaster plan.
•   Monitoring and management of the Trauma Research Fund and smaller research funds
    under the University of Calgary Peoplesoft Program.
•   Continued meetings with the Regional PWS representative to ensure input into PWS funding
    allocations.
•   Participation in the planning for the Simulator Education Centre. Trauma Services will be a
    partner in this Centre in the future.
•   Collaboration with multiple partners at the ACH and FMC site to prepare a proposal to
    improve and support the care of the paediatric trauma patient (age < 14). The proposal was
    submitted to Administration for funding in June 2007 and again in November 2007. Support
    was received. Awaiting next steps.
•   A team retreat was planned for June 2007 to provide an opportunity for team building,
    visioning and planning for the future.
•   Regional Trauma Services moved to their new location at FMC in November 2006. The new
    location is on the 7th floor of the FMC, next door to PCU 71 (the Trauma Unit).




                                               - 17 -
                                               - 15 -
Regional Trauma Services                                                            2006/2007




Committee Representation:

Calgary Health Region:
• ACH, PLC, RGH and FMC Clinical Safety Trauma Committees
• FMC Adult Trauma Care Committee (ATCC)
• FMC Trauma Resuscitation Committee
• ACH Trauma Committee
• SW Portfolio Meetings
• Surgical Executive Committee
• FMC Site Manager Meetings
• City-wide Surgical Managers Meetings
• Site Surgical Process Operations Committee (SSPOC)
• Regional Disaster Planning Committee
• FMC Disaster and Emergency Response Planning Committee
• Calgary Injury Prevention Coalition
• Intensive Care Unit (ICU) Executive Committee
• ICU Quality Council Committee
• Regional Nursing Research Committee

Provincial:
• American College of Surgeons, Alberta Chapter
• College and Association of Registered Nurses

National:
• The TAC Conference Planning Committee
• The Canadian Trauma Trials Collaborative (CTTC)
• The TAC Accreditation Committee
• The TAC Executive Committee
• The TAC Abstract Review Panel
• The TAC Canadian Forces Medical Liaison/Disaster Committee
• The Royal College of Physicians & Surgeons of Canada Test Committee for General Surgery
• The Trauma Registry Information Specialists of Canada (TRISC) Committee
• Canadian Nurses' Association

International:
• American College of Surgeons, Alberta Chapter
• American College of Surgeons Committee on Trauma & ATLS® Subcommittee
• Editorial Review Panel, Journal of Trauma & Injury
• Calgary, Critical Care Fellowship Steering Committee




                                             15
                                          -- 18 --
Regional Trauma Services                                                                          2006/2007




     6. Human Resource Activities

•    Ms. Sherry MacGillivray was hired as the fulltime Regional Paediatric Trauma Coordinator
     commencing on. November 27, 2006.
•    The Clinical Nurse Specialist (CNS) position for Adult Trauma was reclassified to fulltime in
     2007. Ms. Barbara Matiakis was hired into the CNS role on March 5, 2007.
•    Ms. Natalie Hohman was hired as the fulltime Administrative Assistant for Regional Trauma
     Services on March 19, 2007. This role also includes Office Coordinator for the Trauma
     Association of Canada central office.
•    New funding was acquired for Data Analysts in 2006. Ms. Michelle Mercado was hired as a
     fulltime Data Analyst on February 19, 2007. Michelle also assumed the role of Webmaster for
     the Trauma Association of Canada website.
•    New funding was acquired for a fulltime Regional Trauma Research Coordinator. Dr. Kent
     Ranson was hired into this new role on October 16, 2006.
•    Ms. Alma Badnjevic was hired as a temporary fulltime Data Analyst to replace Ms. Sukhi Lally
     for a leave. She commenced in this role on March 19, 2007.

7.   Data Management

As part of TAC guidelines, an accredited trauma centre requires a trauma registry. Both FMC and
ACH have stand-alone trauma registries, in use since April 1995. The PLC and RGH, although
not accredited trauma centres, implemented the registry in the fall of 2005 as part of the Trauma
System. The software, Collector, was developed by an American company and is supported by
Digital Innovation based out of Maryland, USA. This application is used by over 200 hospitals
worldwide including hospitals in Canada, the U.S., Australia, New Zealand and Sweden. It is a
complete data management tool and report writing package.

To qualify for the trauma registry, a patient must have an Injury Severity Score (ISS) > 12 and be
admitted to the trauma centre or die in the emergency department of the trauma centre. ISS is an
anatomical scoring tool that provides an overall score for patients with single system or multiple
system injuries. Each injury is assigned an Abbreviated Injury Scale (AIS) score and is allocated
to one of six body regions (head, including cervical spine; face; chest, including thoracic spine;
abdomen, including lumbar spine; extremities, including pelvis; and external). Only the highest
AIS score in each body region is used when calculating the ISS. The three most severely injured
body regions have their highest score squared and added together to produce the ISS score. The
higher the ISS score; the more severe the patient’s injuries.

To ensure all appropriate patients are included into the trauma registry, all injury admissions,
discharges and emergency department resuscitations are reviewed at FMC and ACH. This fiscal
year, 4139 (3870 05/06) FMC patient records and 760 (798 05/06) ACH patient records were
reviewed to determine eligibility for the trauma registry. This is an increase of 7% at FMC and a
decrease of 4.8% at ACH from last year. Once registry eligibility was determined, data was
abstracted from the patient record and manually entered into the trauma registry.

At the PLC and RGH, patients are selected for review based on discharge diagnosis. Please see
the PLC and RGH Reports for further information.

Data collected includes patient demographics, mechanism of injury information, pre-hospital
information, sending hospital information, trauma centre emergency department information,
trauma centre inpatient information including operative information, injury diagnosis information,
outcome information and specific audit filters and performance indicators. The Health Information
Act (HIA), section 27(1) (g), outlines clearly the parameters whereby Trauma Services is
authorized to collect this data:

       27 (l) A custodian may use individually identifying health information in its custody or
              under its control for the following purposes:

                                                - 15 -
                                                - 19 -
Regional Trauma Services                                                                                              2006/2007




           (g) for internal management purposes, including planning, resource allocation, policy
               development, quality improvement, monitoring, audit, evaluation, reporting,
               obtaining or processing payment for health services and human resource
               management.

Effort is made to gather as much information as possible. In some cases, follow-up is necessary
with pre-hospital providers and sending hospitals.

Data is retrieved and analyzed for internal quality improvement initiatives with Regional Trauma
Services (FMC, ACH, PLC and RGH Trauma Clinical Safety Committees) and with departments
involved in the care of the trauma patient. Following the appropriate approval process, the
registry is also used as a source of data for research, resource utilization, education and injury
prevention initiatives, and outcome studies. Collector supports unique projects by providing the
ability to customize the trauma registry and to write queries and reports.

One way the performance of the overall trauma system is measured is by collection,
documentation and review of 42 performance indicators. Thirteen of these are related to patient
flow and outcome. Twenty-nine of these are related to clinical benchmarks. All major trauma
patients are evaluated to determine if they meet the inclusion or exclusion criteria for each of the
individual performance indicators. Data management workload is directly impacted by the number
of performance indicators, as well the number of data elements, collected on each major trauma
patient. Up to 1300 data elements may be collected for each patient.

The following clinical benchmark summary illustrates the number of indicators per department /
service for major trauma patients arriving at the FMC. A similar pattern is seen for patients
arriving at the ACH. For more information, please see the FMC and ACH Performance Indicator
sections later in this document.

                                             Foothills Medical Centre

        Department or Service                         # of clinical                % total of overall clinical
                                                       indicators                          indicators
 Trauma / General Surgery                                   7                                24.1%
 Orthopaedic Surgery                                        7                                24.1%
 Emergency Department                                       3                                10.3%
 Pre-hospital Care                                          1                                 3.4%
 Neurosurgery                                               1                                 3.4%
 Plastic Surgery                                            1                                 3.4%
 Spinal Service                                             1                                 3.4%
 Vascular Surgery                                           1                                 3.4%
 Multiple Departments / Services *                          7                                24.1%
* This includes indicators that are patient specific as opposed to department or service specific. An example is unplanned
return to the OR. This is related to the actual service involved in the surgery of a particular patient, not to a particular
service or department.

FMC and ACH data is submitted to the Alberta Trauma Registry (ATR) central site based at the
University of Alberta Hospital (U of A) in Edmonton, Alberta. The central site also captures data
from the U of A Hospital and the Royal Alexandra Hospital in Edmonton. Data is then submitted
from the central site to the National Trauma Registry of Canada. Currently the information
gathered at the PLC and RGH is not sent forward to the central site in Edmonton and the National
Trauma Registry. In the future, inclusion of the PLC and RGH data in the submissions to the
central site and the National Trauma Registry will provide a more comprehensive picture of major
trauma in Calgary. Regional Trauma Services works closely with colleagues in Edmonton to
develop and maintain a consistent data dictionary ensuring a comprehensive and comparative
data set.
Prepared by: Christi Findlay, Regional Trauma Services Data Analyst

                                                           - 15 -
                                                           - 20 -
Regional Trauma Services                                                                  2006/2007




Current Projects/Future Directions

These are just a few of the Regional Trauma Services projects planned for the next year:
• A team retreat is scheduled for June 2008. The focus will be three of the Regional Trauma
Services top priorities:
            o Pediatric Trauma Program Enhancement
            o Provincial Trauma System Work
            o Injury Prevention: Brief Intervention for alcohol related trauma
• The introduction of a fourth fulltime Data Analyst and the hiring of a part-time Data Entry
   Clerk to support the quality/safety data management and reporting, research and new
   initiatives. These include the introduction of SCM, Trauma ICD-10 Coding, the new AIS
   Coding and new safety initiatives and to provincial work. Plans are underway for hiring an
   additional 0.5 FTE Data Analyst to backfill the ACH Data Analyst to allow more dedicated
   time for the pediatric data management processes.
• The development of a process for statistical/data management on PCU 71 (the Trauma Unit)
   at FMC.
• Explore new ways to track Mortality and Morbidity data through SCM.
• Explore new ways to initiate CNS referrals through SCM.
• Acquisition of external funding for staff education and Trauma Rounds.
• Further development of the trauma research program with the new leadership role.
• Establishment of the fulltime Nurse Practitioner role to support clinical practice and quality
   assurance.
• Re-development of the Trauma Services internal and external website, including both Adult
   and Pediatric protocols, projects and new initiatives.
• Regional and Public Communication Projects
• Participation and leadership in the new integrated Provincial Trauma System.
• Implementation of Brief Intervention for alcohol related trauma project on PCU 71.
• Continued support for the enhancement of the Pediatric Trauma Program. (more details in
   the ACH Trauma Program Report)
• Continued work on the application of Trauma Registry to the data collection and case review
   processes at PLC and RGH.
• Explore new data management strategies that gather both retrospective and prospective data
   to support timely quality improvement and clinical care initiatives.
• Continued updates and revisions to Trauma Orientation Manuals for FMC and ACH.
• Explore ways to measure patient and family satisfaction within the trauma system and
   address concerns once identified.
• Begin discussions and work towards Trauma Accreditation in 2010 with the new June 2007
   TAC Accreditation Guidelines.
• Participation in the planning process for the new South Health Campus.
• Seek opportunities to benchmark trauma care with national and international groups.
• Continued active participation in the Trauma Association of Canada committees,
   accreditation processes, research and management and coordination of the TAC central
   office.

Regional Trauma Services will continue to promote the integrated Provincial Trauma System
proposal and support system performance through data management and quality improvement
projects and initiatives based on current trauma research, clinical evidence and measurement of
performance.

Note: For additional detailed information on Future Directions for pediatric trauma care please
see the ACH Trauma Program report.




                                             - 15 -
                                             - 21 -
Regional
Trauma & Injury
Statistics Summaries
FOOTHILLS MEDICAL CENTRE
ALBERTA CHILDREN’S HOSPITAL
PETER LOUGHEED CENTRE
ROCKYVIEW GENERAL HOSPITAL
Project Leads:

•     Ms. Christi Findlay, Data Analyst
      Regional Trauma Services

•     Ms. Maria Vivas, Data Analyst
      Regional Trauma Services
                         Regional Trauma Services                                                                        2006/2007




                         The following table summarizes the injury data, based on injury discharge codes provided by
                         QSHI and Trauma Registry, for the fiscal year 2003/2004 vs. 2004/2005 vs. 2005/2006 vs.
                         2006/2007(all ages combined).

                               2003/2004                          2004/2005                   2005/2006                  2006/2007
Sites                      Injury      ISS ≥ 12               Injury       ISS ≥ 12       Injury      ISS ≥ 12       Injury      ISS ≥ 12
                        Discharges                         Discharges                  Discharges                 Discharges
FMC                         3532         860                   3594          895           3762         969           3758         1094
ACH                         696           97                   737            88           748           87           705           91
PLC                         1525          22                   1493           10           1464          20           1508          22
RGH                         2017          30                   1835           28           1855          33           1660          23
Total                       7770         1009                  7659          1021          7829         1109          7631         1230


                                                          Traumatic Injury Inpatient Summary
                                                       >18 years of age by Site and Month (QSHI)
        # of patients




                                Apr       May       Jun       Jul    Aug     Sep      Oct   Nov     Dec     Jan    Feb     Mar
                        FMC     253       310       330       350     322    311      294    295    282     314    266     327
                        PLC     118       122       119       117     135    108      112    136    110     128    111     144
                        RGH     105       151       136       137     118    130      109    140    131     174    158     152
                        ACH        0        0          0       0       0      0        0      0      0       1       0       0

                         Totals:
                                 FMC            3654
                                 PLC            1460
                                 RGH            1641
                                 ACH            1
                         Overall Total          6756


                         This year there is no clear evidence of a peak in trauma injury inpatient admissions in any one
                         specific month and/or grouping of months in the ≥18 year age group. It has been the past
                         practice that, based on high trauma patient numbers, the staff resources were increased in
                         summer months and over the Christmas season. The ability to accurately predict peaks in adult
                         trauma patient numbers is however; becoming less reliable and accurate and therefore presents
                         significant challenges for the manager(s) planning for quality patient care. The numbers are
                         consistently high and impact the overall system on an on-going basis.




                                                                             - 25 -
 Regional Trauma Services                                                                                                                                             2006/2007


                                                             Child Health Inpatient Pediatric Trauma Study:
                                                              0-17 Years of Age by Site and Month (QSHI)
# of patients




                                       Apr        May        Jun         Jul         Aug         Sep          Oct         Nov        Dec        Jan        Feb        Mar
                                ACH    57         77         62          79          84           58          56          47         50          43         41         45
                                FMC     7         10          7          8           10           12           9           5          8          13         8          4
                                PLC     7          8          6          3           10           1            6           6          6          2          1          9
                                RGH     0          5          2          0            0           5            2           3          1          3          3          3

                                             2005/2006                               2006/2007
 Totals: ACH                                 748                                     705
         FMC                                 140                                     104
         PLC                                 66                                      65
         RGH                                 35                                      27

 There was a decrease in the total number of 0-17 years old patients admitted to the four sites as
 compared to the previous year’s data.


                                                                  Child Health Inpatient Pediatric Trauma Study:
                                                                   15-17 Years of Age by Site and Month (QSHI)
                # of patients




                                            Apr        May        Jun          Jul        Aug           Sep         Oct        Nov         Dec        Jan        Feb        Mar
                                 ACH         8          7           8          12          12            5           9          11         11         11          9          5
                                 FMC         7          8           5          8           10           12           9          8           7         13          8          4
                                 PLC         6          7           3          1           3             1           3          4           2          2          0          5
                                 RGH         0          5           2          0           0             5           2          3           1          2          3          3


                                             2005/2006                  2006/2007
 Totals: ACH                                 121                        108
         PLC                                 37                         37
         FMC                                 131                        99
         RGH                                 23                         26

 There was a decrease in the total number of 15-17 years old patients admitted at ACH and FMC;
 however, RGH saw a 13% increase in the admissions of 15-17 years old patients. No change
 was seen at PLC’s 15-17 years old patients.




                                                                                               - 26 -
Major Trauma
Statistics &
Outcome Data
FOOTHILLS MEDICAL CENTRE
Project Lead:
•     Ms. Christi Findlay, Data Analyst
      Regional Trauma Services
Regional Trauma Services                                                                                                                                                                2006/2007



MONTHLY TRAUMA TOTALS

Monthly trauma totals include patients with an Injury Severity Score (ISS) > 12 and who are admitted to
hospital or die in the emergency departments at the Foothills Medical Centre (FMC). Patients who die at
the scene of their traumatic event are not represented in this report. ISS is an anatomical scoring tool that
provides an overall score for patients with single system or multiple injuries. The ISS captured in the
Alberta Trauma Registry ranges between 12 and 75. The higher the ISS, the more serious the injury.
Patients who die at the scene of their traumatic event are not included in this report. Based on the
inclusion criteria, these totals represent 29.9% of injury discharges at FMC.

In the fiscal year 2006/2007, the FMC total was 1094 patients. FMC experienced a 12.9% increase in
annual trauma case totals compared to an 8% increase in 2005/2006.

July accounted for the largest monthly trauma case total at FMC. Summer months and December were
high volume months for major trauma cases in 2006/2007.


                                           FMC - 2006/2007                                                                                         FMC - 2005/2006
                                           130
                                                                                                                                                          105
                                                  112 114                   110                                                        94                       92
                                                                                                                                 82                 84                      86                      86
                                     96                                                                                                                                                 80




                                                                                                                 # of patients
                                                                94                                                                           76
      # of patients




                                                                                                                                                                      73          74
                        76     78                                                 80           80
                                                                      66                                                                                                                      57
                                                                                         58




                                                                                                                                 Apr   May   Jun    Jul   Aug   Sep   Oct   Nov   Dec   Jan   Feb   Mar
                        Apr    May   Jun    Jul    Aug   Sep    Oct   Nov   Dec   Jan    Feb   Mar




YEARLY TRAUMA TOTALS




                                     FMC - 5 Year Trend
                                                                                        1094

                                           860            897
                                                                        969                                   The FMC five-year trend demonstrated rising
        # of patients




                              772                                                                             major trauma case numbers with an 11.4%
                                                                                                              increase in 2003/2004, a 4.1% increase in
                                                                                                              2004/2005, an 8.0% increase in 2005/2006
                                                                                                              and a 12.9% increase in 2006/2007. When
                                                                                                              comparing 2002/2003 to 2006/2007, there was
                                                                                                              a 41.7% jump in major trauma cases.
                          02/03            03/04         04/05         05/06           06/07




                                                                                                     - 35 -
                                                                                                     - 29 -
Regional Trauma Services                                                                                                                                                                                              2006/2007




                                                                         Projected Major Trauma Cases
                                                               Projected Trauma Cases
                                                                    Foothills Medical Centre
                                                                              Foothills Medical Centre

                    1,800
                                                                                                                                                                                                          1,611
                                                                                                                                                                                              1,552
                    1,600                                                                                                                                                          1,494
                                                                                                                                                                       1,435
                                                                                                                                                           1,376                                                1,438
                                                                                                                                               1,318
                    1,400                                                                                             1,200 1,259                                                       1,341
                                                                                                                                                                                                       1,390

                                                                                                        1,142                                                                  1,293
                                                                                                                                                                 1,244
                    1,200                                                                    1,083
                                                                                                                                          1,147
                                                                                                                                                       1,196
                                                                                                                                                                                                  1,227 1,265
                                                                                                                               1,099                                       1,188
                                                                       894 969                                   1,050                                         1,112 1,150
                    1,000                                      860                                                                     1,035
                                                                                                                                                  1,073
                                                                                                     920                      997
                                          790 767                                                             958
                           800

                           600                   Actual Cases                                                                  Projected Cases

                           400

                           200
                              0
                                    7

                                    8

                                    9

                                    0

                                    1

                                    2

                                    3

                                    4
                                    2

                                    3

                                    4

                                    5

                                    6




                                   5

                                   6
                                 /0

                                 /0

                                 /0

                                 /1

                                 /1

                                 /1

                                 /1

                                 /1
                                 /0

                                 /0

                                 /0

                                 /0

                                 /0




                                 /1

                                 /1
                               08

                               09

                               10

                               11

                               12

                               13
                               01

                               02

                               03

                               04

                               05

                               06

                               07




                               14

                               15
                                                                              High                   Most Likely                                       Low

          Prepared in collaboration with:
          Mr. Stafford Dean, Health Systems Analysis Unit, (QSHI) - The Health Systems Analysis Unit (HSAU) supports the
          monitoring and evaluation of the Region's health requirements and the services provided by the Health Region.
          Dr. Andrew Kirkpatrick, Medical Director Regional Trauma Services
          Dr. Kent Ranson, Regional Trauma Research Coordinator
          December 2006

METHOD

This trend was prepared based on a combined 3 1/2 % population and aging growth with an extra 1/2 %
for a growth in the incidence rate of trauma events. The estimates assumed one standard deviation of
uncertainty for the first-year estimate; increasing by 0.125 standard deviations for each subsequent year.

                CALGARY HEALTH REGION: HISTORICAL AND PROJECTED POPULATION

        1,600,000


        1,400,000



        1,200,000



        1,000,000


         800,000



         600,000


         400,000
                    1992


                            1993


                                   1994


                                          1995


                                                 1996


                                                        1997


                                                                1998


                                                                       1999


                                                                               2000


                                                                                      2001


                                                                                              2002


                                                                                                      2003


                                                                                                               2004


                                                                                                                       2005


                                                                                                                                2006


                                                                                                                                        2007


                                                                                                                                                2008


                                                                                                                                                        2009


                                                                                                                                                                2010


                                                                                                                                                                        2011


                                                                                                                                                                                2012


                                                                                                                                                                                       2013


                                                                                                                                                                                                2014


                                                                                                                                                                                                        2015


                                                                                                                                                                                                               2016


                                                                                                                                                                                                                       2017


                                                                                                                                                                                                                              2018




                                           Historical Actual Growth:                                                                           1992-2005: 296,881
                                                                                                                                               2006-2007: 28,183 (2.84%)
                                           Projected Growth:                                                                                   2005-2018: 333,301
                                                                                                             - 35 -
                                                                                                             - 30 -
Regional Trauma Services                                                                                                            2006/2007



MALE/FEMALE




                                    FMC - 5 Year Trend

                                                                           823
                                                              727                                As noted in previous trauma reports, males
       # of patients




                                      646         658
                       559                                                                       continued to out number females in the total
                                                                                 271
                                                                                                 adult trauma population. In 2006/2007, the
                              208           214         236         242
                                                                                                 ratio was 3:1, also the ratio for 2005/2006.


                       02/03          03/04        04/05      05/06            06/07

                                              Male      Female




AGE DISTRIBUTION




                                        FMC - 2006/2007

                                256
                                                                                                 The majority of the trauma population falls
       # of patients




                                        168       157
                                                        173                                      between the ages of 15-44, with the greatest
                                                               123                               representation in the 15-24 (23.4%) age
                                                                          99
                                                                                  84             range. 69% of the major trauma population is
                                                                                                 between 0 and 54.
                                                                                       33
                        1

                       0-14    15-24 25-34 35-44 45-54 55-64 65-74 75-84               >84




                                                                                        - 35 -
                                                                                        - 31 -
Regional Trauma Services                                                                         2006/2007



MECHANISM OF INJURY (MOI)

As in previous years, MOI is reported by four broad categories: transportation, falls, violence and other.

"Transportation" continued to be cited as the “number one” MOI in data collected at FMC accounting for
47.1% of the registry cases (42.7% 2005/2006).

"Falls" resulting in major injury accounted for 31.3% of patients arriving at FMC (38.5% 2005/2006).

"Violent" causes of injury represented 13% of FMC major trauma patients (10.2% 2005/2006).
Limitations of the ISS scoring system in evaluating penetrating injuries that involve single system or single
organ injuries may lead to under representation of violence.

“Other” MOI contributed to 8.7% of the total at FMC (8.6% 2005/2006). “Other” is defined as unspecified,
or not within the three categories defined above. Please see Mechanism of Injury – Other for further
clarification.


                                                            FMC - 2006/2007

                                                515
                           # of patients




                                                             342


                                                                                142
                                                                                          95



                                           Transportation    Falls            Violence   Other




The following four pages show a further breakdown of each category:

  •   Transportation
  •   Falls
  •   Violence
  •   Other




                                                                     - 35 -
                                                                     - 32 -
Regional Trauma Services                                                                                                                                      2006/2007




MECHANISM OF INJURY – TRANSPORTATION




                                                         FMC 2006/2007                                                     The categories used in graph on the left
                                                                                                                           represent the injured individual. For example,
                           360
                                                                                                                           a pedal cyclist injured in a collision with a
                                                                                                                           motor vehicle is counted as a pedal cyclist.
      # of patients




                                                                                                                           Motor vehicle collisions (MVC) comprised
                                                                                                                           32.9% of all major traumas at FMC, an
                                                                                                                           increase from 31.4% last year. Within the
                                               64
                                                            47          37
                                                                                                                           transportation category, MVC’s represented
                                                                                   3          2              2             69.9% (73.4% 2005/2006) of all transportation
                            MVC             Pedestrian    Off Road     Pedal   Watercraft   Aircraft      Other
                                                                                                                           related mechanisms of injury.




                                                 FMC - 5 Year Trend


                                                                                                       515
      # of patients




                                                     430              449           414
                                      406




                              02/03                 03/04            04/05         05/06               06/07




MECHANISM OF INJURY - FALLS



                                                     FMC - 2006/2007
                                               180

                                                                                                                           Multi-level falls continued to have the highest
                      # of patients




                                                                        118
                                                                                                                           numbers in the fall category and represent
                                                                                                                           52.6% of the fall category compared to 48.5%
                                                                                              44                           (181) from 2005/2006. Multi-level falls make
                                                                                                                           up 16.5% of the total major trauma
                                                                                                                           population.
                                            Multi-level              Same Level        Other/Unspecified




The incidence of falls in the older adult population may be under represented in this data due to the ISS >
12 scoring system for major trauma. Ground level falls are very common and may produce injuries and
may be scored ISS < 12 (e.g. hip fractures). As will be stated later in the report, falls claimed the highest
percentage of lives in the major trauma adult population this year.




                                                                                                                  - 35 -
                                                                                                                  - 33 -
Regional Trauma Services                                                                                                                                2006/2007




                                                   FMC - 5 Year Trend
                                                                                   373
                                                                                                342

                                                                     264
                       # of patients

                                                      244
                                            207




                                        02/03        03/04          04/05        05/06         06/07




MECHANISM OF INJURY - VIOLENCE

Incidents of violence in the FMC major trauma population increased to 142 patients this year compared to
99 last year. Interpersonal violence is comprised of unarmed assaults, assault with a weapon and other or
unspecified assaults.

Self inflicted violence does not include intentional injury caused by poisoning.



                                                      FMC 2006/2007
                                                                                                                   There was a decrease in unarmed assaults this
                                                              80                                                   year to 32 (22.5%) from 37 (37.4%) in
                                                                                                                   2005/2006. Assaults with an object increased
                                                                                                                   to 80 (56.3%) in 2006/2007 from 39 (39.4%) in
       # of patients




                                                                                                                   2005/2006.

                                            32                                                                     This year the number of patients with self
                                                                                                                   inflicted violence dropped to 14 (9.9%) patients
                                                                                 14                  16            from 16 (16.2%) in 2005/2006. This figure does
                                                                                                                   not include individuals who died at the scene of
                                                                                                                   their injury event or intentional injury caused by
                            Unarmed assault               Assault with      Self-inflicted    Unknown/other        poisoning.
                                                            object                            type of assault




                                                  FMC - 5 Year Trend
                                                                                             142                   Violence is under represented in the major
                                                                                                                   trauma population. Many patients experience a
                                                    107            106
                                                                                99                                 violent assault, penetrating injury or other
      # of patients




                                       80                                                                          violent act and do not qualify for the Trauma
                                                                                                                   Registry due to exclusion of many single-
                                                                                                                   system organ or limb injuries.


                                   02/03           03/04        04/05         05/06          06/07




                                                                                                          - 35 -
                                                                                                          - 34 -
Regional Trauma Services                                                                                                                           2006/2007




MECHANISM OF INJURY – OTHER

Mechanical MOI include injuries caused by machinery or a moving object, injuries sustained in or
between objects, and injuries sustained when struck by an object or a person. Animal MOI includes
animal attacks, and injuries sustained while riding, or in other contact with animals.


                                                         FMC 2006/2007
                                         37

                                                        27                                                    Mechanical injuries made up 38.9% of the other
    # of patients




                                                                                                              category (50.6% 2005/2006). Fire / explosion /
                                                                     18
                                                                                                              electrical injuries jumped to 18.9% from 2.4% in
                                                                                                   8          2005/2006.
                                                                                  4
                                                                                             1


                                         1              2            3            4          5     6


                                         Legend

                                         1. Mechanical
                                         2. Animal
                                         3. Fire / explosion / electric
                                         4. Environmental
                                         5. Drowning
                                         6. Other



                                                    FMC - 5 Year Trend
                                                                                                  95
                                                             79                         83
                                           74                              75
         # of patients




                                         02/03           03/04            04/05       05/06      06/07



TYPE OF INJURY

‘Type of injury’ categories are used to broadly describe the type of force that results in injury. The majority
of injuries were the result of blunt forces.

                                                              FMC 2006/2007

                                              1014
                                                                                                             Blunt trauma represented 92.7% of the total major
                                                                                                             trauma population arriving at FMC (94.5%
                         # of patients




                                                                                                             2005/2006). Penetrating trauma made up 5% of
                                                                                                             the total population (4.7% in 2005/2006) and
                                                                                                             burns consisted of 1.7% to the total population
                                                                     55               19           6         (0.2% in 2005/2006).

                                                Blunt             Penetrating         Burn        Other




                                                                                                          - 35 -
Regional Trauma Services                                                                                                    2006/2007




   Blunt Injury

                                          FMC - 5 Year Trend

                                                                       1014
                                                              916
                                            805      812
                # of patients



                                  724




                                 02/03     03/04    04/05    05/06     06/07




  Penetrating Injury


                                          FMC - 5 Year Trend                            Penetrating trauma may not include patients
                                                                         55             sustaining a single system/single organ injury
                                                     45          46                     (i.e. ISS < 12) due to a stabbing incident and
                                                                                        may include patients that fall or injure
           # of patients




                                            35
                                  30                                                    themselves on a sharp object.

                                                                                        The new Trauma Association of Canada
                                                                                        Accreditation Guidelines (June 2007) requires
                                                                                        collection of data related to penetrating trauma
                                02/03      03/04    04/05    05/06     06/07            (any ISS) for Level 1 Trauma Centres.
                                                                                        This includes: Any ISS Deaths, # Admissions,
                                                                                        # Stab, # GSW, # Other, Direct to OR, Direct to
                                                                                        ICU.



  Burn Injury

                                         FMC - 5 Year Trend
                                                    28
       # of patients




                                                                       19
                                           13
                                 9

                                                             2


                                02/03     03/04    04/05    05/06     06/07


For more information on adult burn cases (2006/2007) see the Calgary Firefighters Burn Treatment
Centre report.




                                                                               - 35 -
                                                                               - 36 -
Regional Trauma Services                                                                                                            2006/2007




  Other Injury

                                         FMC - 5 Year Trend
                                                       9
                                            7
            # of patients




                                                                             6
                                                                    5
                              4




                            02/03         03/04       04/05        05/06    06/07




DIRECT VS TRANSFER

Direct means the patient was transported “directly” from the scene to a trauma centre; whereas, transfer
means the patient was initially treated at another facility and then “transferred” to a trauma centre.

 Direct vs. Transfer

                                     FMC - 5 Year Trend

                                                                               661
                                                                                                In 2006/2007, 60.4% of           patients were
      # of patients




                                                      512           569
                                            511                                                 transported directly from the    scene to FMC
                               446
                                                                               433              (58.7% 2005/2006) and 39.6%     of patients were
                                            349         382          400                        transferred from another        facility (41.3%
                               321
                                                                                                2005/2006).

                            02/03        03/04       04/05        05/06    06/07
                                            Direct              Transfer


CALGARY INTERHOSPITAL TRANSFERS

These patients were the major trauma patients that arrived at one site (e.g. PLC) by pre-hospital care
providers, walk-in or private vehicle and were transferred to FMC. The Peter Lougheed Centre (PLC),
Rockyview General Hospital (RGH) or the Alberta Children’s Hospital (ACH) may be the first or second
hospital prior to transfer to FMC.


                                            FMC 2006/2007

                                    40
       # of patients




                                                           27




                                                                              1


                                  PLC                   RGH                  ACH




                                                                                        - -
                                                                                     - 3735 -
Regional Trauma Services                                                                                                          2006/2007




Policies are in place in the Calgary Health Region to support and guide decisions regarding the transport
and transfer of trauma patients. These policies include the Regional Policy on “Trauma Services
Transfers” (#1353), policies and algorithms for the Southern Alberta Regional Coordinators Centre
(SARCC), EMS and STARS policies, as well as guidelines (i.e. Pre-Hospital Index). The “Trauma
Services Transfers” policy is currently under review and being revised to include new system initiatives,


GROUND VS AIR TRANSPORT
“Ground” refers to ground (road) ambulance transport. “Air” includes fixed wing and rotary wing aircraft. In
situations where both modes of transport are utilized to get patients to FMC, only the air transport portion
was represented in this collection of statistics.

  Ground vs. Air

                              FMC - 5 Year Trend
                                                                                                76% of patients were transported to the FMC
                                                                               831              Trauma Centre by ground ambulance (67.3%
      # of patients




                                                630   602        652
                         522                                                                    2005/2006). Air transport to FMC included
                                                                                                20.3% of the total major trauma population
                                                                                                (27.5% 2005/2006).
                                                                               222
                                                201    246        266
                         203

                      02/03    03/04                04/05     05/06      06/07
                                                 Ground         Air


     Private vehicle/walk-in 2006/2007: 36 (3.3%)
     Unknown mode of arrival 2006/2007: 5
     Private vehicle/walk-in 2005/2006: 51 (5.3%)




                                                                      Ground vs Rotary Wing - 2006/2007
                                                                        Transport Direct From Scene
                                                                  554
                                # of patients




                                                                                                                    70



                                                               Ground                                         Rotary Wing

                                                       Excludes patients arriving direct from scene via private vehicle/walk in




88.8% of the major trauma patients arrived to the FMC from the scene via ground ambulance (69.7% in
2005/2006). 11.2% of the major trauma patients arrived from the scene via rotary wing ambulance (16.5%
in 2005/2006).


NOTE: For more information on Ground and Air Transport see the City of Calgary Emergency Medical
Services Trauma Report and the Shock Trauma Air Rescue (STARS) Society Report in this document.




                                                                                       - 35 -
                                                                                       - 38 -
Regional Trauma Services                                                                    2006/2007




ADMITTING PHYSICIAN SERVICE ANALYSIS

The majority of trauma patients at the FMC site were admitted under the services of the general surgeon,
followed by the intensivist. This complied with the performance indicator for quality trauma care and was
closely monitored. “Other” included hospitalists at the FMC site. This analysis does not include transfers
of care, nor consulting services.


                                              FMC 2006/2007
                      529
      # of patients




                            220         206

                                                           56                                   29
                                                                     17            2
                      GS    ICU          NS                OS        PS            CV           Other




  Legend:
  GS - general surgery; ICU - intensive care unit; NS - neurosurgery; OS - orthopaedic surgery; PS -
  plastic surgery; CV – cardiovascular; Other – hospitalists, neurology

All cases of admission to “Other” category physicians are reviewed as part of the quality assurance
review process.




                                                  - 35 -
                                                  - 39 -
Regional Trauma Services                                                                                                                           2006/2007




SURGICAL PROCEDURES

In 2006/2007, physicians performed 1121 surgical procedures on major trauma patients at the FMC
(2005/2006 – 1343). The procedures were done during 664 visits (2005/2006 – 647) to the operating
rooms, requiring 1779 operating room hours (2005/2006 – 1624 hours).


                                                                                                 FMC 2006/2007
                                  467
          # of procedures




                                                     243                 240

                                                                                            127

                                                                                                          23          16                                3
                                                                                                                                 1          1
                                    OS                    PS                 GS                 NS         CV         Thor       Urol     Ob/Gyn      Other




Legend:
OS - orthopaedics; PS - plastic surgery; GS - general surgery; NS - neurosurgery; CV - cardiovascular
surgery; Thor - thoracic surgery; Urol - urology; Ob/Gyn – obstetrics/gynecology; Other - anaesthesia,
radiology, etc.

Orthopaedic procedures continued to be the highest number of surgical procedures performed at FMC
(41.7% compared to 39.2% or 526 in 2005/2006).

ICU TRAUMA ADMISSIONS

In 2006/2007, 300 or 27.5% (31.3% - 2005/2006) of the major trauma patients were admitted to the FMC
ICU. This does not include patients re-admitted to the ICU.



                                              FMC 2006/2007                                                    Total ICU trauma admissions at the FMC were
                                                                                                               320 patients. Twenty patients of the 320 ICU
                                                           36 37
                                              34 34                                                            admissions were ICU readmissions. This graph
                                                                                                               depicts ICU admissions and re-admissions. All
     # of admissions




                                  27                                         26
                            23          23                                                23                   unplanned ICU admissions and readmissions
                                                                                    20          20
                                                                       18                                      were reviewed as part of the trauma quality
                                                                                                               assurance process. FMC major trauma ICU
                                                                                                               admissions comprised 24.1% of the total overall
                                                                                                               ICU admissions of 1326 for the fiscal year.
                            Apr   May   Jun   Jul   Aug    Sep   Oct   Nov    Dec   Jan   Feb   Mar




                                                                                                      - 35 -
                                                                                                      - 40 -
Regional Trauma Services                                                                                                           2006/2007




 ICU TRAUMA ADMISSIONS cont.


                                            FMC - 5 Year Trend
                                                                   313         320
                                                         290
                                   264
     # of admissions




                                              254




                                   02/03     03/04      04/05      05/06       06/07




MEDIAN ICU LOS FOR TRAUMA PATIENTS
Medians provide a better evaluation of LOS for comparison purposes; averages are greatly affected by
the ranges of LOS, particularly by extended LOS.



                                             FMC - 5 Year Trend

                                                               5
                                                                                  5.5             The median ICU LOS increased from 4 to 5.5
                                      4.5                                                         days at the FMC ICU.
                                                    4                    4
                       # of days




                                     02/03     03/04       04/05       05/06     06/07
                                                        all patients


 All patients range 1-74 days
 Average 7.8
 Standard deviation (SD) 7.9
 Comparison: 05/06 average 8.3


Improved access and patient flow was and is a priority issue for the Calgary Health Region quality
improvement initiatives. At FMC access to ICU beds has presented many challenges over the last year. In
some cases, patients had to be transferred from FMC ICU to other acute care sites to accommodate the
admission of the trauma patient. Processes and policies regarding inter-facility transfers between sites
were well established and further developed with the introduction of the Southern Alberta Regional
Coordination Centre (SARCC). In other cases the patients waited in Post Anaesthetic Recovery Room
(PAAR) for an ICU bed. The Regional “no-diversion policy” was strictly upheld for trauma patients
however, becoming more and more difficult with the growing demands and pressures on the system.




                                                                                         - 35 -
                                                                                         - 41 -
Regional Trauma Services                                                                                                                   2006/2007




MEDIAN HOSPITAL LENGTH OF STAY (LOS)

The median hospital LOS has demonstrated little change over the past 5 years. This included the acute
phase of the hospital stay at FMC, not the rehabilitation phase, which can range from days to months.


                                FMC - 5 Year Trend
                                                     9
                         8            8                           8             8
       # of days




                                                                                                        All patients range 1-154 days
                                                                                                        Average 13.3
                                                                                                        Standard deviation (SD) 16.0
                                                                                                        Comparison: 05/06 average 13.1

                    02/03            03/04       04/05          05/06          06/07
                                             all patients




OUTCOMES BY AGE

The literature states that, generally, outcomes for older adults (65+) or the very young trauma patient (<1)
are poor. This is supported by current trauma registry statistics for the older adults (65+).



                                       FMC 2006/2007
                                                                                                        In 2006/2007, there was a decrease in the
                                                                                        27.3
                                                                                                        percentage of older adult trauma patients (65+)
                                                                                21.4
     % mortality




                                                                        18.2
                                                                                                        who died from injuries sustained (20.8%),
                                                                                                        compared to 2005/2006 (21.5%). The %
                                9              9.6
                                                         7.5                                            mortality rate however is highest in the older
                                                                6.5
                                       3.6                                                              adult population. Of the younger adult age
                     0
                                                                                                        groups (< 65), 7.4% died (10% in 2005/2006).
                   0-14      15-24   25-34   35-44   45-54     55-64   65-74   75-84   >84


                                                % Mortality




The older adult population continues to grow in numbers in the City of Calgary. The 2007 Civic Census
Summary (www.calgary.ca) indicated that the growth in the age 55-64, 65-74, 75+ population was 17,783
persons, between 2004-2006 (most recent Age/Gender data was collected in 2006). This was 30.8% of
the overall population growth for that time period (58,264). The Calgary Health Region and Regional
Trauma Services will continue to face new challenges to ensure quality care and outcomes for this
complex population within the trauma system. Prevention of injury will be paramount.




                                                                                               - 35 -
                                                                                               - 42 -
Regional Trauma Services                                                                                                             2006/2007




OUTCOMES BY MAJOR MECHANISM OF INJURY



                                          FMC 2006/2007
                         474                                                                      At the FMC, the percentage of major trauma
                                                                                                  patients who succumbed to their injuries was
       # of Patients




                                           296                                                    highest for falls (13.5%), followed by, violence
                                                                                                  (9.9%), then “other” mechanism of injury (9.5 %),
                                                                128                               and lastly transportation (8%).
                                                                              86
                               41                  46
                                                                      14           9

                       Transportation           Falls           Violence       Other


                                         Survivors          Non-survivors




YEARLY OUTCOMES BY SURVIVORS/NON-SURVIVORS

The mortality rate at FMC (10.1%) has decreased when compared with 2005/2006 (13.1%).

                                    FMC - 5 year trend
    # of Patients




                                                                             984
                                    773             797          842
                       675

                             92            87              97          127         110


                        02/03           03/04           04/05      05/06     06/07

                                        Survivors         Non-survivors



The Office of the Chief Medical Examiner (Edmonton, Alberta) Alberta Justice, has provided a submission
for the trauma services report for the past three years. The data in their report includes the trauma deaths
at the scene and other fatalities in Southern Alberta.

For more information/details see the Chief Medical Examiner’s Report in this document.




                                                                                         - 35 -
                                                                                         - 43 -
                OUTCOMES BY ISS

                ISS ranges captured by the trauma registry are from 12 to 75.


                                                                                            FMC 2006/2007

                                      600
                                                                   529

                                      500
                      # of patients




                                      400

                                      300
                                               208
                                                                                     177
                                      200

                                      100                                  60                               52
                                                                                            34
                                                      0                                                          9   14   6         3   0    1   1
                                        0
                                                12-15                   16-25         26-35                 36-45    46-55          56-65    66-75

                                                                                                       ISS scores
                                                                                survivor                                      non-survivor




                DISCHARGE LOCATION

                The majority of trauma patients from both sites were discharged “home”. From the documentation
                in the chart, it is often difficult to determine which, if any, support services may be provided at
                “home”; therefore “home with support” may be under represented. The other/unknown category
                represents patients discharged to locations other than previously defined or for which no specific
                discharge location was documented in the chart.


                                               FMC 2006/2007
                642
# of Patients




                                      164
                                               122                                  110
                                                            16            13                     27

                 Home                  Rehab   Acute Care   Nursing /     Home /     Died         Other /
                                                            Chronic       Support                Unknown
                                                             Care




                                                                                                        - 44 -
ISS ≥ 16 TRAUMA TOTALS

In 1992, the inclusion criterion for the Trauma Registry was ISS ≥ 16. In 1993, this was revised to
an ISS ≥ 12. The following graph depicts a 5-year span of patients with an ISS ≥ 16.


                          FMC - 5 year trend
                                                   886
                                           805
                           713     720
  # of Patients




                  627
                                                                    At FMC, there has been a 41.3% increase in
                                                                    the number of patients with an ISS ≥ 16 over
                                                                    the last 5 years (02/03 - 627).



                  02/03    03/04   04/05   05/06   06/07



                              ISS ≥16


This rise in major trauma cases has resulted in increased pressures on acute care and
community resources, with demands for improvements in access to services, technology,
performance and efficiency measures.

Regional Trauma Services, in partnership with various acute care and community groups, plays a
lead role in supporting providers to meet the challenges and ensure quality, effective care for
trauma patients and their families throughout the system.




                                                           - 45 -
Foothills
Medical
Centre
PERFORMANCE INDICATORS
Project Lead:
   • Ms. Christi Findlay, Data Analyst
      Regional Trauma Services
Regional Trauma Services                                                                                                       2006/2007


                                        TRANSPORT SYSTEM PERFORMANCE
                                         Interhospital Transfers within Calgary

                               (Transfers from PLC/RGH/ACH to FMC Trauma Centre)

Note: These sites may have received patients from or be a primary or secondary hospital site.

 Peter Lougheed Centre                                                  PLC Total Injury Discharges 2006/2007 = 1453
 If the patient was transferred from another hospital
 to the FMC, were they transferred from the PLC?




 n = all FMC ISS >/= 12 patients transferred from any hospital to
 FMC                                                                         92.5            92.0           91.4              93.5           90.8
 Indicator                  Yes                  No

 2006/2007, n = 433         40                   393                                 7.5            8.0               8.6            6.5             9.2
 2005/2006, n = 400         26                   374                       2002/2003       2003/2004      2004/2005         2005/2006      2006/2007

 2004/2005, n = 382         33                   349                                                   %Yes        %No
 2003/2004, n = 349         28                   321
 2002/2003, n = 321         24                   297



 Rockyview General Hospital                                                          RGH Total Injury Discharges
 If the patient was transferred from another hospital                                    2006/2007 = 1623
 to the FMC, were they transferred from the RGH?



 n = all FMC ISS >/= 12 patients transferred from any hospital to
 FMC




                                                                              94.1           90.5          92.7             90.7           93.8

 Indicator                     Yes                  No

 2006/2007, n = 433            27                   406                              5.9            9.5           7.3              9.3            6.2
                                                                            2002/2003      2003/2004      2004/2005     2005/2006        2006/2007
 2005/2006, n = 400            37                   363
 2004/2005, n = 382            28                   354                                                %Yes        %No

 2003/2004, n = 349            33                   316
 2002/2003, n = 321            19                   302




                                                                59
                                                             -- 48 --
Regional Trauma Services                                                                                                 2006/2007


  Alberta Children’s Hospital                                                    ACH Total Injury Discharges
                                                                                      2006/2007 = 706
  If the patient was transferred from another hospital
  to the FMC, were they transferred from the ACH?

  n = all FMC ISS >/= 12 patients transferred from any hospital to
  FMC



  Indicator                   Yes                  No
                                                                          99.0           99.4          100.0           99.5           99.8
  2006/2007, n = 433          1                    432
  2005/2006, n = 400          2                    398
  2004/2005, n = 382          0                    382                                                         0.0
                                                                                 1.0            0.6                           0.5            0.2
  2003/2004, n = 349          2                    347
                                                                        2002/2003      2003/2004      2004/2005      2005/2006      2006/2007
  2002/2003, n = 321          3                    318


                                                Foothills Medical Centre
                                              PERFORMANCE INDICATORS

As part of the Regional Trauma Services quality improvement process, several indicators throughout the
continuum of care are monitored on a regular basis as a measure of performance. Some of the indicators
stem from audit filters set out by the American College of Surgeons’ Committee on Trauma and Trauma
Registry performance measures published by the Southwestern Sydney Region Trauma Department,
Liverpool, Australia. Other indicators were developed at FMC and ACH as site specific performance
indicators. The following is a summary of these indicators at FMC for patients who meet the inclusion
criteria for the Alberta Trauma Registry (patients with an ISS > 12 and who are admitted to the hospital or
die in the ED at the FMC). ISS is an anatomical scoring tool that provides an overall score for patients with
single system or multiple system injuries. The higher the ISS score the more severe the injury. Each
performance indicator number is based on the specific determinant of the indicator within the total of 1094
major trauma patients. Nurses, physicians and/or Department/Division Heads review cases of identified
non-compliance to determine the need for follow-up regarding process/system issues.

                                          PRE-HOSPITAL PHASE
  GCS (Glasgow Coma Scale) ≤ 8 at
  Scene / Airway
  Did the patient with a first recorded scene GCS ≤ 8
  receive an airway as an intervention at the scene?

  Prior to 2006/2007, this indicator monitored mechanical airways
  only. Mechanical airway included intubation (nasal and oral),            52.7           52.9           47.3           58.3           39.2
  cricothyroidotomy and tracheostomy. In 2006/2007, this indicator
  expanded to include Laryngeal Mask Airway (LMA) and oral or
  naso-pharyngeal airways as an airway intervention at the scene.
                                                                           47.3           47.0            52.7          41.7           60.8

  n = all patients with first recorded scene GCS ≤8.                     2002/2003      2003/2004      2004/2005      2005/2006      2006/2007
        Indicator                    Yes                 No
                                                                                                      %Yes        %No
  2006/2007, n = 148          90                   58
  2005/2006, n =120           50                   70
  2004/2005, n = 131          69                   62
  2003/2004, n = 121          57                   64
  2002/2003, n = 129          61                   68

                                                             -- 49 --
                                                                59
Regional Trauma Services                                                                                            2006/2007

                                    INTERHOSPITAL TRANSFERS outside Calgary

  Time Spent at Sending hospital
  Did the patient spend < 3 hours at the sending
  hospital prior to transfer to FMC trauma centre?
                                                                               30.4                 36.2                 59.4


  n = all patients transferred from a non-trauma centre outside
  Calgary, with a known sending hospital LOS.
                                                                               69.9                 63.8                 40.6

  Note: revised from < 2 hours to < 3 hours in 2004/2005
                                                                             2004/2005            2005/2006          2006/2007
  Indicator                    Yes                  No
                                                                                                %Yes       %No
  2006/2007, n = 288           117                  171

  2005/2006, n = 177           113                  64

  2004/2005, n = 181           126                  55




  District Centre Transfers
  Was the patient transferred from proposed district
  trauma centres?
  Red Deer = 26
  Lethbridge = 44
  Medicine Hat = 34

  n = all patients transferred from hospital outside Calgary                77.1         70.6        70.7         71.6          71.6

  Indicator                    Yes                  No

  2006/2007, n = 366           104                  262
                                                                            22.9         29.4        29.3         28.4          28.4
  2005/2006, n = 335           95                   240
                                                                          2002/2003   2003/2004    2004/2005   2005/2006    2006/2007
  2004/2005, n = 321           94                   227
                                                                                                  %Yes      %No
  2003/2004, n = 286           84                   202
  2002/2003, n = 275           63                   212



The Provincial Trauma System Proposal was approved for funding by Alberta Health and Wellness in
Febraury 2007. Five centres were identified as District Trauma Centres: Lethbridge Regional Hospital,
Medicine Hat Regional Hospital, Red Deer Regional Hospital, Queen Elizabeth II Hospital, Grande Prairie,
and Northern Lights Regional Hospital, Fort McMurray.

The goal of the Provincial Trauma System is to develop and maintain an organised, integrated provincial
trauma system that is cost effective while reducing mortality and morbidity due to injury. This model aims
to get "the injured person to the right treatment at the right trauma facility in the shortest time". (Source:
Provincial Trauma System: Proposal for Alberta (2001, June). Each identified District Centre strives to
become an accredited trauma centre by the Trauma Association of Canada, which includes the
establishment of a trauma team, a trauma registry and adequate educational and equipment resources.
The Tertiary Trauma Centres (Calgary/Edmonton) will provide support to the sites as required directed by
a Provincial Trauma Advisory Committee.



                                                               -- 50 --
                                                                  59
Regional Trauma Services                                                                                                       2006/2007




  Injury Time to Trauma Centre
  If the patient was transferred from a hospital outside
  Calgary, was it less than 4 hours from injury time to
  arrival at FMC Trauma Centre?
                                                                                      66.5           73.3             77.0            78.6
  The 2006/2007 data demonstrates the acute and
  growing need for a provincial trauma system
  designed to monitor and evaluate delays and ensure                                  33.5           26.7             23.0            21.4
  timely access to tertiary trauma care.
                                                                                    2003/2004      2004/2005       2005/2006        2006/2007

  n = all patients transferred from a hospital outside Calgary with a
  known time of injury event and known time of arrival to FMC                                            %Yes      %No
  Trauma Centre
  Indicator                        Yes                      No

  2006/2007, n = 210               45                       165

  2005/2006, n = 126               29                       97

  2004/2005, n = 116               31                       85

  2003/2004, n = 161               54                       107




  Out of Province Transfers
  Was the patient, a non-resident of Calgary,
  transferred from out of province to Calgary?
  Of the 84 out of province transfers (non-residents of Calgary), 51
  (60.7%) were transferred from hospitals in British Columbia.
                                                                                     79.8                                    76.0        72.7
                                                                                                  85.2         83.9
  n = all patients transferred from a hospital outside of Calgary with patient
  home address outside of Calgary.

  Indicator                        Yes                      No                       20.2                                    24.0        27.3
                                                                                                  14.8         16.1
  2006/2007, n = 308               84                       224                    2002/2003    2003/2004    2004/2005   2005/2006     2006/2007

  2005/2006, n = 295               72                       223                                             %Yes      %No
  2004/2005, n = 274               44                       230
  2003/2004, n = 270               40                       230
  2002/2003, n = 238               48                       190




                                                                        -- 51 --
                                                                           59
Regional Trauma Services                                                                                            2006/2007


                                               RESUSCITATIVE PHASE

Trauma Team Activations
At FMC, the trauma team is activated at the discretion of the ED physician, using specific activation
criteria and/or through the pre-hospital process of communication. The activation criteria are based on the
Gold Book, published by the American College of Surgeons Committee on Trauma, with input from the
American College of Emergency Physicians and the various providers within the trauma system.


The criteria for automatic trauma team activation (TTA), (level 1), are:
    1.   confirmed shock, defined as BP systolic < 90 or temp < 28°
    2.   intubated patient en route or in the emergency department or patient with respiratory compromise
    3.   patient with a GCS < 8
    4.   gunshot wound to the head, neck or trunk
    5.   need for blood transfusion en route to hospital or in the emergency department.


In cases of significant mechanism of injury or obvious significant injury to patients who do not meet these
criteria, early discussion/consultation with the trauma surgeon/service and the trauma resident is
recommended to ensure timely intervention. The triage nurse, the emergency physician or the nurse
clinician may activate the Trauma Team prior to arrival of the patient, or upon arrival of the patient to the
Trauma Centre.

The second level of activation is consult only.

Nurses and/or physicians review charts when the TTA criteria are met and the trauma team is not
activated and/or the Trauma Team Leader response exceeds 20 minutes. Recommendations may be
made for action as appropriate. The activation criteria are reviewed and may be revised if appropriate to
quality care by the Adult Trauma Care Committee.



Trauma Team Leader (TTL) Response Time

Was the TTL response time < 20 minutes?
                                                                       7.7          3.8         3.1          4.1        2.9


n = all patients with trauma team activation and a known trauma
team leader response time (excludes direct admits)
Unknown trauma team response times (12) excluded from                 92.3         96.2         96.9         95.9       97.1
response time analysis.

Indicator                  Yes                No
                                                                     2002/2003   2003/2004    2004/2005   2005/2006   2006/2007
2006/2007, n = 209         203                6
2005/2006, n = 193         185                8                                              %Yes      %No

2004/2005, n = 226         219                7
2003/2004, n = 210         202                8
2002/2003, n = 196         181                15




                                                          -- 52 --
                                                             59
Regional Trauma Services                                                                                                                   2006/2007


                                                        FMC Trauma Total Comparisons


           45                                                                                          Traum a Te am Activations any
                                                                                                       ISS
           40                                                                                          M ajor Traum a Adm is s ions w ith
                                                                                                       ISS >= 12
           35
           30
           25
           20
           15
           10
            5
            0
             Apr         M ay       Jun           Jul      Aug          Se p          Oct   Nov      De c        Jan           Fe b        M ar


In 2006/2007 there were 340 documented trauma team activations in total, 220 patients were classified as
major trauma (ISS ≥ 12).
This graph represents the number of documented trauma team activations/month (any ISS) in 2006/2007
compared with the major trauma patient (ISS ≥ 12). In some months the number of patients ISS ≥ 12 is
less than 50% of the number of patients that trigger a trauma team activation. Trauma experts advise that
is better to over activate and err on the “side of caution”.



  Trauma Team Activation (TTA) Criteria in the Major Trauma Population (ISS ≥ 12)


                                            TTA Criteria Met                                                               TTA Criteria Not Met

                                              32.1% (336)                                                                           67.9% (711)




     Yes, TT Activated          No, TT Not Activated              Unknown TT                                   Yes, TT Activated                  No, TT Not Activated

        57.4% (193)                 42.3% (142)                Activation 0.3% (1)                                 3.8% (27)                          96.2% (684)




         Response Time within                                                                                    Response Time within

             20 Minutes?                                                                                             20 Minutes?




             Yes                  No                Unknown Response                                 Yes                       No                  Unknown Response

         93.3% (180)            2.1% (4)                Time 4.7% (9)                             85.2% (23)             7.4% (2)                     Time 7.4% (2)




Excludes direct admits (47)

In 2006/2007, of the 142 cases in which the criteria were met but the team was not activated, 53 (37.3%)
were single system head injured patients. In many cases of the single system head injury the patient is
referred directly to the neurosurgeon on-call and, if non-operative, the patient is admitted to the hospitalist.
If the patient qualifies as major trauma (i.e. ISS > 12) the case is flagged using the Trauma Registry and
reviewed. The concern with this type of direct referral is the potential for a missed injury when the focus is
on a single system; the tertiary survey is a critical step in the process of assessment.



                                                                              59
                                                                           -- 53 --
Regional Trauma Services                                                                                               2006/2007

NEW INDICATOR
 Trauma Consult
 If the trauma team was not activated, was trauma
 consulted at any time during the patient’s length of
 stay?
                                                                                                      56.0


 n = all patients admitted to FMC without trauma team activation or                                   44.0
 admission to trauma services.
 Indicator                   Yes                    No
                                                                                                    2006/2007

 2006/2007, n = 425          187                    238
                                                                                                   %Yes      %No




 GCS < 8 Mechanical Airway in ED
 Did the patient with a first recorded trauma centre
 GCS < 8 receive a mechanical airway as an
 intervention in the FMC ED?
                                                                             18.2        15.0          25.0                      16.4
 Mechanical     airway     includes   intubation       (oral,     nasal,                                              23.3
 cricothyroidotomy and tracheostomy).
                      st
 n = all patients with 1 recorded trauma centre GCS ≤ 8.
 Indicator                   Yes                   No                        81.8        85.0          75.0           76.7       83.6

 2006/2007, n = 55           46                    9
 2005/2006, n = 43           33                    10
                                                                           2002/2003   2003/2004     2004/2005    2005/2006    2006/2007
 2004/2005, n = 28           21                    7
 2003/2004, n = 40           34                    6                                               %Yes         %No

 2002/2003, n = 33           27                    6



 ED Length of Stay (LOS)
 Did the patient have an FMC ED length of stay < 4
 hours?
 Median ED LOS: 5.6 hours         Range: 0 to 60.3 hours
 Average ED LOS: 7.4 hours                                                  56.4         62.5         57.6         63.3         68.3

 n = all patient seen in FMC ED with a known LOS.
                                                                            43.6         37.5         42.4         36.7
 Indicator                    Yes                  No                                                                           31.7

                                                                           2002/2003   2003/2004    2004/2005    2005/2006    2006/2007
 2006/2007, n=1015            322                  693
 2005/2006, n = 911           334                  577                                             %Yes      %No

 2004/2005, n = 840           356                  484
 2003/2004, n = 798           299                  499
 2002/2003, n = 714           311                  403




                                                                -- 54 --
                                                                   59
Regional Trauma Services                                                                                             2006/2007




  Joint Reduction
  If the patient had a joint dislocation (hip, shoulder,
  knee, elbow) was there an attempt to relocate or a
  successful relocation of the joint within 1 hour of
  arrival to the FMC trauma centre?
                                                                                                                             37.9
  Note: revised to include attempt at relocation of joint within 1 hour                  48.6
  of arrival to FMC trauma centre in 2006/2007                                                                     58.8
                                                                             68.8                     70.6
  n = (2006/2007) All patients with a hip, shoulder, knee or elbow
  dislocation with a hospital LOS ≥1 hour and a known reduction
  time. Wrist and ankles were excluded in 2005/2006.
                                                                                                                             62.1
  Indicator                   Yes                   No                                   51.4
                                                                                                                   41.2
                                                                             31.3                     29.4
  2006/2007, n = 29           18                    11
  2005/2006, n = 34           14                    20                     2002/2003   2003/2004    2004/2005   2005/2006   2006/2007


  2004/2005, n = 34           10                    24                                             %Yes      %No
  2003/2004, n = 35           18                    17
  2002/2003, n = 16           5                     11




  CT of the Head
  If the patient had a GCS < 13, was a CT of the head
  performed within 4 hours of arrival to the FMC                            5.2          4.8           0.0          7.7          2.3
  trauma centre?

  n = all patients with a known FMC ED GCS, a known time of CT
  head, LOS >/= 4 hours and no head CT at sending hospital.                 94.8         95.2        100.0                       97.7
                                                                                                                   92.3
  Indicator                   Yes                   No

  2006/2007, n = 87           85                    2
                                                                          2002/2003    2003/2004    2004/2005   2005/2006   2006/2007
  2005/2006, n = 52           48                    4
  2004/2005, n = 40           40                    0                                           %Yes      %No

  2003/2004, n = 62           59                    3
  2002/2003, n = 58           55                    3




                                                               -- 55 --
                                                                  59
Regional Trauma Services                                                                                            2006/2007


                                            DEFINITIVE CARE PHASE
  Craniotomy
  If the patient had an epidural or subdural brain
  hematoma, was a craniotomy performed within 4
  hours of arrival at the FMC trauma centre?                              16.0         13.6         11.1         20.7      17.1

  Note: This indicator excludes documented subacute or chronic
  injuries.
                                                                          84.0         86.4         88.9                    82.9
                                                                                                                 79.3

  n = all patients with epidural or subdural hematoma where
  operative management was the planned intervention.
                                                                         2002/2003   2003/2004    2004/2005   2005/2006   2006/2007
  Indicator                 Yes                  No
                                                                                                 %Yes      %No
  2006/2007, n= 41          34                   7
  2005/2006, n = 29         23                   6
  2004/2005, n = 36         32                   4
  2003/2004, n = 44         38                   6
  2002/2003, n = 25         21                   4

  Gunshot Wound to Abdomen
  Was the abdominal gunshot wound managed
  operatively?



                                                                           100         100          100          100        100
  n = all patients with abdominal gunshot wound admitted to FMC
  Trauma Centre.
  Indicator                 Yes                  No
                                                                         2002/2003   2003/2004    2004/2005   2005/2006   2006/2007
  2006/2007, n= 5           5                    0
  2005/2006, n = 4          4                    0                                               %Yes      %No

  2004/2005, n = 4          4                    0
  2003/2004, n = 1          1                    0
  2002/2003, n = 1          1                    0




                                                                 59
                                                              -- 56 --
Regional Trauma Services                                                                            2006/2007

  Pelvic Fracture
  If the patient sustained a pelvic ring fracture and
  was hemodynamically unstable in the emergency
  department, was provisional stabilization done within
  12 hours of arrival to the trauma centre?
  Hemodynamically unstable: Systolic BP < 90 or greater than 4             100          100            100
  units of packed red blood cells given in the first hour.

  n = all hemodynamically unstable patients with pelvic ring fracture
  and provisional stabilization
                                                                         2004/2005    2005/2006      2006/2007
  Indicator                   Yes                   No

  2006/2007, n = 4            4                     0                                %Yes     %No

  2005/2006, n = 9            9                     0
  2004/2005, n = 7            7                     0



  Pelvic Fracture
  Did this patient (from previous indicator) have their
  pelvic fracture definitively repaired within 7 days of
  arrival to trauma centre?

  Excludes patients who died prior to definitive repair
                                                                           100          100            100

  n = all patients with pelvic ring fracture who were
  hemodynamically unstable in ED, had provisional stabilization
  and survived at least 7 days                                           2004/2005    2005/2006      2006/2007
  Indicator                   Yes                   No
                                                                                     %Yes     %No
  2006/2007, n = 3            3                     0
  2005/2006, n = 7            7                     0
  2004/2005, n = 2            2                     0



  Acetabular Fracture
  If the patient sustained an acetabular fracture and
  was hemodynamically unstable in the emergency                              0            0
  department, was provisional stabilization done within
  12 hours of arrival to trauma centre?
  Hemodynamically unstable: SBP < 90 or greater than 4 units of            100          100
  packed red blood cells in the first hour
                                                                                                        0

  n = all hemodynamically unstable patients with acetabular              2004/2005    2005/2006      2006/2007
  fracture and provisional stabilization
  Indicator                   Yes                   No                               %Yes     %No

  2006/2007, n = 0            n/a                   n/a
  2005/2006, n = 2            2                     0
  2004/2005, n = 6            6                     0




                                                              -- 57 --
                                                                 59
Regional Trauma Services                                                                                           2006/2007



  Acetabular Fracture
  Did this patient (from previous indicator) have their
  acetabular fracture definitively repaired within 7 days                       0                    0
  of arrival to trauma centre?

  Excludes patients who died prior to definitive repair
                                                                             100                   100

  n = all patients with acetabular fracture who were                                                                     0
  hemodynamically unstable in ED, had provisional stabilization
  and survived at least 7 days
  Indicator                   Yes                   No                   2004/2005              2005/2006          2006/2007

  2006/2007, n = 0            n/a                   n/a                                         %Yes      %No

  2005/2006, n = 1            1                     0
  2004/2005, n = 1            1                     0




  Femur Fracture
  Did the patient have operative management of the
  femur fracture within 24 hours of arrival to FMC                       19.4         3.8          13.2         12.7         7.0
  trauma centre?

  This indicator was reviewed by the Division of Orthopaedics and
  will remain unchanged for the 2006/2007 year. Criteria is                           96.2         86.8         87.3         93.0
                                                                         80.6
  undergoing further review.

  n = all patients with operative management of femur fracture.
  Indicator                   Yes                   No                 2002/2003    2003/2004    2004/2005   2005/2006   2006/2007


  2006/2007, n = 57           53                    4                                           %Yes      %No
  2005/2006, n = 63           55                    8
  2004/2005, n = 53           46                    7
  2003/2004, n = 53           51                    2
  2002/2003, n = 31           25                    6




                                                            -- 58 --
                                                               59
Regional Trauma Services                                                                                                2006/2007




Open Fracture

Did the patient with open long bone fracture have
operative management performed within 6 hours                          17.5                          16.7            37.2           23.8
                                                                                       10.0
(grade 3) or 12 hours (grade 1, 2) of arrival to FMC
trauma centre?
Long bones include radius, ulna, humerus, tibia, femur and fibula.
This indicator was reviewed by the Division of Orthopaedics and
will remain unchanged for the 2006/2007 year.
                                                                       82.5            90.0          83.3            62.8           76.2

n = all patients with operative management of open long bone
fracture.
Indicator                    Yes                    No
                                                                     2002/2003    2003/2004     2004/2005          2005/2006      2006/2007
2006/2007, n = 42            32                     10
                                                                                                %Yes            %No
2005/2006, n = 43            27                     16

2004/2005, n = 24            20                     4

2003/2004, n = 40            36                     4

2002/2003, n = 40            33                     7




Unplanned Return to OR
Did the patient have an unplanned return to the
operating room within 48 hours of the initial
procedure?


                                                                        96.7           99.2           98.5           97.3          98.0
n = all patients with at least one operating room visit.

Indicator                     Yes                   No
                                                                                 3.3          0.8            1.5            2.7            2.0
2006/2007, n = 444            9                     435               2002/2003    2003/2004        2004/2005      2005/2006      2006/2007

2005/2006, n = 406            11                    395
                                                                                               %Yes          %No
2004/2005, n = 407            6                     401
2003/2004, n = 374            3                     371
2002/2003, n = 337            11                    326




                                                            - 59 -
Regional Trauma Services                                                                                                        2006/2007



  Admitting Physician
  Was the patient admitted under a surgeon or
  intensivist at the FMC trauma centre?                                        3.0           3.5             2.3             3.8            2.3

  The majority of cases, determined to require review, were
  admissions to a Hospitalist.

  NOTE: Excludes patients admitted for palliative care.                      97.0            96.5            97.7           96.2            97.7

  n = all patients admitted to FMC Trauma Centre.
  Indicator                      Yes                      No
                                                                            2002/2003      2003/2004      2004/2005       2005/2006      2006/2007
  2006/2007, n=1054              1030                     24
                                                                                                       %Yes         %No
  2005/2006, n = 931             896                      351
  2004/2005, n = 864             844                      20
  2003/2004, n = 838             809                      29
  2002/2003, n = 740             718                      22

  Delayed Diagnosis/Missed Injury
  Did the patient have a delayed diagnosis or missed
  injury diagnosed > 48 hours from arrival at the FMC
  trauma centre?
  Missed injuries: 50% extremity, 23.1% spine, 15.4% face, and
  7.7% thorax.
  48 hours allows time for the comprehensive tertiary survey.                95.7            98.1            99.4           97.5            98.7
  n = all patients admitted to FMC Trauma Centre who survived >
  48 hours from arrival.                                                                                                                           1.3
                                                                                     4.3            1.9             0.6            2.5
  Indicator                      Yes                      No
                                                                            2002/2003      2003/2004      2004/2005       2005/2006      2006/2007
  2006/2007, n=1035              13                       1022
                                                                                                       %Yes         %No
  2005/2006, n = 896             22                       874
  2004/2005, n = 866             5                        861
  2003/2004, n = 839             16                       823
  2002/2003, n = 741             32                       709

  Missed C-Spine Injury
  Was there a missed c-spine injury with c-spine
  precautions removed at the FMC trauma centre?
  10.8% of the total major trauma admissions had a c-spine injury.

  NOTE: Excludes patients admitted for palliative care.

                                                                              99.7           99.1            99.9            100.0           100.0
  n = all patients admitted to FMC Trauma Centre.
  Indicator                      Yes                      No
                                                                                     0.3                               0.1            0.0            0.0
  2006/2007, n=1054              0                        1054                                         0.1
                                                                            2002/2003      2003/2004       2004/2005       2005/2006        2006/2007
  2005/2006, n = 935             0                        935
  2004/2005, n = 867             1                        866                                          %Yes         %No

  2003/2004, n = 839             1                        838
  2002/2003, n = 741             2                        739


                                                                    59
                                                                 -- 60 --
   Regional Trauma Services                                                                                                2006/2007




Unplanned ICU Admission
Was there an unplanned ICU trauma admissions at
the FMC trauma centre?
In total, there were 300 trauma patients admitted to the ICU
(planned and unplanned) within an overall total of 1326 ICU
admissions. Most unplanned trauma admissions were due to                                       97.0
                                                                     95.8         98.0                        97.6           96.5
respiratory compromise.

n = all patients admitted to FMC Trauma Centre.                                                                                     3.5
                                                                            4.2          2.0          3.0            2.4
Indicator                     Yes                   No
                                                                    2002/2003   2003/2004    2004/2005      2005/2006      2006/2007
2006/2007, n=1059             37                    1022
                                                                                            %Yes      %No
2005/2006, n = 936            22                    914
2004/2005, n = 867            26                    841
2003/2004, n = 839            17                    822
2002/2003, n = 741            31                    710




Unplanned ICU Readmission
Did the patient have an unplanned trauma
readmission to ICU at the FMC trauma centre?
Of the 20 patients readmitted to ICU, 15 were unplanned, 1 was
planned, and 4 were readmitted 3 times.
                                                                     96.0         97.6         96.7           95.9           95.0

n = all patients with at least one ICU admission.
Indicator                     Yes                   No                                   2.4          3.3            4.1            5.0
                                                                            4.0
                                                                    2002/2003   2003/2004    2004/2005      2005/2006      2006/2007
2006/2007, n = 300            15                    285
2005/2006, n = 293            12                    281                                     %Yes      %No

2004/2005, n = 274            9                     265
2003/2004, n = 245            6                     239
2002/2003, n = 252            10                    242




                                                           - 65 -
                                                           - 61 -
   Regional Trauma Services                                                                                                 2006/2007




Ischemic Limb
Was the ischemic limb revascularized at the FMC
trauma centre, within 6 hours of injury?                                0.0                         0.0
Patient must have penetrating wound to an artery or severe
                                                                                   20.0
fracture where the limb is pulseless. Attempts to reduce the limb                                                              28.6
have failed and the patient has gone to the OR for vascular repair                                               50.0
(shunt, graft or amputation).


                                                                      100.0        80.0         100.0
n = all patients with ischemic limb, LOS ≥ 6 hours and stable                                                                  71.4
enough for OR.                                                                                                   50.0
Indicator                  Yes                    No

2006/2007, n = 7           5                      2                  2002/2003   2003/2004     2004/2005        2005/2006    2006/2007

2005/2006, n = 2           1                      1                                           %Yes        %No
2004/2005, n = 3           3                      0
2003/2004, n = 5           4                      1
2002/2003, n = 2           2                      0




Thromboembolic (DVT) Prophylaxis
Did the immobile patient receive documented
thromboembolic prophylaxis within 24 hours of                                                                    6.6
admission at the FMC trauma centre?                                                             12.5                          13.1
                                                                       23.2        19.2
This indicator includes all units with trauma patients and relies
heavily on nursing documentation of the intervention.

n = all immobile patients whose LOS ≥ 24 hours.                                                 87.5            93.4          86.9
                                                                       76.8        80.8
Indicator                     Yes                 No

2006/2007, n = 674            586                 88
2005/2006, n = 655            612                 43                 2002/2003   2003/2004    2004/2005     2005/2006       2006/2007


2004/2005, n = 546            478                 68
                                                                                             %Yes         %No
2003/2004, n = 511            413                 98
2002/2003, n = 495            380                 115




                                                           - 62 -
                                                           - 65 -
   Regional Trauma Services                                                                                             2006/2007




Major Facial Fracture
Did the patient receive operative management of
major facial fractures (mandible, maxilla or orbit) at                   2.3         7.0          6.3          8.5        4.5
the FMC trauma centre, within 7 days of injury?


n = all patients who have operative intervention of major facial         97.7       93.0          93.8         91.5       95.5
fracture.
Indicator                   Yes                   No
                                                                       2002/2003   2003/2004    2004/2005   2005/2006   2006/2007
2006/2007, n = 44           42                    2
2005/2006, n = 47           43                    4                                            %Yes      %No

2004/2005, n = 48           45                    3
2003/2004, n = 43           40                    3
2002/2003, n = 43           42                    1




Spinal Fracture
Did the patient receive operative management of
spinal fractures at the FMC trauma centre, within 7                      13.2       11.4          0.0          9.8        5.8
days of injury?


                                                                                                 100.0                    94.2
n = all patients who have operative intervention of spinal fracture.     86.8       88.6                       90.2


Indicator                   Yes                   No
                                                                       2002/2003   2003/2004    2004/2005   2005/2006   2006/2007
2006/2007, n = 52           49                    3
2005/2006, n = 41           37                    4                                            %Yes      %No

2004/2005, n = 31           31                    0
2003/2004, n = 44           39                    5
2002/2003, n = 38           33                    5




                                                             - 65 -
                                                             - 63 -
   Regional Trauma Services                                                                               2006/2007




                                            LAPAROTOMY CATEGORIES
   These categories include all patients with suspected intra-abdominal injury requiring a
   laparotomy. Nurses and/or physicians reviewed all laparotomy cases to determine the need for
   follow-up regarding process/system issues. Patients were categorized based on the following
   criteria:
   Category 1: Hemorrhagic shock.
   Time to laparotomy < 1 hour. Patients with a blood pressure, systolic < 90 in the trauma room,
   confirmed, or a need for > 4 units of packed red blood cells in the first hour, for hemorrhage due
   to injury.
   Category 2: Hemodynamically stable patients requiring emergency laparotomies.
   Time to laparotomy < 4 hours. Patients presenting with truncal injury requiring emergency
   laparotomy who do not meet criteria for shock. Transfusion requirements are < 4 units in the first
   hour. BP systolic is > 90. Typically, these represent patients with injuries identified at the time of
   CT scanning.
   Category 3: Patients requiring delayed laparotomy.
   Patients for whom acute indications for emergency laparotomy were not identified at the time of
   initial trauma assessment and resuscitation (i.e. patients with stable visceral injury with delayed
   development of bleeding, or patients with occult intra-abdominal injuries, diagnosed after
   admission).

Category 1 Laparotomies
If the patient received a Category 1 laparotomy, was
it performed within 1 hour of arrival to FMC trauma
centre?
                                                                       30.3        30.4                    28.6
                                                                                               57.1
 2005/2006                        2006/2007
 median time to lap: 59           median time to lap: 38.5
 minutes                          minutes                              69.7        69.6                    71.4
 average time to lap: 108.9       average time to lap: 227.1                                   42.9
 minutes                          minutes
 range: 14 - 797 minutes          range: 11 – 4231 minutes
                                                                     2003/2004   2004/2005   2005/2006   2006/2007
n = all patients with Category 1 laparotomy. Of patients requiring
category 1 laparotomy, and laparotomy was not performed within                       %Yes    %No
1 hour of arrival to trauma centre, 50% had laparotomy within 2
hours.
Indicator                  Yes                  No

2006/2007, n = 28          20                   8

2005/2006, n = 28          16                   12

2004/2005, n = 23          16                   7
2003/2004, n = 33          23                   10




                                                          - 65 -
                                                          - 64 -
   Regional Trauma Services                                                                                 2006/2007




Category 2 Laparotomies
If the patient received a category 2 laparotomy, was
it performed within 4 hours of arrival to FMC trauma
centre?                                                                23.5         22.2        12.9        23.1
 2005/2006                        2006/2007
 median time to lap: 125          median time to lap: 120
 minutes                          minutes                                                       87.1
                                                                       76.5         77.8                    76.9
 average time to lap: 303.5       average time to lap: 215.9
 minutes                          minutes
 range: 26 - 3354 minutes         range: 11 – 1235 minutes
                                                                     2003/2004    2004/2005   2005/2006   2006/2007
n = all patients with Category 2 laparotomy.
Indicator                  Yes                  No                                    %Yes     %No

2006/2007, n = 39          30                   9

2005/2006, n = 31          27                   4

2004/2005, n = 27          21                   6
2003/2004, n = 17          13                   4


Therapeutic Laparotomies: Category 1
If the patient required laparotomy at the FMC trauma
centre, was the laparotomy therapeutic?
                                                                      12.1                      14.3         7.1
                                                                                   21.7
Therapeutic laparotomy is defined as discovery of an injury that
requires suturing or packing.
                                                                      87.9                      85.7        92.9
                                                                                   78.3
n = all patients with Category 1 laparotomy.
Indicator                                 Yes         No
                                                                    2003/2004    2004/2005    2005/2006   2006/2007
2006/2007, n = 28                         26          2

2005/2006, n = 28                         24          4                               %Ye s    %No

2004/2005, n = 23                         18          5
2003/2004, n = 33                         29          4

Therapeutic Laparotomies: Category 2
If the patient required laparotomy at the FMC trauma
centre, was the laparotomy therapeutic?                                11.8         11.8          0          7.7

Therapeutic laparotomy is defined as discovery of an injury that
requires suturing or packing.
                                                                                    100         100         92.3
                                                                       88.2
n = all patients with Category 2 laparotomy.
Indicator                                 Yes         No
                                                                    2003/2004    2004/2005    2005/2006   2006/2007
2006/2007, n = 39                         36          3

2005/2006, n = 31                         31          0                                %Yes    %No

2004/2005, n = 27                         27          0
2003/2004, n = 17                         15          2


                                                           - 65 -
   Regional Trauma Services                                                                              2006/2007




Therapeutic Laparotomies: Category 3
If the patient required laparotomy at the FMC trauma
centre, was the laparotomy therapeutic?                                           7.7        16.7         33.3
                                                                     13.3

Therapeutic laparotomy is defined as discovery of an injury that
requires suturing or packing.

                                                                     86.7        92.3        83.3
n = all patients with Category 3 laparotomy.
                                                                                                         66.7

Indicator                                 Yes        No
                                                                   2003/2004   2004/2005   2005/2006   2006/2007
2006/2007, n = 9                          6          3

2005/2006, n = 12                         10         2                             %Yes     %No

2004/2005, n = 13                         12         1
2003/2004, n = 15                         13         2




                                                          - 66 -
                                                          - 65 -
   Regional Trauma Services                                                                                                      2006/2007




                                                        OUTCOMES

Death during First 24 Hours
Did the patient die within the first 24 hours of arrival
to the FMC trauma centre?

All death cases are reviewed by Trauma Services.                       44.6            39.1           41.2                         43.6
                                                                                                                     55.9

n = all patients who die.
                                                                        55.4           60.9           58.8                         56.4
                                                                                                                     44.1
Indicator                                 Yes           No
                                                                      2002/2003   2003/2004       2004/2005     2005/2006        2006/2007
2006/2007, n = 110                        62            48
2005/2006, n = 127                        56            71                                     %Yes          %No

2004/2005, n = 97                         57            40
2003/2004, n = 87                         53            34
2002/2003, n = 92                         51            41




Mortality
Did the patient die at the FMC trauma centre?




                                                                        88.0            89.9           89.1            86.9          89.9
n = all patients arriving at FMC trauma centre.
Indicator                     Yes                 No

2006/2007, n=1094             110                 984                                          10.1                                          10.1
                                                                               12.0                           10.9            13.1
2005/2006, n = 969            127                 842                 2002/2003       2003/2004    2004/2005         2005/2006     2006/2007

2004/2005, n = 894            97                  797
                                                                                                  %Yes        %No
2003/2004, n = 860            87                  773
2002/2003, n = 767            92                  675




                                                             - 65 -
                                                             - 67 -
   Regional Trauma Services                                                                                                    2006/2007




                  TRAUMA SCORE INJURY SEVERITY SCORE (TRISS) METHODOLOGY

   TRISS methodology uses logistic regression to predict survival based on the Revised Trauma
   Score (RTS), injury severity score (ISS), mechanism of injury (blunt vs. penetrating) and patient
   age. Unexpected deaths are trauma patients with a predicted probability of survival of 0.5 or more
   that die and unexpected survivors are trauma patients with a predicted probability of survival of
   0.49 or less that survive.

   TRISS ‘z’ statistic measures the statistical significance of the difference between the actual
   number of survivors among a set of patients and the number of survivors expected from outcome
   norms. W measures the clinical significance of the differences between the actual and
   unexpected survivors. W is the number of survivors more than would be expected from the
   outcome norms per 100 patients treated. W can be calculated if the z score is greater than 1.96.
   Due to the physiologic parameters used in the Revised Trauma Score, patients who do not have
   a recorded Glasgow Coma Scale (GCS) will not have a TRISS value calculated.

  Fiscal Year: April 1, 2006 - March 31, 2007
                               z Score                                 W Score                                 Sample Size
 Adult Blunt                     3.19                                   2.59                                      740
 Adult Penetrating               0.25                                     -                                        44
 Paediatric                        -                                      -                                         0
 Total Subset                    3.18                                   2.47                                      784

   Data: 1995 – 2007
                                         z Score                       W Score                                 Sample Size
 Adult Blunt                               5.37                         1.52                                      5700
 Adult Penetrating                         2.35                         2.73                                       261
 Paediatric                                0.63                           -                                        14
 Total Subset                              5.73                         1.58                                      5975

   For 1995 - 2007, there were 1.58 more survivors per 100 than would have been expected from
   the major trauma outcome study.

   The Alberta Trauma Registry at FMC has 8849 major trauma patient records in total. 67.5%
   (5975 patients) were eligible for z and W score while 32.5% (2874) were not eligible for the
   following reasons: not blunt or penetrating injury, missing data required for calculation of revised
   trauma score (respiratory rate, systolic blood pressure, GCS).

Outcome and Probability of Survival
With a probability of survival > 20%, did the patient
die at the FMC trauma centre?



                                                                         97.0           96.9         96.4         93.9           96.3
n = all patients with probability of survival valued and probability
of survival > 20%.
Indicator                     Yes                  No                           3.0            3.1          3.6          6.1            3.7

                                                                        2002/2003     2003/2004    2004/2005    2005/2006      2006/2007
2006/2007, n = 783            29                   754
2005/2006, n = 688            42                   646                                            %Yes      %No

2004/2005, n = 587            21                   566
2002/2003, n = 536            17                   519
2001/2002, n = 515            11                   504

                                                              - 65 -
                                                              - 68 -
Regional
Pediatric Trauma
Report
ALBERTA CHILDREN’S HOSPITAL




                                   ACH Trauma Services Staff

Dr. Vincent Grant .....................................................................Medical Director

Sherry MacGillivray ........................... Regional Pediatric Trauma Coordinator

Maria Vivas...................................................................................... Data Analyst
Regional Trauma Services                                                                                     2006/2007




                                        TABLE OF CONTENTS


1. Introduction..................................................................................................73

2. Clinical Care ................................................................................................74

3. Education ....................................................................................................76

4. Research ......................................................................................................77

5. Quality Assurance.......................................................................................78

6. Future Planning ..........................................................................................79




                                               APPENDICES


Appendix A ...............................................................Trauma Quality Indicators

Appendix B .................................................................. Major Trauma Statistics




                                                       - 72 -
1.    Introduction

The year 2006-2007 was a year of significant change for the Pediatric Trauma Program. There
were transitions in several positions within the Pediatric Trauma Program.

There was a transition between Medical Directors for the Pediatric Trauma Program. Dr.
Francois Belanger held the role of interim Medical Director up until June 30, 2006. Dr. Belanger
is to be commended for his outstanding leadership of the Pediatric Trauma Program. He
oversaw the initial development of a comprehensive proposal to both enhance the current
Trauma Program and plan for potential expansion to the 15-17 year old trauma population. He
also oversaw a complete overhaul of the trauma audit and review process, allowing for a
significant decrease in the length of time before cases could be reviewed by the Trauma Audit
Committee. Dr. Vincent Grant assumed the role of Medical Director of Pediatric Trauma as of
July 1, 2006. Dr. Grant is a Pediatric Emergency Physician who has undertaken a formal
fellowship in Pediatric Trauma and was most recently the Medical Director of Trauma at the
Children’s Hospital of Eastern Ontario in Ottawa.

There was also a transition in the role of Pediatric Trauma Coordinator. Mr. Laurie Leckie left the
position in August of 2006. Mr. Leckie is to be commended for his enthusiasm and commitment
to the role of Pediatric Trauma Coordinator. As a result of the most recent TAC accreditation
recommendations, the position of Pediatric Trauma Coordinator increased from a 0.5 FTE to a
1.0 FTE. One of the benefits of this increase was that it allowed Mr. Leckie to help revise and
implement the new trauma audit and review process. Sherry MacGillivray assumed the position
of Trauma Coordinator in November 2006. Ms. MacGillivray has a wealth of trauma experience
from work in large volume trauma centres in Calgary, Vancouver and the Middle East and has
already proven to be a great addition to the ACH Trauma Program, particularly in the area of
trauma education for front-line staff.

Our main goals continued to be strong clinical care, excellence and leadership in pediatric trauma
education both within the Alberta Children’s Hospital and to our regional partners, on-going
advocacy in injury prevention and continued productivity in quality assurance and research.

We wish to thank all of the staff at the Alberta Children’s Hospital who have had an impact on the
Trauma Program, and who continue to support our goals in caring for critically injured children
and youth. In particular, a great deal of thanks goes to the nurses, physicians, respiratory
therapists, and other front-line staff who remain devoted to the care of these children and their
families, as well as all of the other staff who make excellence in pediatric trauma care at the
Alberta Children’s Hospital a veritable “team effort”.




                                               - 73 -
2.    Clinical Care

Identifying ways to improve the clinical care of the trauma patient at the Alberta Children’s
Hospital (ACH) is a major focus of the Pediatric Trauma Program. Over the past year the
following activities have been carried out:

     i)     Trauma Expansion Plan
              • This extensive plan underwent further review and revision in 2006-07. It was
                 formally divided into two phases, each with distinctive objectives and timelines.
                 Phase 1 represented enhancements required for clinical excellence in the current
                 patient volume at ACH for the 0-14 year population. These objectives are to be
                 completed by the Spring of 2008, and contain important steps that must be fulfilled
                 prior to entertaining expansion of the trauma population to the 15-17 year
                 population.
              • Phase 1 plans (October 2006 - March 2008) include:
                      o Review and revision of current trauma team activation (code 77)
                           guidelines - revisions currently being reviewed by Trauma Committee
                      o Review and revision of current trauma team composition - revisions
                           currently being reviewed by Trauma Committee
                      o Implementation of a designated trauma team leader roster - awaiting
                           funding
                      o Enhancement of surgical services staffing to ensure appropriate response
                           time for patients requiring urgent OR (16 hrs/day x 7 days/week in-house
                           coverage with appropriate on-call response for other hours) - awaiting
                           funding
                      o Enhancement of Diagnostic Imaging staffing to ensure appropriate
                           response time for patients requiring urgent CT (16 hrs/day x 7 days/week)
                           in-house CT response (with appropriate on-call response for other hours)
                           - awaiting funding
                      o Development of in-patient trauma service with appropriate coverage and
                           consultation - under negotiation
                      o Development of dedicated In-patient Trauma Unit
                      o Development of Trauma / Rehabilitation Nurse Practitioner role - funding
                           received and position in development
                      o Admission guidelines for trauma patients with respect to admitting service
                           - under negotiation
                      o Improvements in rehabilitation coverage and services
                      o Development of protocols to address thoracic, vascular surgery and
                           interventional radiology medical coverage
                      o Enhancement of transfusion medicine services
                      o A written no refusal policy for trauma patients
                      o Enhancement in staff education in pediatric trauma - funding received and
                           Trauma Nursing Core Courses (TNCC) planned for emergency, critical
                           care and in-patient nurses

     ii)     Re-organization of the Trauma Room in the Emergency Department
                     o completed and approved

     iii)    Revised Trauma Chart for Emergency Department Nursing
                     o currently under development

     iv)     Revised Drug Manual for Emergency Department
                     o currently under development

     v)      Revised Medication Cart for Emergency Department Trauma Room
                     o currently under development


                                                 - 74 -
vi)    Development of an Advanced Trauma/Resuscitation Orientation
              o completed and approved

vii)   Development of a Hypothermia Kit with Management Guidelines for
       the Emergency Department Trauma Room
               o completed and approved

viii) Revised Hypothermia Protocol
              o completed and approved

ix)    Direct Admissions Policy
               o new policy regarding trauma admissions in that all trauma patients should
                   stop in the emergency department prior to admission (ie. no further direct
                   admissions of trauma patients)

x)     Liaising with Regional, Provincial and National Groups
                o Trauma Coordinators of Canada - Member
                o Trauma Association of Canada - Member
                o Canadian Hospitals Injury Prevention & Reporting Prevention Programs
                    (CHIRPP)




                                           - 75 -
3.    Education

     i)      Trauma Rounds
               March 2007, Pediatric Trauma Centres: Are we making a difference? - Dr. V. Grant

     ii)     Mock Trauma Codes
              Regular mock trauma codes provided residents, ED physicians, nurses, respiratory
              therapists, nursing aides and unit clerks with an opportunity to learn from simulated
              trauma codes (performed weekly from October - December 2006 then bi-weekly)

     iii)    Emergency Nursing Trauma Education Sessions
              Monthly trauma education sessions were held for ED nurses on a sign- up basis.
              Trauma statistics, common mechanisms of injury and trauma assessment was the
              focus, but round table discussions and procedures were encouraged. These
              sessions were very well received and will continue in the future.

     iv)     Emergency Nursing Trauma Simulation Sessions
                  o Monthly trauma simulation sessions were held for ED nurses on a sign-up
                     basis in conjunction with ED residents. The Human Patient Simulator was
                     used to facilitate the management of trauma patients in real time. These
                     sessions were very well received and will continue in the future.
                  o A one time simulation was held for emergency nurses for each of the adult
                     sites. In the future there are plans to increase this exposure.

     v)      Other Nursing Sessions
               Trauma education was included in General Nursing Orientation for new PICU and
               ED nurses at the ACH. In the future, this education will be given to a wider range of
               new nurses on different units at ACH.

     vi)     Department of Pediatrics Postgraduate Medical Education
                    o Academic half-day

     vii)    University of Calgary Undergraduate Medical Education
                     o Human Development Course Lecture

     viii)   Advanced Pediatric Life Support Course
                    o Trauma Lecture

     ix)     Advanced Trauma Life Support
                    o Dr. V. Grant – Instructor

     x)      Injury Prevention in Children and Adolescents Symposium
                      o “Innovations in Pediatric Trauma”- Dr. V. Grant




                                                  - 76 -
4.   Research

The following research projects were in progress during 2006/2007:

        o Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, Parsons D, Howard J.
            FEMORAL FRACTURES IN CHILDREN LESS THAN THREE YEARS OLD: THE
            ROLE OF NON-ACCIDENTAL INJURY.

        o Hagel BE, Rowe BH, Cherry N, Jhangri G, Belton K, Dorey A. THE EFFECT OF
            BIKE HELMET LEGISLATION ON HELMET USE, HEAD INJURIES AND CYCLING
            HABITS.




                                             - 77 -
5.   Quality Assurance

As part of the Regional Trauma Services quality improvement process, several performance
indicators throughout the continuum of care are monitored on a regular basis as a measure of
performance. Some of the indicators stem from audit filters set out by the American College of
Surgeons’ Committee on Trauma and Trauma Registry performance measures published by the
South Western Sydney Region Trauma Department, Liverpool, Australia. Other indicators were
developed at the ACH as site specific performance indicators. All cases flagged by a performance
indicator or audit filter are reviewed by the ACH Trauma Clinical Safety Committee to determine
appropriateness of care and follow-up to care providers and trauma systems. The list of
performance indicators is listed below. ACH performance indicators for 2006-07 are summarized
in Appendix B.

Pre-ACH care:
    1. Presence of pre-hospital documentation from any phase of patient transport.
    2. GCS < 8 at scene with mechanical airway intervention.
    3. Length of stay at rural hospital > 2 hours.
    4. Injury time to any Trauma Center (TC) <= 4 hours.
    5. Utilization of ACH Transport team for transfer.
Resuscitative care:
    6. Trauma Team Activation.
    7. Direct admission (bypassed the Emergency Department (ED)).
    8. GCS <8 at the TC with mechanical airway intervention.
    9. Presence of ED nursing documentation every 30 minutes.
    10. Presence of sequential neurological documentation in the ED for suspected head/spinal
        cord injuries.
    11. Hypothermic in the ED (< 35.0˚C).
    12. GCS < 12 in the TC with a CT head performed within 4 hours from trauma center arrival
        (TCA).
    13. Patient stay in the ED less than 4 hours.
Definitive care:
    14. Admission to a surgeon or intensivist.
    15. Craniotomy within 4 hours after TCA with unstable epidural/subdural hematoma.
    16. Missed cervical spine injury after 48 hours from TCA without maintaining spinal
        precautions.
    17. Any laparotomy procedure performed.
    18. Femur fracture to the OR within 24 hours from TCA.
    19. Open long bone fracture to the OR within 6-12 hours from TCA (depending on the
        severity of #).
    20. Unplanned return to the OR within 48 hours of initial procedure.
    21. Missed injuries identified after 48 hours from TCA.
    22. Reduction of joint dislocation/fracture dislocation after 1 hour from TCA.
    23. Revascularization of an ischemic limb within 6 hours from the time of injury.
    24. ORIF of facial fractures within 7 days after injury.
    25. Operative repair of spinal fractures within 7 days after injury.
    26. Pelvic ring fracture/acetabular fracture (with hemodynamic instability) provisional
        stabilization > 6 hours from TCA.
    27. Definitive treatment of displaced acetabular fracture > 7 days from TCA.
    28. Unplanned PICU admission or re-admission.
Outcome:
    29. Death during the first 24 hours from TCA.
    30. Did the patient die in ACH?




                                             - 78 -
6.   Future Planning

The 2007-2008 year will focus on the following activities:

•     Implementation of phase 1 of the Pediatric Trauma Expansion Plan
             o Revised trauma code activation and response
             o Development of a designated trauma team leader roster
             o Enhancement of surgical services
             o Enhancement of Diagnostic Imaging services
             o Development of in-patient trauma service
             o Development of dedicated In-patient Trauma Unit
             o Development of Trauma / Rehabilitation Nurse Practitioner role
             o Improvements in rehabilitation coverage and services
             o Development of protocols to address thoracic, vascular surgery and
                 interventional radiology medical coverage
             o Enhancement of transfusion medicine services
             o A written no refusal policy for trauma patients
             o Enhancement in staff education in pediatric trauma
•     Improving and enhancing Pediatric Trauma Rounds
•     Implementation of regular TNCC courses at ACH
•     Continuing excellence in pediatric trauma education within the ACH
•     Establishing excellence in pediatric trauma outreach education within the Calgary Health
      Region and throughout Southern Alberta and Southeastern British Columbia
•     Continuing advocacy of injury prevention initiatives
•     Continuing leadership on a regional, provincial and national level
•     Development of an active pediatric trauma research program
•     Continuing excellence in quality assurance leadership
•     Developing good clinical documentation tools for trauma care providers
•     Focusing on improving communication with all of the services impacted in trauma delivery
      through the Trauma Committee
•     Establishing and growing connections with other Canadian Pediatric Trauma Programs to
      work collaboratively on research, quality assurance projects and improving standards of
      care for pediatric trauma patients




                                                - 79 -
   Regional Trauma Services                                                                                      2006/2007




   Appendix A
   Alberta Children’s Hospital Trauma Quality Indicators for 2006/2007

   Pre-ACH Care:

   1. Presence of pre-hospital documentation from any phase of patient transport.

Are all pre-hospital ambulance reports from all phases of patient transport present on the medical
record?

Exclusions: Inappropriate where patients arrived by private             8.6       8.0       12.8         8.8    12.8
vehicle, walk-ins, and unknown how patient arrived at hospital.
Unknown: missing PCR.
Inclusions: n=all patients with pre-hospital care provider(s).

                                                                        91.4      92.0      87.2         91.2   87.2


Indicator                  Yes                   No

2006/2007, n = 78          68                    10                   2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2005/2006, n = 68          62                    6
                                                                                         %Yes      %No
2004/2005, n = 78          68                    10
2003/2004, n = 88          81                    7
2002/2003, n = 81          74                    7


   Pre-hospital documentation is sometimes difficult to obtain. Every attempt is made to locate
   missing Patient Care Records (PCR) from the various ambulance services.

   2. Glasgow Coma Scale (GCS) ≤ 8 at scene with mechanical airway
   intervention.

Did the patient with a first recorded scene GCS <=8 receive a mechanical airway as an
intervention at the scene?
Mechanical airway includes: oral intubation, nasal intubation,
tracheostomy, and cricothyroidotomy. It does not include
nasopharyngeal airway, laryngeal mask (LMA) or oropharyngeal
airway.                                                                                     55.6         53.8
                                                                        57.9
Exclusions: Inappropriate - patients with unknown GCS, patients                   75.0                          80.0
without prehospital care, intubated patients prior to GCS
calculation.
Inclusions: n = all patients with first recorded GCS ≤ 8 at the         42.1                44.4         46.2
scene.                                                                            25.0                          20.0

Indicator                  Yes                   No                   2002/2003 2003/2004 2004/2005 2005/2006 2006/2007


2006/2007, n = 15          3                     12                                      %Yes      %No

2005/2006, n = 13          6                     7
2004/2005, n = 18          8                     10
2003/2004, n = 12          3                     9
2002/2003, n = 19          8                     11


   Pediatric experts advise that it is best practice to move the injured pediatric patient from the
   scene quickly to acute care for intubation, if required, rather than attempt intubation at the scene.


                                                             - 80 -
   Regional Trauma Services                                                                                       2006/2007




   3. Length of stay at rural hospital greater than two hours.

Was the length of stay at a rural hospital > 2 hours?

Exclusions: Inappropriate - patients had no first or second
hospital. Unknown - missing arrival or departure time at first or
second hospital                                                                              25.0         29.0
                                                                         33.0      37.0
Inclusions: n = all patients arriving at ACH from hospital outside
                                                                                                                 58.0
Calgary.

                                                                         67.0                75.0         71.0
                                                                                   63.0
                                                                                                                 42.0
Indicator                  Yes                   No
                                                                       2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2006/2007, n = 26          11                    15
2005/2006, n = 31          22                    9                                        %Yes      %No

2004/2005, n = 24          18                    6
2003/2004, n = 41          26                    15
2002/2003, n = 36          24                    12


   If at any time the ACH Clinical Safety Committee feels that the Rural Hospital LOS is not
   acceptable, a letter is sent to that hospital for clarification of the time line and appropriate follow
   up. In 2006/2007 note the decrease in the number of cases that stayed at rural hospitals for more
   than 2 hours. With outreach education and follow up on cases, it is hoped this number continues
   on a downward trend.

   4. Injury time to any trauma centre < 4 hours.

Did the patient arrive at a trauma centre < 4 hours from the time of injury?

Trauma Centre is defined as ACH, FMC, or Stollery Hospital in
Edmonton.
Exclusions: Out of the 43 patient transfers, 4 patients were                       30.8
transferred from within Calgary and 11 patients had unknown              37.3
                                                                                                                 53.6
time of injury, resulting in a total (n) of 28 patients for this                             73.9         82.1
indicator.
Inclusions: n = all patients transferred from a hospital outside                   69.2
                                                                         62.7
Calgary with a known time of injury and known time of arrival.                                                   46.4
                                                                                             26.1         17.9
Indicator                  Yes                   No
                                                                       2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2006/2007, n = 28          13                    15
                                                                                          %Yes      %No
2005/2006, n = 28          5                     23
2004/2005, n = 23          6                     17
2003/2004, n = 65          45                    20
2002/2003, n = 51          32                    19


   A significant change was noted with this performance indicator. A significantly higher number of
   patients were seen at a Trauma Centre within the 4 hour cutoff, meaning a significant
   improvement in the mobilization of transport to the Trauma Centre. Although many factors
   contribute to delays, most are found to be related to challenges in mobilizing transfer of patients
   from rural health centers.



                                                              - 81 -
  Regional Trauma Services                                                                                      2006/2007




  5. Utilization of ACH Transport team for transfer.

ACH Transport Team Utilization
Was the patient transported by the ACH Transport
Team?


                                                                       83.3      85.1      75.8         80.5   81.4

Inclusions:n=all patients transferred from a primary or secondary
hospital.
                                                                       16.7      14.9      24.2         19.5   18.6
Indicator                 Yes                  No                    2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2006/2007, n = 43         8                    35
                                                                                        %Yes      %No
2005/2006, n = 41         8                    33
2004/2005, n = 33         8                    25
2003/2004, n = 47         7                    40
2002/2003, n = 36         6                    30

  The Alberta Children’s Hospital offers a specialized Pediatric Transport Team Service, which
  transports critically ill or injured children from referring centers located in southern Alberta, south-
  eastern British Columbia, and south-western Saskatchewan. The transport team travels by
  ambulance, helicopter or fixed-wing aircraft and provides quality pediatric critical care to the
  residents of these areas who do not otherwise have access to pediatric critical care specialists.
  Through Link Center communications, medical control and mobilization of the team is achieved
  via the Pediatric Intensive Care Unit (PICU) attending physician. The team consists of a
  respiratory therapist (RT) and an ACH ICU registered nurse (RN) with a physician on call for
  difficult cases. Ongoing review and quality assurance of all pediatric transport occurs with
  monthly transport team meetings.




                                                            - 82 -
     Regional Trauma Services                                                                                                                               2006/2007




     Resuscitative care:

           6. Trauma Team Activation

                                                            Major Trauma Team Activation
                                                                2004/2005 to 2006/2007

                                                                                   5
  # of Activations




                     4                                                4                                                                             4
                         3       3                       33 3     3                                 3                  3                  3
                                     2       2                                22            2                  2               2                        2       2
                                         1           1                    1                                1       1       1       11         1 1
                             0                   0                                              0                                                           0

                     A pr        M ay         J un       J ul      A ug       Sep           Oct             Nov         D ec        Jan         F eb    M ar


                                                                2004/2005      2005/2006                   2006/2007


     Activation of the trauma team (Code 77) is initiated through the ED at the discretion of the ED
     physician based on criteria. The above graph illustrates Code 77 activation for the major trauma
     population only (ISS > 12). In some cases, the trauma team may be called however; the patient
     does not meet the Trauma Registry inclusion criteria. In 2006/2007 there were 26 activations. It
     was felt that an additional 23 cases should have been an activation of the trauma team (Code
     77). Given this, the criteria are expected to be revised this year and a more detailed reporting
     system will be utilized in the future.



     7. Direct Admission - Bypassed the Emergency Department (ED)

Direct Admission

Exclusions: ED deaths
Inclusions: n=all patients who were admitted to the trauma
centre.

                                                                                                          83.0         85.0        89.0         83.0    89.0
Indicator                                    Yes                      No
2006/2007, n = 90                            10                       80
2005/2006, n = 86                            15                       71                                  17.0         15.0        11.0         17.0    11.0
2004/2005, n = 83                            9                        74                                2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 96                            14                       82
                                                                                                                               %Yes       %No
2002/2003, n = 89                            15                       74

     In February 2007, a new policy was written whereby all referred trauma patients are to be
     assessed in the ED. Therefore, in the future, there will be very little direct admission numbers.




                                                                                   - 83 -
   Regional Trauma Services                                                                                      2006/2007




   8. GCS < 8 at the trauma centre (TC) with mechanical airway intervention.

Did the patient with a first recorded trauma centre GCS < 8 receive a mechanical airway as an
intervention in the ACH ED?


Exclusions: Patients with GCS>8 at ACH-ED.
Inclusions: n = all patients with first recorded trauma centre GCS                 0         0           0       0
≤ 8.
                                                                         50
Indicator                  Yes                  No
                                                                                  100       100         100     100
2006/2007, n = 4           4                    0
                                                                         50
2005/2006, n = 5           5                    0
2004/2005, n = 2           2                    0                     2002/2003 2003/2004 2004/2005 2005/2006 2006/2007


2003/2004, n = 3           3                    0                                       %Yes      %No

2002/2003, n = 4           2                    2




   9. Presence of ED nursing documentation every 30 minutes.

After arrival to the trauma centre, was q 30 documentation present on the ED record for the ED
length of stay?


Exclusions: Direct admits and unknown/missing ED notes.
Inclusions: n = all patients seen in ED.

                                                                         40                  37         31       42
Indicator                  Yes                  No                                 48

2006/2007, n = 81          47                   34
                                                                         60                  63         69       58
                                                                                   52
2005/2006, n = 72          50                   22
2004/2005, n = 79          50                   29                    2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 81          42                   39
                                                                                        %Yes      %No
2002/2003, n = 78          47                   31


   A new Trauma ED Record is being developed to improve documentation issues.




                                                             - 84 -
   Regional Trauma Services                                                                                                    2006/2007




   10. Presence of sequential neurological documentation in the ED for suspected
   head/spinal cord injuries

After arrival to the trauma centre, was sequential neurological documentation present on the
ED record for the ED length of stay, if the patient had a diagnosis of skull fracture, intracranial
injury, or spinal cord injury?


Exclusions: Direct admits and unknown/missing ED notes.
Inclusions: n = all patients seen in ED with a diagnosis of skull
fracture, intracranial injury or spinal cord injury.                       11          19                        17.5
                                                                                                    26                        26
Indicator                  Yes                    No

2006/2007, n = 61          45                     16                       89          81           74           82.5         74
2005/2006, n = 40          33                     7
2004/2005, n = 38          28                     10                    2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 52          42                     10
                                                                                              %Yes         %No
2002/2003, n = 46          41                     5


   Trauma Packs which include a separate Neurological Vital Sign sheet has been put in the ACH
   ED Trauma Room to remind nurses to trend this important vital sign.



   11. Hypothermic in the ED (<35.0 degrees C)

Was the patient hypothermic in the emergency department? Temperature was recorded at
<35.0 degrees C.


Exclusions: Direct admits and unknown/missing ED temp.
Inclusions: n = all patients seen in ED.

Indicator                  Yes                    No
                                                                          93.5         93.4         93.0         92.6         98.7
2006/2007, n = 77          1                      76
2005/2006, n = 68          5                      63                             6.5          6.6          7.0          7.4          1.3
2004/2005, n = 71          5                      66                    2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 76          5                      71
                                                                                              %Yes         %No
2002/2003, n = 62          4                      58


   In 2006/2007 the one trauma patient that was identified as hypothermic in the ED was an isolated
   head injury that was cooled further in the PICU. A new emphasis was placed on temperature
   assess with the creation of a new hypothermia kit and guidelines. This has improved assessment,
   documentation and management of hypothermia patients.




                                                               - 85 -
  Regional Trauma Services                                                                                      2006/2007




  12. GCS <12 in the TC with a CT head performed within 4 hours from trauma
  centre arrival (TCA).

Did the patient with a GCS < 12 receive a CT of the head within 4 hours of arrival at the ACH
trauma centre?


Exclusions: Inappropriate – GCS ≥12, intubated patients arriving                            0.0         0.0
in ACH. Unknown – missing GCS documentation.                                                                    0.0
Inclusions: n = all patients with a known ED GCS and a known           14.3      16.7
time of CT head.

Indicator                 Yes                  No                                          100          100    100.0
                                                                       85.7      83.3

2006/2007, n = 6          6                    0
2005/2006, n = 6          6                    0                     2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2004/2005, n = 5          5                    0
                                                                                        %Yes      %No
2003/2004, n = 6          5                    1
2002/2003, n = 7          6                    1




  13. Patient stay in ED less than 4 hours.

Did the patient have an ACH ED length of stay < 4 hours at the ACH trauma centre?


Exclusions: Direct Admissions and unknown ED LOS.
Inclusions: n=all patients seen in ACH ED with a known ED
LOS.
                                                                       39.5      43.6      38.9         37.9   33.3
Indicator                 Yes                  No

2006/2007, n = 66         44                   22                      60.5      56.4      61.1         62.1   66.7

2005/2006, n = 70         44                   26
2004/2005, n = 77         47                   30                    2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 78         44                   34                                       %Yes      %No
2002/2003, n = 76         46                   30


  There is a slow improvement in ED length of stay (LOS). On-going assessment will continue.




                                                            - 86 -
  Regional Trauma Services                                                                                        2006/2007




  Definitive care:

  14. Admission to a surgeon or intensivist.

Was the patient admitted to a surgeon or an intensivist at the ACH trauma centre?


Exclusions: ED deaths.
Inclusions: n = all patients admitted to ACH Trauma Centre.
                                                                                   16.7      18.1         22.1   20.0
                                                                         28.1
Indicator                 Yes                  No

2006/2007, n = 90         72                   18                                  83.3      81.9         77.9   80.0
                                                                         71.9

2005/2006, n = 86         67                   19
2004/2005, n = 83         68                   15                      2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 96         80                   16                                         %Yes      %No
2002/2003, n = 89         64                   25


  In 2006/2007 16 patients were admitted to the hospital-based pediatricians. The other 2 patients
  were admitted under Urology. Part of the planned expansion of trauma services at the Alberta
  Children’s Hospital includes the development of an in-patient trauma service and a dedicated unit
  for trauma patients. Both of these changes should have a significant impact on this indicator.
  These changes are anticipated in the next fiscal year.

  15. Craniotomy within 4 hours after TCA with unstable epidural/subdural
  hematoma.

If the patient had an epidural or subdural brain hematoma, was a craniotomy performed within
4 hours of arrival at ACH trauma centre?

Exclusions: Inappropriate – all patients without epidural or
subdural hematoma.                                                                  0                      0       0
Inclusions: n = all patients with epidural or subdural hematoma                               25
where operative management was the planned intervention.                  50

Indicator                 Yes                  No                                  100                    100    100
                                                                                              75
                                                                          50
2006/2007, n = 4          4                    0
2005/2006, n = 1          1                    0                       2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2004/2005, n = 8          6                    2
                                                                                          %Yes      %No
2003/2004, n = 4          4                    0
2002/2003, n = 2          1                    1




                                                              - 87 -
  Regional Trauma Services                                                                                                    2006/2007




  16. Missed cervical spine injury after 48 hours from TCA without maintaining
  spinal precautions.

Did the patient have a missed c-spine injury with spinal precautions removed at the ACH
trauma centre?


Exclusions: ED deaths.
Inclusions: n = all patients admitted to ACH Trauma Centre.


Indicator                 Yes                 No
                                                                         100          100          100          100          100
2006/2007, n = 90         0                   90
2005/2006, n = 86         0                   86
2004/2005, n = 83         0                   83                       2002/2003 2003/2004 2004/2005 2005/2006 2006/2007


2003/2004, n = 96         0                   96                                             %Yes         %No

2002/2003, n = 89         0                   89



  17. Any laparotomy procedure performed.

Did the patient require a laparotomy?

Exclusions: None
Inclusions: n = all major trauma patients.


Indicator                 Yes                 No
                                                                         95.7         96.9         97.7         95.4         98.9
2006/2007, n = 91         1                   90
                                                                                4.3          3.1          2.3          4.6          1.1
2005/2006, n = 87         4                   83
                                                                       2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2004/2005, n = 88         2                   86
2003/2004, n = 97         3                   94                                             %Yes         %No

2002/2003, n = 93         4                   89


  In 2006-07, only 1 trauma patient required a laparotomy. This continues to reflect the current
  conservative and non-operative approach to pediatric patients with solid organ injuries.




                                                              - 88 -
   Regional Trauma Services                                                                                      2006/2007




   18. Femur fracture to the OR within 24 hours from TCA.

Did the patient have operative management of the femur fracture within 24 hours of arrival at
ACH trauma centre?


Exclusions: No femur fracture or no surgical intervention                         11.1        25
                                                                        16.7
planned.
Inclusions: n = all patients requiring operative management of                                                   20
femur fracture.                                                                                          40

Indicator                  Yes                  No                                88.9
                                                                        83.3                 75                  80
                                                                                                         60
2006/2007, n = 5           1                    4
2005/2006, n = 5           3                    2
                                                                      2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2004/2005, n = 8           6                    2
                                                                                         %Yes      %No
2003/2004, n = 9           8                    1
2002/2003, n = 6           5                    1


   In 2006/2007 there was one patient that was not taken to the OR within 24 hours as the child was
   too unstable. The Clinical Safety Committee felt it was an appropriate decision for this case.

   19. Open long bone fracture to the OR after 6-12 hours from TCA (depending on
   the severity of the fracture).

Did the patient with open long bone fracture have operative management performed within 6
hours (grade 3) or 12 hours (grade 1, 2) of arrival to ACH trauma centre?


The long bones include the radius, ulna, humerus, tibia, femur
and fibula.

Exclusions: No open long bone fractures; patients with open
long bone #s but too unstable for operative repair within the
timeframe; patients with open long bone #s who died within the          100       100       100
timeframe.
                                                                                                         0        0
Inclusions: n = all patients requiring operative management of
open fracture where grade of fracture is known.

Indicator                  Yes                 No                     2002/2003 2003/2004 2004/2005 2005/2006 2006/2007


2006/2007, n = 0           0                   0                                         %Yes      %No

2005/2006, n = 0           0                   0
2004/2005, n = 2           2                   0
2003/2004, n = 4           4                   0
2002/2003, n = 4           4                   0




                                                             - 89 -
   Regional Trauma Services                                                                                                  2006/2007




   20. Unplanned return to the OR within 48 hours of initial procedure.

Did the patient have an unplanned return to the operating room at the ACH trauma centre?


Exclusions: No operating room visit.
Inclusions: n = all patients with at least one operating room visit.

Indicator                   Yes                   No
                                                                           100          100          94.1         100       93.7
2006/2007, n = 23           1                     22
2005/2006, n = 28           0                     28                                                        5.9                    4.3

2004/2005, n = 34           2                     32                     2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 31           0                     31
                                                                                               %Yes         %No
2002/2003, n = 23           0                     23


   In 2006/2007 one unplanned return to the OR was for a second evacuation of an epidural and a
   leg fasciotomy.

   21. Missed injuries identified after 48 hours from TCA.

Did the patient have a delayed diagnosis or missed injury at the ACH trauma centre?


Exclusions: ED deaths.
Inclusions: n = all patients admitted to ACH Trauma Centre.

Indicator                   Yes                   No
                                                                           96.6         97.9         96.4         99        100
2006/2007, n = 90           0                     90
2005/2006, n = 86           1                     85                              3.4          2.1          3.6         1          0
2004/2005, n = 83           3                     80
                                                                         2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2003/2004, n = 96           2                     94
                                                                                               %Yes         %No
2002/2003, n = 89           3                     86




                                                                - 90 -
   Regional Trauma Services                                                                                  2006/2007




   22. Reduction of joint dislocation/fracture dislocation after 1 hour from TCA.

If the patient had a joint dislocation or fracture dislocation (hip, shoulder, knee, elbow), was it
reduced within first hour of TCA.


Exclusions: No joint dislocation, died within first hour, wrist or
ankle dislocations.
Inclusions: n = all patients with joint dislocation or fracture
dislocation who survived at least 1 hour.

Indicator                   Yes                    No

2006/2007, n = 0            0                      0                        0.0          0.0           0.0
                                                                            0.0          0.0           0.0
2005/2006, n = 0            0                      0                      2004/2005    2005/2006     2006/2007
2004/2005, n = 0            0                      0
                                                                                      %Yes     %No




   23. Revascularization of an ischemic limb within 6 hours from the time of injury.

If the patient had an ischemic limb, was it re-vascularized within 6 hours from the time of
injury?


Exclusions: No ischemic limb or patient died prior to repair.
Inclusions: n = all patients with ischemic limb.




                                                                                         1.0

Indicator                   Yes                    No
                                                                             0.0         0.0           0.0
2006/2007, n = 0            0                      0                        0.0                        0.0
                                                                          2004/2005    2005/2006     2006/2007
2005/2006, n = 1            0                      1
                                                                                      %Yes     %No

2004/2005, n = 0            0                      0




                                                                 - 91 -
   Regional Trauma Services                                                                                                2006/2007




   24. ORIF of facial fractures within 7 days after injury.

Did the patient with a facial fracture go to the operating room at ACH trauma centre within 7
days of injury?


Exclusions: No major facial fractures or died prior to repair.
Inclusions: n = all patients requiring operative management of
major facial fractures who survive at least 7 days.                                                                     16.7
                                                                                                33.3


Indicator                  Yes                    No                      100          100                   100
                                                                                                                        83.3
                                                                                                66.7
2006/2007, n = 6           5                     1
2005/2006, n = 4           4                     0                      2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2004/2005, n = 3           2                     1
                                                                                             %Yes      %No
2003/2004, n = 3           3                     0
2002/2003, n = 2           2                     0


   In 2006/2007 one case was not taken to the OR for repair until cervical spines were cleared. This
   was deemed appropriate management by the Clinical Safety Committee as it was a complicated
   case in which the child also needed a tracheostomy.

   25. Operative repair of spinal fractures within 7 days after injury.

If the patient had an operative repair of spinal fractures, was it completed within 7 days after
injury.


Exclusions: No operative repairs or patient died prior to repair.
Inclusions: n = all patients with operative repair of spinal                    0.0
fracture who survive at least 7 days.

                                                                             100.0
Indicator                  Yes                    No

2006/2007, n = 0           0                     0                                              0.0                  0.0
                                                                                                0.0                  0.0
2005/2006, n = 0           0                     0                         2004/2005          2005/2006            2006/2007


                                                                                             %Yes      %No

2004/2005, n = 1           1                     0



   26. Pelvic ring fracture / acetabular fracture (with hemodynamic instability)
   provisional stabilization > 6 hours from TCA.

   New indicator for 2007/2008.

   27. Definitive treatment of displaced acetabular fracture > 7 days from TCA.

   New indicator for 2007/2008.

                                                               - 92 -
   Regional Trauma Services                                                                                         2006/2007




   28. Unplanned PICU admission or re-admission.

Did the patient have an unplanned admission to ICU at the ACH trauma centre?


Exclusions: ED deaths.
Inclusions: n = all patients admitted to ACH Trauma Centre.


Indicator                  Yes                   No
                                                                           100        99       100         100     97.8
2006/2007, n = 90          2                     88
                                                                                           1                              2.2
2005/2006, n = 86          0                     86
                                                                         2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2004/2005, n = 83          0                     83
2003/2004, n = 96          1                     95                                        %Yes      %No

2002/2003, n = 89          0                     89


   In 2006/2007 one case was admitted to a unit stable, but became unstable after 6 hours and was
   transferred to the PICU post-op. The second case was admitted to a unit stable, but once the
   radiology report was read was transferred to the PICU for closer monitoring.

Did the patient have an unplanned readmission to ICU at the ACH trauma centre?


Exclusions: Patients without admission to ICU.
Inclusions: n = all patients with at least one ICU admission.



                                                                           100       100       100         100     98.2


Indicator                  Yes                   No                                                                       1.8
                                                                            0         0         0           0
                                                                         2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2006/2007, n = 55          1                     54
2005/2006, n = 44          0                     44                                        %Yes      %No

2004/2005, n = 44          0                     44
2003/2004, n = 52          0                     52
2002/2003, n = 36          0                     36


   In 2006/2007 one case was re-admitted to the PICU as the condition changed after transfer out to
   a unit.




                                                                - 93 -
  Regional Trauma Services                                                                                                    2006/2007




  Outcome:

  29. Death during the first 24 hours from TCA.

Did the patient die within the first 24 hours of admission to the ACH trauma centre?


Exclusions: All patients who survived.
Inclusions: n = all patients who died.
                                                                                     28.6         30
Indicator                 Yes                   No                      44.4                                                 42.9
                                                                                                               57.1

2006/2007, n = 7          4                     3
                                                                                     71.4         70
                                                                        55.6                                                 57.1
2005/2006, n = 7          3                     4                                                              42.9

2004/2005, n = 10         7                     3                     2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

2003/2004, n = 7          5                     2
                                                                                            %Yes         %No
2002/2003, n = 9          5                     4


  In 2006/2007 there were two patients with strangulation injuries and two patients with severe
  head trauma who died within 24 hours.

  30. Did the patient die in ACH?

Did the patient die?


Exclusions: None.
Inclusions: n = all trauma patients arriving at ACH trauma
centre.

Indicator                 Yes                   No                      90.3         92.8         88.6          92.0         92.3

2006/2007, n = 91         7                     84
                                                                                                                                    7.7
                                                                               9.7          7.2          11.4          8.0
2005/2006, n = 87         7                     80
                                                                      2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
2004/2005, n = 88         10                    78
2003/2004, n = 97         7                     90                                          %Yes         %No

2002/2003, n = 93         9                     84


  In addition to the 4 patients who died within 24 hours in 2006/2007, an additional 3 patients died
  in ACH. Two had severe head injuries while the other one had head/lung and liver injuries.




                                                             - 94 -
Regional Trauma Services                              2006/2007




APPENDIX B

Major Trauma Statistics for 2006/2007

    1. General Overview
       Age
       Gender

    2. Etiology of Injuries
       Mechanism of Injury
       Type of Injury
       Place of Injury

    3. Referrals
       Referrals from Health Regions
       Mode of Transportation to ACH
       Ground vs Air Transport
       ED Arrival By Month, Day and Time of Arrival
       Disposition from the Emergency Department

    4. Patient Care Management
       Diagnostic Imaging Statistics
       Day of Week and Time of CT
       Non-Operative Procedures Performed in ED
       Surgical Procedures
       OR Data by Service
       Time to OR
       Length of Stay
       Admitting Physician Service
       Hospital Discharge Destination
       Outcomes by Age and ISS
       TRISS Pre-Charts




                                    - 95 -
Regional Trauma Services                                                                   2006/2007




1. General Overview

Table 1. ACH Major Trauma Statistics – Five-year Trend Analysis
Data Source: Alberta Trauma Registry at ACH


                                 2002/2003        2003/2004      2004/2005   2005/2006   2006/2007

Total Patients                           93                97          88          87            91

Males                                     57                67          52          61          58
                                      61.3%             69.1%       59.1%       70.1%       63.7%

Females                                   36                30          36          26          33
                                      38.7%             30.9%       40.9%       29.9%       36.3%

Total Length of Stay (LOS)              708               890         599         889          810
(days)

Median LOS                                5                 5           5           5             5

Mean LOS                                  8                 9           7          10             9

Total Emergency Department            253.3             280.5        264.0       256.2       218.7
(ED) LOS (hours)

Direct Admits                            15                14           9          15            10

Median ED LOS (hours)                    3.3               3.6         3.3         3.0          2.7

Mean ED LOS (hours)                      3.3               3.6         3.4         3.7          3.3

ICU Admissions                            36                52          44          44          53
                                      38.7%             53.6%       50.0%       50.6%       58.2%

Median ICU LOS (days)                     1                 1           1           2             2

Mean ICU LOS (days)                       3                 3           2           4             4

Total ICU LOS (days)                     98               176         106         178          218

Median ISS                               17                17          17          17            21

Mean ISS                               21.8              19.7         19.6        20.3         23.0

Referrals to ACH from other               37                47          33          42          43
centres                               39.8%             48.5%       37.5%       48.3%       47.3%

Deaths                                    9                 7           10          7            7
                                       9.7%              7.2%       11.4%        8.0%         7.7%




                                               - 96 -
Regional Trauma Services                                                                     2006/2007




        In 2006/2007, 91 major trauma patients (meeting criteria for inclusion in the trauma
registry) were seen at the ACH. This volume is in keeping with the five-year average of 91 major
trauma patients seen annually. This 2006/2007 trauma volume represents 12.9% of all patients
admitted to the ACH with injuries (n=705), which is a 4.6% increase from last year. As seen in
previous years, the percentage of major trauma patients who are males (63.7%) continues to be
greater than females, which is consistent with the five-year average of 64.7%. Major trauma
patients referred in from other centers represented 47.3% of the major trauma volume for
2006/2007. This is slightly higher than the five-year average of 44.3%.
        Length of stay for major trauma patients ranged between 1 and 113 days, with a mean
LOS of 9 days and a median LOS of 5 days. These values are consistent with the five-year
trend. The total ED LOS was 218.7 hours, down 17.1% from last year and lower than the 5 year
average of 254.5 hours. Both the mean and median LOS were also lower than the 5 year
average.
        There was a 20.5% increase in ICU admissions from 2005/06 to 2006/07. Overall, 58.2%
of major trauma patients were admitted to the ICU, which is significantly higher than the five-year
average of 50.2%. Total ICU LOS was 218 days, which is significantly higher than the five-year
average of 155. Median and mean ICU LOS were consistent with the five-year average.
        Both the mean (23.0) and median (21) ISS for major trauma patient from 2006/2007 were
higher than the five-year averages of 20.9 (mean) and 17.8 (median). There was a 23.5%
increase in median ISS from 2005/2006 to 2006/2007. This is likely the reason for the increase in
ICU admissions seen in 2006/2007.
        A total of 7 deaths were seen in major trauma patients in 2006/2007. This represents
7.7% of major trauma volume, and is slightly lower than the five-year average of 8.8%.




                                               - 97 -
Regional Trauma Services                                                                             2006/2007




Figure 1. Age and Gender Distribution for ACH Major Trauma Patients for 2006/2007


                                        Age and Gender Distribution
                                                2006/2007

                    30                                                         24
    # of Patients




                                                                                    17
                    20
                                            10              10                             9
                    10    5                      7
                                   2                                3                          4
                    0
                              <1             1-4                 5-9           10-14       >14
                                                          Age Groups

                                                          Male     Female

       Figure 1 shows the number of males and females for the above age groups. On the
average, males comprise 64.7% of major trauma population over a period of five years.


Figure 2. Age Distribution of 15 to 17 years old admitted to Calgary Hospitals



                                   15 to 17 years old major trauma patients

                         50

                         40
    # ofpatients




                         30

                         20

                         10
                          0
                               2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
                         ACH           10            17                   16         20        13
                         FMC           34            40                   33         39        39
                         PLC           0             1                    2            0         0
                         RGH           0             0                    0            0         0


         Figure 2 shows the number of major trauma patients aged 15-17 admitted to Calgary
Hospitals over the past five years. Current Calgary Health Region guidelines state that all trauma
patients 15-17 years of age should normally be transported to the Foothills Medical Centre
(FMC). The Pediatric Trauma Program Expansion Proposal contains steps to eventually assume
primary trauma care for trauma patients 15-17 years of age. The graph above displays that
approximately 1/3 to 1/2 of this group is already cared for at the ACH, mainly due to cases where
patient’s ages are unknown at the time of transport or when the FMC is at capacity.


                                                                 - 98 -
Regional Trauma Services                                                                                2006/2007




2. Etiology of Injuries
        Mechanism of Injury describes the nature of the injury, such as transportation, falls,
violence, and other mechanism of injury.

Figure 3. Breakdown by Mechanism of Injury


                            2006/2007                                     2002/2003-2005/2006


                                                                        Other
            Other                                                        19%
             30%

                                        Transport            Violence
                                                                                                Transport
                                          47%                  6%
                                                                                                  46%

        Violence
          3%

                    Falls                                               Falls
                    20%                                                 29%




       Figure 3 shows the breakdown of the mechanism of injuries for the incidents in
2006/2007 as compared to 2002/2003-2005/2006.

          In 2006/2007:
    •     Major cause of injuries were transportation-related incidents: 47%, n=43.
    •     Falls-related incidents: 20%, n=18.
    •     Assault and self-intentional harm comprised the violence-related incidents: 3%, n=3.
    •     Other mechanism of injury included animal-related incidents, accidental drowning, and
          mechanical-related incidents: 30%, n=27. Struck by falling object, striking against/by
          objects or persons in sports or non-sports, caught between objects, or contact with
          cutting tools are some examples of mechanical-related incidents.




                                                    - 99 -
Regional Trauma Services                                                                                  2006/2007




Mechanism of Injury – Transportation

Figure 4. Transportation Statistics


                      2006/2007                                                 2002/2003-2005/2006
                                Water
                                 0%                                                  Water   Railw ay
                                                                                       1%      1%
                                        Railw ay
                       MRV                0%
                                                                                 MRV
                           5%
        Cy clist                                                                 14%
         21%

                                                   MVC                                                  MVC
                                                   48%                                                  47%
                                                                   Cy clist
                                                                    21%


        Pedestrian
           26%                                                                Pedestrian
                                                                                 16%



      Figure 4 shows the breakdown of transportation-related injuries in 2006/2007 as
compared to 2002/2003-2005/2006.

         In 2006/2007:
          Major cause of injuries were due to motor vehicle collisions (MVC): 48%, n=21.
          Pedestrians: 26%, n=11.
          Cyclists includes pedal cyclists, or bicyclists: 21%, n=9.
          Motorized Recreational Vehicle (MRV) includes all-terrain vehicles (ATV), snowmobiles:
          5%, n=2.
          Water includes motorized vehicle used for water transport: 0%, n=0.
          Railway includes collisions with the train: 0%, n=0.

        A total of 43 patients (47% of major trauma patients) were involved in transportation-
related incidents in 2006/2007.
         Mortality: 7% (n=3) did not survive.
         ISS ranged from 13 to 57.
         For survivors, mean ISS was 23 and median ISS was 25.
         For non-survivors, mean ISS was 41 and median ISS was 38.




                                                         - 100 -
Regional Trauma Services                                                                                      2006/2007




Figure 5. Five-Year Trend for Transportation as the MOI


                                               MOI - Transportation

                    45

                    44
    # of patients




                                 43               43                                        43
                    43

                    42
                                                                41             41
                    41

                    40
                          2002/2003        2003/2004         2004/2005     2005/2006    2006/2007


       Figure 5 shows the 4.7% decrease in transportation-related incidents from 2003/2004 to
2004/2005, and the 4.9% increase from 2005/2006 to 2006/2007.

Figure 6. Transportation by Age Group


                                      2006/2007                                        2002/2003-2005/2006

                                          <1                                                     <1
                           >14                         1-4                           >14               1-4
                                          2%                                                     0%
                           14%                         12%                           17%               15%



                                                               5-9
                                                              16%                                            5-9
                                                                                                             19%




                         10-14                                                      10-14
                         56%                                                         49%




      Figure 6 shows the breakdown of transportation incidents by age groups in 2006/2007 as
compared to 2002/2003-2005/2006.

                     In 2006/2007:
                      Age Group < 1 (n=1, 2%) included one passenger. There was one death in this age
                      group.
                      Age Group 1-4 (n=5, 12%) included four passengers and one pedestrian.
                      Age Group 5-9 (n=7, 16%) included two passengers in motor vehicles and one
                      motorcycle, two cyclists, and two pedestrians. There were two deaths in this age group.
                      Age Group 10-14 (n=24, 56%) included eight passengers, seven cyclists, six pedestrians,
                      two drivers, and one motorcyclist.



                                                                     - 101 -
Regional Trauma Services                                                                                2006/2007




         Age Group >14 (n=6, 14%) included two passengers, two pedestrians, one driver and
         one other specified person.

Mechanism of Injury – Falls

Figure 7. Statistics for Falls as the MOI


                      2006/2007                                        2002/2003-2005/2006

                                                                             Other &
                                                                           Unspecified
                                                                               2%
                                                             Same lev el
      Other &                                                   27%
    Unspecified
       44%                           Multi-level
                                      50%

                                                                                         Multi-lev el
                  Same level                                                                 71%

                     6%




       Figure 7 shows the breakdown of falls incidents in 2006/2007 as compared to 2002/2003-
2005/2006.

      In 2006/2007, multi-level falls accounted for 50% (n=9) of falls. Other/unspecified falls
and same level falls accounted for 44% (n=8) and 6% (n=1) respectively.

         A total of 18 patients (20% of major trauma patients) were admitted for falls-related
injuries.
          Mortality: 0%: All patients survived.
          ISS ranged from 13 to 29.
          Mean ISS was 20 and the median ISS was 18.




                                                   - 102 -
Regional Trauma Services                                                                                              2006/2007




         Figure 8. Five-Year Trend for Falls as the MOI


                                                     MOI - Falls

                                  28
                   30                           27                       27
                                                             25
                   25
                                                                                         18
   # of patients




                   20

                   15

                   10

                     5

                     0
                           2002/2003         2003/2004   2004/2005   2005/2006    2006/2007



       While there is a significant change in the mechanisms and types of falls in 2006/2007 as
compared to 2002/2003-2005/2006, Figure 8 shows the overall decrease of 35.7% in falls from
2002/2003 to 2006/2007.

Figure 9. Falls by Age Group


                                       2006/2007                                              2002/2003-2005/2006

                                       >14                                                                     <1
                          10-14        6%                                                >14
                                                            <1                                                13%
                           11%                                                           20%
                                                           28%

                    5-9
                   11%
                                                                                                                    1-4
                                                                                                                    25%
                                                                                 10-14
                                                                                 22%


                                             1-4                                                        5-9
                                             44%                                                       20%




       Figure 9 shows the breakdown of falls incidents by age groups in 2006/2007 as compared
to 2002/2003-2005/2006.

                     In 2006/2007:
                      Age Group < 1 (n=5, 28%) included one multi-level fall and four falls resulting in bumping
                      against objects and other unspecified mechanism.
                      Age Group 1-4 (n=8, 44%) included three falls from or out of building or other structures,
                      three multi-level falls, and two falls resulting in bumping against objects.
                      Age Group 5-9 (n=2, 11%) included one fall from or out of building or other structures,
                      and one multi-level fall.



                                                                      - 103 -
Regional Trauma Services                                                                                           2006/2007




         Age Group 10-14 (n=2, 11%) included one same level fall and one fall resulting in
         bumping against object.
         Age Group >14 (n=1, 6%) included in one fall resulting in bumping against object.


Mechanism of Injury – Violence

Figure 10. Violence as the MOI


                      2006/2007                                                       2002/2003-2005/2006

                                                                                             Other &
                            Unarmed
                                                                                           Unspecified
                             assault
                                                                                               5%
        Other &                 0%           Assault
      Unspecified                           w ith object             Self-inflicted
         33%                                   34%                       27%

                                                                                                            Unarmed
                                                                                                            assault
                                                                                                             54%

                                                                              Assault
                           Self-inflicted
                                                                            w ith object
                               33%
                                                                                14%




       Figure 10 shows the breakdown of violence-related incidents in 2006/2007 as compared
to 2002/2003-2005/2006.

          In 2006/2007, violence-related incidents were comprised of assault with object 34% (n=1),
self-inflicted 33% (n=1), and other/unspecified assault 33% (n=1). Small numbers account for the
large percentage differences when comparing years.

         A total of 3 patients (3% of major trauma patients) were admitted for violence-related
injuries.
          Mortality: 33% (n=1) survived and 67% (n=2) did not survive.
          ISS ranged from 17 to 27.
          For survivors, mean ISS and median ISS was 17.
          For non-survivors, mean ISS and median ISS was 26.




                                                           - 104 -
Regional Trauma Services                                                                                                 2006/2007




Figure 11. Five-Year Trend for Violence as the MOI


                                              MOI - Violence

                    10       9
                     9
                     8                        7
                     7
    # of patients




                     6                                     5
                     5
                     4                                                                       3
                     3
                     2                                                     1
                     1
                     0
                          2002/2003     2003/2004    2004/2005     2005/2006           2006/2007



                     Figure 11 shows the overall downward trend from 2002/2003 to 2006/2007.

Figure 12. Violence Incidents by Age Group


                                 2006/2007                                                   2002/2003-2005/2006



                                                                                       >14                      <1
                    >14                                    <1                          23%                     23%
                    33%                                   34%




                                                                               10-14
                                                           1-4                  14%
                                                           0%                                                      1-4
                                                    5-9                                                            26%
                                                                                              5-9
                                      10-14         0%
                                                                                             14%
                                      33%




      Figure 12 shows the breakdown of violence incidents by age groups in 2006/2007 as
compared to 2002/2003-2005/2006.

                     In 2006/2007:
                      Age Group < 1 (n=1, 34%) included one non-accidental trauma resulting in death.
                      Age Group 1-4 (n=0, 0%)
                      Age Group 5-9 (n=0, 0%)
                      Age Group 10-14 (n=1, 33%) included one hanging incident resulting in death.
                      Age Group >14 (n=1, 33%) included one assault.




                                                                 - 105 -
Regional Trauma Services                                                                                 2006/2007




Mechanism of Injury – Other

Figure 13. Statistics for Other Mechanism of Injury


                        2006/2007                                    2002/2003-2005/2006


               Submersion                                             Other &
               & Drow ning         Animal                 Submersion Unspecified   Animal
                   7%               7%                    & Drow ning   5%          15%
                                                             15%
                                                                                                Fire &
                                                                                              Ex plosion
                                                                                                 13%



                                                                                            Inhalation &
                                                                                             Ingestion
                                                            Mechanical
                        Mechanical                                                             13%
                                                               39%
                             86%




      Figure 13 shows the breakdown of other mechanism of injuries in 2006/2007 as
compared to 2002/2003-2005/2006.

         In 2006/2007, other mechanism of injuries included: animal-related incidents 7.4% (n=2),
accidental drowning 7.4% (n=2), and mechanical-related incidents 85.2% (n=23). Struck by
falling object, striking against/by objects or persons in sports or non-sports, caught between
objects, or contact with cutting tools are some examples of mechanical-related incidents.

         This year saw a large increase in mechanical-related incidents mostly related to sports
injuries. Also note the absence of fire & explosion (including electrical) and inhalation & ingestion
mechanisms in 2006/2007.

         A total of 27 patients (30% of major trauma patients) were admitted for other mechanism
of injuries.
          Mortality: 93% (n=25) survived and 7% (n=2) did not survive.
          ISS ranged from 16 to 45.
          For survivors, mean ISS was 21 and median ISS was 17.
          For non-survivors, mean ISS and median ISS was 23.




                                                - 106 -
Regional Trauma Services                                                                                          2006/2007




Figure 14. Five-Year Trend for Other Mechanism of Injury


                                              MOI - Other

                   30                                                                27

                   25
                                         20
                                                                    18
                                                      17
   # of patients




                   20
                           13
                   15

                   10

                    5

                    0
                        2002/2003   2003/2004     2004/2005      2005/2006     2006/2007



        Figure 14 shows the increasing number of patients whose injuries are caused by animal,
accidental drowning, and mechanical-related incidents.

Figure 15. Other Mechanism by Age Group


                                2006/2007                                                 2002/2003-2005/2006
                                                                                          >14       <1
                                    <1
                        >14                     1-4                                                 3%
                                    0%                                                    13%
                        19%                     15%

                                                                                                                 1-4
                                                           5-9                                                  34%
                                                           15%


                                                                             10-14
                                                                              31%


                          10-14
                                                                                                          5-9
                          51%
                                                                                                         19%




       Figure 15 shows the breakdown of incidents involving other mechanism of injury by age
groups in 2006/2007 as compared to 2002/2003-2005/2006.

                    In 2006/2007:
                     Age Group < 1 (n=0, 0%)
                     Age Group 1-4 (n=4, 15%) included one patient who was caught in between objects
                     resulting in death, two incidents where patients were in contact with cutting objects, and
                     one patient was struck by a falling object.
                     Age Group 5-9 (n=4, 15%) included one accidental drowning, one animal-related injury,
                     and two incidents involving striking against objects or persons in sports.




                                                                  - 107 -
Regional Trauma Services                                                                                   2006/2007




                    Age Group 10-14 (n=14, 51%) included one accidental drowning, and 13 incidents
                    involving striking against objects or persons in sports with or without subsequent falls.
                    There was one death in this age group.
                    Age Group >14 (n=5, 19%) included five incidents involving striking against objects or
                    persons in sports with or without subsequent falls.

The increase in age group 10-14 can be attributed to the large increase in mechanical-related
incidences in 2006/2007 mostly related to sports being played in this age group.


Type of Injury

        Type of Injury indicates whether the most serious injury is blunt, penetrating, burn, or
other type of injury (strangulation, hanging and drowning).

Figure 16. Type of Injury


                                       Type of Injury - 2006/2007
                                            Total Pts = 91

   100                    85
     80
     60

     40
     20                                                                                   4
                                               2                      0
             0
                         Blunt            Penetrating              Burn                 Other

        Figure 16 shows the different types of injuries sustained by the major trauma patients in
2006/2007. Blunt injury comprised 93.4% of major trauma population. Other type of injury (4.4%)
includes drownings and hangings, while penetrating type of injuries comprised 2.2% of the major
trauma patients.

Figure 17. Five-Year Trend for Type of Injury


                                      Type of Injury - Five Year Trend
                                               Total Pts = 456

                   100   88             87               81                               85
                                                                           76
   # of Patients




                   50
                              0 0 5          1 1 8            2 0 5             1 4 6           2 0 4
                    0
                         2002/2003       2003/2004       2004/2005         2005/2006      2006/2007
                                                        Fiscal Years

                                             Blunt   Penetrating      Burn      Other


Figure 17 compares the different types of injuries from 2002/2003 up to 2006/2007.



                                                                 - 108 -
Regional Trauma Services                                                                                              2006/2007




Place of Injury


Figure 18. Statistics for Place of Injury


                          2006/2007                                                2002/2003-2005/2006


                             Farm                                                              Farm
                             2%       Home     Other
                                                                                               2%     Home
   Unspecified                        16%       1%                                                    20%
        27%                                                          Unspecified
                                                                                                               Other
                                                 Public                 34%
                                                                                                                 2%
                                                Building
                                                  3%                                                             Public
                                                                                                                Building
                                                                                                                  4%
                                            Recreation
                                              20%                                                            Recreation
                 Street                                                               Street                   13%
                 31%                                                                  25%




       Figure 18 shows where the patients were injured in 2006/2007 as compared to
2002/2003-2005/2006.

          In 2006/2007:
    •     Most injuries were sustained in the streets (31%, n=27) which is consistent with
          transportation-related incidents.
    •     Twenty percent of patients (n=18) were injured in recreational areas, while 16% of the
          patients (n=15) were injured in their own homes or other person’s homes.
    •     Due to the lack of documentation, a total of 25 (27%) places of injury were not identified
          at the time of this publication.
    •     Three percent (n=3) of incidents occurred in public buildings, 2% (n=2) happened in
          farms, and 1% (n=1) took place in other specified place of injury.




                                                           - 109 -
Regional Trauma Services                                                                           2006/2007




3. Referrals to ACH
Referral Patterns

         Out of 456 major trauma patients from 2002/2003 to 2006/2007, a total of 202 patients
(44.3%) were referred to ACH by other hospitals.
         The highest number of referrals to ACH were made by Lethbridge Regional Hospital with
a total of 17 patients (8.4% of total referrals) over five years. Banff Mineral Springs Hospital and
Red Deer Regional ranked second with a total of 12 patients (5.9%) referred for each hospital.

Table 2. Transfers from Other Centres by Health Region

 Region       Hospital                            2002/2003   2003/2004   2004/2005   2005/2006   2006/2007    Total


 Region 1 - Chinook Health Region, Total = 37
              Blairmore - Crowsnest Pass               1         1                                    1         3
              Cardston - Blood Indian                                                    1                      1
              Cardston - Municipal                                           1                        3         4
              Fort Macleod H.C.C.                                                        1                      1
              Lethbridge Regional                      6         4           4           2            1         17
              Milk River                                         1                                              1
              Pincher Creek Municipal                  1         1           1                        1         4
              Raymond General                                                                         1         1
              Taber H.C.C.                                       1                       2            2         5


 Region 2 - Palliser Health Region, Total = 17
              Bassano General                          1                                 1                      2
              Brooks Health Centre                                           2           3            2         7
              Medicine Hat Regional                    1         2                       1                      4
              Oyen - Big Country                       3                     1                                  4


 Region 3 - Calgary Health Region, Total = 58
              Banff - Mineral Springs                  3         3           1           4            1         12
              Black Diamond - Oilfields General                                                       2         2
              Calgary - Foothills                      1         2           1                        2         6
              Calgary - General/Peter Lougheed         1         3           2           2            1         9
              Calgary – Rockyview General              2         1           1           2            1         7
              Canmore General                          1         1           1           1            1         5
              Claresholm General                                             1           1                      2
              Didsbury - Mountain View H.C.                                  1                        4         5
              High River General                                 5           1                        1         7
              Strathmore - Valley General                        1                       1                      2
              Vulcan General                                                 1                                  1




                                                  - 110 -
Regional Trauma Services                                                                                 2006/2007




 Region       Hospital                                  2002/2003   2003/2004   2004/2005   2005/2006   2006/2007    Total


 Region 4 - David Thompson Health Region, Total = 50
              Castor - Our Lady of the Rosary                                                               1         1
              Coronation Municipal                                     1                                              1
              Drumheller Regional                            1         1           1                        4         7
              Hanna H.C.C.                                   1         1                       1                      3
              Innisfail H.C.C.                                         2           1           1                      4
              Olds General                                   1         1           1                                  3
              Red Deer Regional                                        1           2           1            8         12
              Rocky Mountain House                           1         6                       2                      9
              Stettler General                               3                     2                                  5
              Sundre General                                           1                                              1
              Three Hills H.C.C.                             1         1                       2                      4


 Other Alberta Hospitals, Total = 2                          1                                 1                      2


 British Columbia, Total = 38
              Cranbrook Regional Hospital                    1         3           1           2            1         8
              Creston Valley Hospital                        1                                 2            1         4
              Fernie District Hospital                       1         1                       1            2         5
              Golden & District General Hospital                                   1           2                      3
              Invermere District Hospital                    3         1           1           3                      8
              Nelson, Kootenay Lake District Hospital                                          1                      1
              Nakusp, Arrow Lakes Hospital                   1                                                        1
              Penticton Regional Hospital                                                                   1         1
              Revelstoke, Queen Victoria Hospital                                  1                                  1
              Salmon Arm, Shuswap Hospital                                         1                                  1
              Sparwood, Sparwood General Hospital                                  1                        1         2
              Other BC Hospitals                                       1           1           1                      3




                                                        - 111 -
Regional Trauma Services                                                                                           2006/2007




Mode of Transport for Patients Arriving in ACH

Figure 19. Direct from the Scene


                             2006/2007                                           2002/2003-2005/2006
                                                                                 Priv ate     Other
                  Priv ate          Other
                                                                                 v ehicle     0.5%
                  v ehicle           0%
                                                                                  21%
                   25%
                                                                        Fix ed-
         Fix ed-                                                         w ing
          w ing                                                         0.5%
           0%                                     Ground             Helicopter                           Ground
        Helicopter                                 62%                 13%                                 66%
          13%




      Figure 19 shows the patients arriving in ACH-ED directly from the scene in 2006/2007 as
compared to 2002/2003-2005/2006.

    •     In 2006/2007, 62% of patients (n=30) arrived directly from the scene by ground
          ambulance, 25% of patients (n=12) used private vehicle or walked into the ED.
          Helicopter ambulance brought 13% of patients (n=6) directly to the ED.

Figure 20. Referrals


                             2006/2007                                           2002/2003-2005/2006
                         Priv ate                                                  Priv ate
           Fix ed-                        Other                                                  Other
                         v ehicle                                                  v ehicle
              w ing                         0%                                                    1%
                             2%                                         Fix ed-      1%
              14%
                                                                         w ing
                                                                          22%

                                                                                                         Ground
                                                                                                          45%
                                                  Ground
     Helicopter                                    56%
        28%

                                                                        Helicopter
                                                                           31%


      Figure 20 shows the patients who were referred to ACH for further treatment in 2006/2007
as compared to 2002/2003-2005/2006.

    •     In 2006/2007, 56% of patients (n=24) were brought in by ground ambulance, 28% of
          patients (n=12) were transported by helicopter and 14% (n=6) by fixed-wing. Two
          percent (n=1) were transferred via private vehicle or walked into ACH-ED.



                                                           - 112 -
Regional Trauma Services                                                                                           2006/2007




Figure 21. Ground VS Air


                                            Five-Year Trend

                    70                      60
                            53                           52                               54
                    60
    # of patients




                    50                                                      40
                    40
                    30
                    20                                                      33
                            27              26           26                               24
                    10
                     0
                         2002/2003     2003/2004     2004/2005    2005/2006          2006/2007

                                                     Ground           Air


          Ground ambulance transported 54 patients (59.3%) of major trauma patients in
2006/2007, a 35% increase from previous fiscal year. Figure 21 shows the decrease in the use
of air transport by 27.3% in 2006/2007.


Month and Time of Arrival


Figure 22. Month of Arrival


                          Comparison of ED Arrival by Month for 2006/2007 with
                                        2002/2003 to 2005/2006

                              15.0

                              10.0

                                 5.0

                                 0.0
                                       Apr May Jun Jul        Aug Sep Oct Nov Dec Jan Feb Mar
               Mean 02/03-05/06 7.8 6.3              7.3 12.0 12.8 8.3           7.3 6.0 6.8       4.8 5.5   6.8
               2006/2007                4        9   8   11      14         6    8    2        8   6    5    10


         There was an increase in major trauma patients arriving in ACH-ED for 7 out of 12
months in 2006/2007, as compared to 2002/2003 to 2005/2006 data. The highest percent
increase of 48% was seen in March 2007, while the biggest drop was seen in November 2006,
with a percent decrease of 67%. The month of August consistently showed the highest number
of patients arriving in ACH-ED over the past five years.




                                                              - 113 -
Regional Trauma Services                                                                 2006/2007




Figure 23. Day of Arrival


                              Comparison of ED Arrival by Day
                           for 2006/2007 with 2002/2003-2005/2006

                  20.0


                  10.0


                    0.0
                             Sun     Mon     Tue     Wed      Thu    Fri    Sat

     Mean 02/03-05/06        15.5    10.5    13.0     12.0    10.0   12.3   18.0
     2006/2007                11     15      11        19     14      8     13



        In 2006/2007, there was an increase in major trauma patients arriving in ACH-ED on
Mondays, Wednesdays and Thursdays. The weekend days of Friday, Saturday and Sunday
were less busy in 2006/2007 compared to the previous years.




                                                    - 114 -
Regional Trauma Services                                                                    2006/2007




Time of Arrival

Figure 24. Time of Arrival


                                Comparison of Time of Arrival
                           for 2006/2007 with 2002/2003-2005/2006                  15.2%

                                                             28.3%
                  60.0
                                          4%
                  40.0

                  20.0

                   0.0
                               00:01-08:00       08:01-16:00         16:01-24:00
     Mean 02/03-05/06             12.5              29.3                49.5
     2006/2007                     13                21                  57



       Figure 24 shows a slight increase of 4% for patients arriving in ACH-ED from past
midnight to 8:00 in the morning. There is a 28.3% decrease of patients arriving in ACH-ED
between 8:01 and 16:00 in 2006/2007. More patients arrived from 16:01 to midnight in
2006/2007 (15.2%) compared to the past four years.


Figure 25. Time of Arrival of Patients Arriving Directly from the Scene


             Comparison of Patients Arriving Directly from the Scene
                    for 2006/2007 with 2002/2003-2005/2006
                                                                                     9.1%
                   40.0
                                                             29.6%
                   30.0
                                          7.1%
                   20.0
                   10.0
                     0.0
                                00:01-08:00      08:01-16:00         16:01-24:00
     Mean 02/03-05/06               2.8              21.3               27.5
     2006/2007                       3                15                 30


        Figure 25 shows the same pattern as in Figure 24. There is a 7.1% increase of patients
arriving directly from the scene from past midnight to 8:00 in the morning, a 29.6% decrease from
8:01 to 16:00, and a 9.1% increase from 16:01 to midnight.




                                                   - 115 -
Regional Trauma Services                                                                          2006/2007




Patient Disposition from ED

Figure 26


                      2006/2007                                 2002/2003-2005/2006

                            Died in ED                                      Died in ED
                               1%                                                 3%


         Ward
         41%                                             Ward
                                                                                            ICU
                                                         45%
                                                                                            44%
                                         ICU
                                         54%
       Other
        0%
                                                                Other
                                                                                   OR/ICU
        OR/Ward            OR/ICU                                0%
                                                                        OR/Ward        4%
           0%               4%
                                                                          4%




      Figure 26 shows the breakdown of patient disposition from the ED in 2006/2007 as
compared to 2002/2003-2005/2006.

       In 2006/2007, high percentage of patients (54%, n=49) were admitted to ICU post ED,
while 4% were admitted to ICU post surgery. A total of 37 patients (41%) were admitted to a
ward or unit post ED. There was one ED death for this period.




                                               - 116 -
Regional Trauma Services                                                                      2006/2007




4. Patient Care Management
Diagnostic Imaging Performed-2006/2007

Table 3. Diagnostic Imaging

         A total of 77 patients (84.6% of major trauma patients) went urgently to CT for imaging of
the following body locations.

                Diagnostic Imaging
                                                                Percent of Total Patients
                   CT Locations               # Patients
                                                                                  (n=77)
 Head                                  51                                           66%
 Abdomen                               50                                           65%
 Pelvis                                40                                           52%
 Chest                                 25                                           33%
 Spine                                 14                                           18%
 Face                                   4                                            5%
Note: Some patients had CT’s done on multiple body locations.


Figure 27. Time of CT


                         Time of Urgent CT (within 6 hours of arrival, n=77)

                    70
                                                                               58
                    60
    # of Patients




                    50
                    40
                    30
                    20                               11
                                  8
                    10
                    0
                              00:00-08:00        08:01-16:00              16:01-23:59
                                                Time of Day



        Figure 27 shows that 75% (n=58) of patients who went to CT had CT’s done from 16:01
to midnight. Only 10.4% of patients had CT’s from midnight to 8:00 AM, and 14.3% of patients
had CT’s from 08:01 to 16:00.




                                                           - 117 -
Regional Trauma Services                                                                    2006/2007




Figure 28

                         Day of the week CT performed

                                   17
                    18
                                                             15
                    16
                    14                   12
    # of patients




                                                                         11
                    12   10
                    10
                               7
                     8
                                                   5
                     6
                     4
                     2
                     0        ay


                                              ay




                                                                     y
                                                      ay
                               y
                               y




                             ay
                            da
                            da




                                                                     a
                           sd


                                            id




                                                                   nd
                          sd




                                                    rd
                         es
                         on




                                          Fr


                                                  tu
                        ur




                                                                 Su
                       ne
                      Tu
                    M




                                                Sa
                      Th
                     ed
                    W




         Figure 28 shows the days of the week the CT was performed. The Diagnostic Imaging
department has extended their hours to include evenings, but at this point in time, the ACH does
not have an in-house CT tech on weekend days. It is expected this support will be in place within
the next fiscal year.

Non-Operative Procedures Performed-2006/2007


Table 4. Non-operative Procedures Performed on Patients while in ACH-ED.

    Non-Operative Procedures            # Patients          Percent of Total Patients
                                                                              (n=91)

 Foley Catheter Insertion                      25                               27%
 Gastric Tube Insertion                        20                               22%
 Intubations                                   15                               16%
 Blood Product Administration                   7                                8%
 Arterial Line                                  0                                0%
 Central Line                                   1                                1%
 Chest Tube Insertion                           1                                1%




                                                       - 118 -
Regional Trauma Services                                                                                2006/2007




Surgical Procedures

Table 5. Five-Year Trend

                                          2002/2003    2003/2004     2004/2005    2005/2006    2006/2007
 Total Major Trauma Patients                     93           97            88           87            91
 Total Patients Requiring Surgery                23           31            34           28           24
 Total OR Visits                                 33           37            48            59           30
 Total OR Hours                                  65           80           101          112            72
 Mean (hours per case)                           2.8          2.6           3.0          4.0          3.1
 Mean (visits per case)                          1.4          1.2           1.4          2.1          1.3


Figure 29


                                     Total Patients Requiring Surgery

                    40                                   34
                    35                  31
                                                                         28
                    30                                                                    24
    # of patients




                            23
                    25
                    20
                    15
                    10
                    5
                    0
                         2002/2003   2003/2004      2004/2005        2005/2006        2006/2007


         In 2006/2007, a total of 24 (26%) patients required surgery during the patient’s stay in the
hospital. Table 6 shows the physician services that performed the surgical procedures. During
some procedures, there were multiple physician services in the OR at one time.


Table 6. OR Data by Service

 OR Data by Service - 2006/2007

 Physician Service                               # of Procedures
 ENT                                                                 3
 Neurosurgery                                                       21
 Orthopedics                                                        15
 Pediatric Surgery                                                   7
 Plastics                                                           18
 Urology                                                             4
 Vascular                                                            8
 Other                                                               2



                                                       - 119 -
Regional Trauma Services                                                                             2006/2007




Figure 30. Time to OR - 2006/2007


                                                          Time to OR
                                                            (n=24)

   12                                                                                     11
                                                                     10
   10
                   8
                   6
                   4                      3
                   2
                   0
                                  00:00 - 08:00              08:01 - 16:00           16:01 - 23:59



        Figure 30 shows the time patients went to OR in 2006/2007. Out of the 24 patients who
went to OR, six were urgent OR cases and all were done between 16:01and 23:59.

Length of Stay Statistics


Figure 31. Patient LOS – 2006/2007

                                      LOS by Percentile of Patients

                            40%    36%
                            35%
   Percentile of Patients




                            30%                   26%
                            25%
                                                               20%            19%
                            20%
                            15%
                            10%
                            5%
                            0%
                                    1-3           4-6          7-12          13-60
                                                   Num ber of Days


         In 2006/2007, the median LOS for all patients is 5 days. A majority of patients (62%)
stayed between 1 and 6 days, while 39% of patients stayed between 7 and 60 days. This
calculation excludes one ED death.




                                                                          - 120 -
Regional Trauma Services                                                                                       2006/2007




Admitting Physician Service Analysis – 2006/2007

Table 7

 Physician Service                    #       Percent     # Patients          Total       Total       Mean     Median
                             Patients         of Total   Transferred        Trauma      Days on      LOS on      LOS
                              Initially      Patients     to Service         Cases      Service      Service        on
                             Admitted        Admitted                           per                            Service
                                    to           n=90                       Service
                              Service

 ICU                                 53          58.9%              0            53          218         4.0       2.0
 Neurosurgery                         1           1.1%              3             4           24         6.0       4.5
 Orthopedics                          4           4.4%              0             4           14         3.5       3.5
 Pediatric Surgery                   14          15.6%             13            27          181         6.7       5.0
 Urology                              2           2.2%              0             2            3         1.5       1.5
 Pediatrics                          16          17.8%             33            49          374         7.6       3.0
 Total                               90                            49           139          821

           In 2006/2007, a total of 53 patients (58.9%) were admitted to ICU. Out of those patients
initially admitted to ICU,
           3 patients were transferred to Neurosurgery,
           11 patients went to Pediatric Surgery,
           33 patients were transferred to Pediatrics.
There were two patients admitted to urology who were later transferred to pediatric surgery.


Hospital Discharge Destination

Figure 32. Discharge Destinations


                  Comparison of Discharge Destination for 2006/2007 with
                                  2002/2003-2005/2006

                  100

                  80

                  60

                  40

                  20

                   0
                         Another    Children's                     Home w ith             Rehab
                                                  Died    Home                  Other
                        Acute Care Aid/Foster                       Support               Facility

      Mean 0203/0506       3.25         3         8.25     72           4       0.25        0.5

      2006/2007             3           0          7       81           0         0          0



       Figure 32 shows a 12.5% increase in the number of patients discharged home in
2006/2007 as compared to 2002/2003-2005/2006.


                                                         - 121 -
Regional Trauma Services                                                                 2006/2007




Outcomes by Age


Figure 33. Survivors


                    Comparison of Survivors by Age Group for
                      2006/2007 with 2002/2003-2005/2006

                   60.0

                   40.0

                   20.0

                     0.0
                           <1         1-4              5-9    10-14        > 14
      Mean 0203-0506       5.8        15.8             15.0   31.5         15.0
      2006/2007             5          16              11      39           13



         Figure 33 shows an increase in survivors for age group 1-4 at 1.3% and age group 10-14
at 23.8%. Other age groups showed a decrease in the number of survivors by 13.8% (<1), 26.7%
(5-9), and 13.3% (>14).


Figure 34. Non-Survivors


                Comparison of Non-Survivors by Age Group for
                    2006/2007 with 2002/2003-2005/2006

                     4.0

                     3.0

                     2.0
                     1.0

                     0.0
                           <1         1-4              5-9    10-14        > 14
      Mean 0203-0506       0.5        3.5              2.0     1.5         0.8
      2006/2007             2          1                2       2           0


       Figure 34 shows no change in the number of non-survivors for age group 5-9. A 71.4%
decrease was seen in age group 1-4, while the other age groups experienced an increase in the
number of non-survivors: 300% (<1), 33% (10-14), and 100% (>14).




                                             - 122 -
Regional Trauma Services                                                                  2006/2007




Outcomes by ISS – 2006/2007


Figure 35. Survivors vs Non-Survivors by ISS


                                           2006/2007

                    60           54
    # of patients




                    40
                                           15
                    20   8
                                      2         3     6
                             0                            1    1 0        0 1     0 0
                    0
                         12-15   16-25    26-35       36-45    46-55      56-65   66-75
                                                       ISS

                                          Survivors       Non-Survivors


       Most survivors (64.3%, n=54) had ISS from 16 to 25. Mortality rate was highest in the
ISS range 56-65 with 100% death rate, followed by ISS 26-35 with 16.7% mortality rate, and ISS
range 36-45 with 14.3% mortality rate.




                                                                       - 123 -
Regional Trauma Services                                                                                                      2006/2007




TRISS (Trauma Injury Severity Score) Pre Charts for 2006/2007

         The following charts identify patients according to their probability of survival (Ps). Each
patient is characterized by the Revised Trauma Score (RTS) and the Injury Severity Score (ISS)
and then plotted on a graph.

        The shaded area represents the combination of the RTS and the ISS which yield a
probability of survival (Ps) of >.50. The area above the line represents a probability of survival of
<.50. Patients who are above the shaded area and survive and those who die and are plotted in
the shaded area, are atypical cases and subject for medical review. The age groups are
standard age groups used in the development of the TRISS analysis.

Figure 36. Pediatric Pre Charts include blunt and penetrating mechanisms for patients < 15
years.
                                   Pediatric AIS 90 Coding

                          Report generated on 07/02/2008
                       Range From 01/04/2006 to 31/03/2007
                                Query is EVERYONE


                                          1   5    10    15    20    25    30    35    40    45    50    55    60    65    70    75
                                   +   +---+----+----+----+----+----+----+----+----+----+----+----+----+----+----+ +
                                   |                                                                                              |
                               0   +                                                                                              +   0
                                   |                                                                                              |
                                   +                                                                                              +
                                   |   ..                                                                                         |
                               1   +   ....                                                                                       +   1
                                   |   .......                                                                                    |
                           R       +   .........                                                                                  +
                           E       |   ............                                                                               |
                           V   2   +   ..............                                                                             +   2
                           I       |   ................                                                                           |
                           S       +   ...................                                                                        +
                           E       |   .....................                                                                      |
                           D   3   +   ........................                                                                   +   3
                                   |   ..........................                                                                 |
                           T       +   .............................                                                              +
                           R       |   ...............................                                    D                       |
                           A   4   +   .................................                                                          +   4
                           U       |   ....................................                                                       |
                           M       +   ......................................                                                     +
                           A       |   .........................................                                                  |
                               5   +   ...........................................                                                +   5
                           S       |   .............................................                                              |
                           C       +   ................................................                                           +
                           O       |   ..................................................                                         |
                           R   6   +   .....................L...............................                                      +   6
                           E       |   .......................................................                                    |
                                   +   ............L...........L.................................                                 +
                                   |   ............................................................                               |
                               7   +   ...............L....L....L....................................                             +   7
                                   |   .................................................................                          |
                                   +   ...............LL..L.....L.........................................                        +
                                   |   ............LL.LLL.LLL.LL.L.L......L..................................                     |
                               8   +   +---+----+----+----+----+----+----+----+----+----+----+----+----+----+----+ +                  8
                                       1    5   10    15    20    25    30    35    40    45    50    55    60    65    70    75

                                       L = SURVIVOR(S)                                                     SHADED = Ps >= 0.50
                                       D = DEATH(S)                       INJURY SEVERITY SCORE
                                       B = BOTH


    No Unexpected Deaths:      Pediatric AIS 90 Coding

    No Unexpected Survivors:           Pediatric AIS 90 Coding



        There were no unexpected deaths and no unexpected survivors for patients less than 15
years in 2006/2007 using the TRISS methodology.




                                                                - 124 -
Regional Trauma Services                                                                                                      2006/2007




Figure 37. Adult Pre Charts include patients between 15 and 17 years who sustained a blunt
injury
                       Adult Blunt (15 - 54) AIS 90 Coding

                          Report generated on 07/02/2008
                       Range From 01/04/2006 to 31/03/2007
                                Query is EVERYONE


                                          1   5    10    15    20    25    30    35    40    45    50    55    60    65    70    75
                                   +   +---+----+----+----+----+----+----+----+----+----+----+----+----+----+----+ +
                                   |                                                                                              |
                               0   +                                                                                              +   0
                                   |                                                                                              |
                                   +                                                                                              +
                                   |   ..                                                                                         |
                               1   +   ....                                                                                       +   1
                                   |   .......                                                                                    |
                           R       +   .........                                                                                  +
                           E       |   ............                                                                               |
                           V   2   +   ..............                                                                             +   2
                           I       |   ................                                                                           |
                           S       +   ...................                                                                        +
                           E       |   .....................                                                                      |
                           D   3   +   ........................                                                                   +   3
                                   |   ..........................                                                                 |
                           T       +   .............................                                                              +
                           R       |   ...............................                                                            |
                           A   4   +   .................................                                                          +   4
                           U       |   ....................................                                                       |
                           M       +   ......................................                                                     +
                           A       |   .........................................                                                  |
                               5   +   ...........................................                                                +   5
                           S       |   .............................................                                              |
                           C       +   ................................................                                           +
                           O       |   ..................................................                                         |
                           R   6   +   ................L....................................                                      +   6
                           E       |   .......................................................                                    |
                                   +   ..........................................................                                 +
                                   |   ............................................................                               |
                               7   +   ..............................................................                             +   7
                                   |   .................................................................                          |
                                   +   ...................................................................                        +
                                   |   ...............LL..L....L...L.....L...................................                     |
                               8   +   +---+----+----+----+----+----+----+----+----+----+----+----+----+----+----+ +                  8
                                       1    5   10    15    20    25    30    35    40    45    50    55    60    65    70    75

                                       L = SURVIVOR(S)                                                     SHADED = Ps >= 0.50
                                       D = DEATH(S)                       INJURY SEVERITY SCORE
                                       B = BOTH


    No Unexpected Deaths:      Adult Blunt (15 - 54) AIS 90 Coding

    No Unexpected Survivors:           Adult Blunt AIS 90 Coding (15 - 54)


       There were no unexpected deaths and no unexpected survivors for patients between 15
and 17 years in 2006/2007 using the TRISS methodology.




                                                                - 125 -
Trauma Statistics &
Performance/Outcome
Data
PETER LOUGHEED CENTRE
ROCKYVIEW GENERAL HOSPITAL

Project Lead:
   • Ms. Alma Badnjevic, Data Anaylst
      Regional Trauma Services

  •   Ms. Michelle Mercado, Data Analyst
      Regional Trauma Services
 Regional Trauma Services                                                                          2006/2007




 TRAUMA SUMMARY FOR PETER LOUGHEED (PLC)

 April 1, 2006 – March 31, 2007

 Capturing the major trauma population at the PLC is based on a review of the monthly injury
 discharges prepared by Quality Safety Health Information (QSHI). Trauma patients with an Injury
 Severity Score (ISS) ≥12 were identified through chart audit.

 ISS is an anatomical scoring tool that provides an overall score for patients with single system or
 multiple injuries. The ISS captured in the Alberta Trauma Registry (ATR) ranges between 12 and
 75; the higher the ISS, the more serious the injury.

 Patients that are admitted to the hospital with a trauma related mechanism of injury and any of
 the following injury prompts a chart audit:
        - head injury;
        - comatose;
        - rib fracture > 1 or unknown with/without pneumo/hemothorax;
        - multiple limb injury;
        - abdominal injury;
        - spinal injury;
        - any significant mechanism of injury (cause)

 Staff members are encouraged to complete a trauma follow-up form in the Emergency
 Department with information on the traumatically injured patient. Forms were collected on a
 regular basis. System issues were referred directly to Regional Trauma Services.

 For 2007-2008, Emergency Department deaths will also be reviewed as part of a chart audit.

 The following reports reflect the major trauma population (ISS ≥12) that was identified and
 reviewed by Trauma Services, based on the evaluation process list identified above.


Yearly Major Trauma Totals
           22
                                   20
                                              22             The PLC four year trend demonstrates a
                                                             decrease from 2003/2004 to 2004/2005 (45.4%),
                                                             an increase from 2005/2006 (50%), and an
                      10                                     increase in 2006/2007 (4.4%).



        2003/2004   2004/2005   2005/2006   2006/2007




                                                        - 128 -
 Regional Trauma Services                                                                                                                                                                                                           2006/2007




Monthly Major Trauma Totals
                                                     2006/2007                                                                                                                            2005/2006

                                             4
                                                                                                                                                                                      6
   # of patients




                                                                                                                                              # of patients
                   3      3                                           3

                                                                                         2       2             2                                                                                              3           3
                                                      1        1              1                                                                                                 2           2
                                                                                                                                                              1           1                       1     1
                                   0                                                                                   0                                            0                                               0           0

                   Apr   May       Jun    Jul        Aug       Sep    Oct     Nov    Dec         Jan       Feb         Mar                                    Apr   May   Jun   Jul   Aug   Sep   Oct   Nov   Dec   Jan   Feb   Mar




 At the PLC 2006/2007 the peaks were seen in April, May, July and October where as in
 2005/2006, peaks were seen in August. These graphs demonstrate the unpredictable nature of
 trauma at this site.    The numbers do not reflect the patients that arrived in ED and were
 transferred to the Trauma Centres.


 Males/Female – 2006/2007

                         14                                                         14

                                                                                                                                                   Males continue to outnumber females at the
                                                                                                                                                   PLC, a ratio of 1.12:1.
                                                                                                       8
                                         6




                         2005/2006                                                2006/2007

                                                     Males           Females




 Age Distribution – 2006/2007

                                                               7                                                                 7            The PLC admitted no major trauma patients
                                                                                                                                              between ages 25-34 and 55-64.

                                                                                                                                              In 2006/2007, the majority of the population
                                                           4                                               4       4
                                                                                                                                              was between 45-54 and >84. In 2005/2006 the
                                         3                                3
                                                                                                                                              patient population was distributed across the
                          2                                                              2   2                                                age groups with some higher numbers
            1 1                                  1                                                                           1                between ages 45-54 and 75-84.
                               0                                              0

          18-24           25-34          35-44             45-54        55-64            65-74             75-84             > 84


                                                      2005/2006        2006/2007




                                                                                                                                    - 129 -
Regional Trauma Services                                                                                                                             2006/2007




Mechanism of Injury (MOI) – 2006/2007

                                                        16                                                       The MOI is reported by four broad
                                                                                                                 categories: transportation, falls, violence
   # of patients

                                                   11                                                            and other. These are in keeping with the
                                                                                                                 focus of the Calgary Health Region’s injury
                                                                                                                 control initiatives. Other includes animal
                                                                                5
                             4                                          4                                        related incidents (e.g. riding). Falls
                                 1                                                           1                   continue to be the number one mechanism
                                                                                                  0
                                                                                                                 of injury at the PLC.
                    Transportation                  Falls               Violence              Other


                                                 2005/2006             2006/2007


Mode of Arrival – 2006/2007

                                 21




                        13
                                                                                                                The majority of patients were transported
                                                                                                                by EMS to PLC this year; consistent with
                                                                                                                2005/2006.
                                                        7


                                                                   1
                                                                                        0    0

                         EMS                  Private Vehicle/Walk-in                   Unknown


                                            2005/2006              2006/2007




Discharge Outcomes – 2006/2007


                        15
                   13
                                                                                                                The majority of trauma patients from both
                                                                                                                sites were discharged “home”. The
                                                                                                                other/unknown category represents patients
                                                                                                                discharged to locations other than
                                        4
                                                                3                                               previously defined or for which no specific
                                                            2                                     2
                                             1                                      1        1                  discharge location was documented in the
                                                                            0
                                                                                                                chart.
                   Home               Acute Care            Died        Nursing Home Other / Unknown


                                        2005/2006                        2006/2007




                                                                                                      - 130 -
Regional Trauma Services                                                                   2006/2007

Transfer to FMC Trauma Centre – 2006/2007

                                            41

                           34
              28
                                 26
                                                           Patients who were seen at PLC ER and
                                                           were transferred to FMC Trauma Centre
                                                           with an ISS ≥ 12.

                                                           Note:    One patient for 2006/2007 was
                                                           admitted to PLC for 1 day prior to being
                                                           transferred at FMC.

      2003/2004     2004/2005   2005/2006    2006/2007




                                                  - 131-
   Regional Trauma Services                                                                2006/2007

                                              PETER LOUGHEED HOSPITAL
                                              PERFORMANCE INDICATORS

                                                    PRE-HOSPITAL PHASE


GCS (Glasgow Coma Scale) ≤ 8 at
Scene / Mechanical Airway
Did the patient with a first recorded scene GCS ≤ 8
receive a mechanical airway as an intervention at
                                                                             100.0
the scene?
Mechanical airway includes intubation (nasal and oral),
cricothyroidotomy and tracheostomy. Laryngeal mask airway
(LMAs) are considered a very effective airway however, not a               2006/2007
mechanical/definitive airway.
                                                                           %Yes      %No
n = all patients with first recorded scene GCS ≤8.
       Indicator                     Yes                   No

2006/2007, n = 1               0                    1



                                                        IN-HOSPITAL CARE

Chart Documentation
Was 1 hour chart documentation present for the
patient beginning with ER, including time in
radiology, up to admission to the OR, ICU, ward,
death or transfer to another hospital?                                       100.0




n = all patients seen in ED.                                               2006/2007
Indicator                      Yes                  No
                                                                           %Yes      %No
2006/2007, n = 22              22                   0



Neurological Documentation
Was sequential neurological documentation present
on the ER record if the patient had a diagnosis of
skull fracture, intracranial injury or spinal cord injury?                   57.1



                                                                             42.9
n = all patients seen in ED with skull fracture, intracranial injury or
spinal cord injury.
                                                                           2006/2007
Indicator                      Yes                  No
                                                                           %Yes      %No
2006/2007, n = 14              6                    8




                                                              - 132 -
   Regional Trauma Services                                                               2006/2007




Ambulance Reports
Are all prehospital ambulance reports from all
phases of patient transport present on the medical
record?
                                                                      100.0


n = all patients with prehospital care provider(s)
Indicator                     Yes                    No             2006/2007

2006/2007, n = 21             21                     0              %Yes      %No




ED Length of Stay (LOS)
Did the patient have a PLC ED length of stay < 4
hours?
Median ED LOS: 8.04 hours   Range: 3.783 to 32.733 hours
Average ED LOS: 11.17 hours                                            95.5

n = all patient seen in PLC ED with a known LOS.                                    4.5
Indicator                     Yes                    No              2006/2007
2005/2006, n = 22             1                      21
                                                                    %Yes      %No




Hospital Admitting Doctor
Was the patient admitted to a surgeon or an
intensivist at the PLC?
                                                                       54.5


                                                                       45.5
n = all patients admitted to PLC
                                                                    2006/2007
Indicator                     Yes                    No
                                                                    %Yes      %No
2006/2007, n = 22             10                     12




CT of the Head
If the patient had a GCS < 13, was a CT of the head
performed within 4 hours of arrival to the PLC?
                                                                    No Cases
n = all patients with a known FMC ED GCS, a known time of CT
head, LOS >/= 4 hours and no head CT at sending hospital.


Indicator                   Yes                      No

2006/2007, n = 0            0                        0
                                                          - 133 -
   Regional Trauma Services                                                               2006/2007




Patient transfer
Was any patient with ISS ≥ 12 transferred to FMC
trauma centre?

                                                                      95.5


                                                                                    4.5
n = all patients admitted to PLC with an ISS ≥ 12.

Indicator                     Yes                No                 2006/2007

2006/2007, n = 22             1                  21                 %Yes      %No




Missed Injuries
Did the patient have any new injuries diagnosed 48
hours after arrival to the PLC?

                                                                      100.0


n = all admitted patients who survive at least 48 hours

Indicator                     Yes                No                 2006/2007

2006/2007, n = 19             0                  19                 %Yes      %No




Joint Reduction
If the patient had a joint dislocation, was there an
attempt at relocation within 1 hour of arrival to the
PLC?
                                                                      100.0

n = all patients with a hip, shoulder, elbow or knee joint
dislocation with a hospital LOS ≥ 1 hour and a known reduction
time.                                                               2006/2007
Indicator                  Yes                   No
                                                                    %Yes      %No
2006/2007, n = 1           0                     1




                                                          - 133 -
                                                          - 134 -
   Regional Trauma Services                                                           2006/2007




Femur Fracture
Did the patient have operative management of the
femur fracture within 24 hours of arrival to PLC?
                                                                         50.0


n = all patients with operative management of femur fracture.            50.0


                                                                      2006/2007
Indicator                  Yes                    No
                                                                      %Ye s     %No
2006/2007, n = 2           1                      1




Open Fracture

Did the patient with open long bone fracture have
operative management performed within 6 hours
(grade 3) or 12 hours (grade 1, 2) of arrival to FMC
trauma centre?

Long bones include radius, ulna, humerus, tibia, femur and fibula.    No Cases

n = all patients with operative management of open long bone
fracture.
Indicator                  Yes                    No

2006/2007, n = 0           0                      0



Major Facial Fracture
Did the patient receive operative management of
major facial fractures (mandible, maxilla or orbit) at
the PLC, within 7 days of injury?
                                                                      No Cases

n = all patients who have operative intervention of major facial
fracture.
Indicator                  Yes                    No

2006/2007, n = 0           0                      0




                                                            - 133 -
                                                            - 135 -
   Regional Trauma Services                                                                       2006/2007




Category 1 Laparotomies
If the patient received a Category 1 laparotomy, was
it performed within 1 hour of arrival to PLC?
N = all patients with Category 1 laparotomy. Of patients requiring          No Cases
category 1 laparotomy, and laparotomy was not performed within
1 hour of arrival to trauma centre, 50% had laparotomy within 2
hours and 25% had it performed within 3 hours.


Indicator                   Yes                    No

2006/2007, n = 0            0                      0

   Category 1 Laparotomy:
   Time to laparotomy < 1 hour. Patients with a blood pressure, systolic ≤ 90 in the trauma room,
   confirmed, or a need for > 4 units of packed red blood cells in the first hour, for hemorrhage due
   to injury.


Unplanned Return to OR
Did the patient have an unplanned return to the
operating room within 48 hours of the initial
procedure?
                                                                              100.0


                                                                                      0.0
n = all patients with at least one operating room visit.
Indicator                     Yes                  No                       2006/2007

2006/2007, n = 2              0                    3                        %Yes      %No




ICU Admission
Was there an ICU admission at the PLC?

                                                                               91.0


n = all patients admitted to the PLC                                                        9.0

                                                                            2006/2007
Indicator                     Yes                  No
                                                                            %Yes      %No
2006/2007, n = 22             2                    20




                                                           - 133 -
                                                           - 136 -
   Regional Trauma Services                                                        2006/2007




Unplanned ICU Admission
Was there an unplanned ICU trauma admission at
the PLC?

                                                                     100.0


n = all patients admitted to PLC Trauma Centre.                              0.0

Indicator                     Yes                 No               2006/2007

2006/2007, n = 22             0                   22               %Yes      %No




Death during First 24 Hours
Did the patient die within the first 24 hours of arrival
to the PLC?

All death cases are reviewed by Trauma Services. Cases may be        100.0
presented at the Trauma Clinical Safety Committee if there are
system issues/concerns for follow-up.

                                                                   2006/2007
n= all patients who die.
Indicator                    Yes              No                   %Yes      %No

2006/2007, n = 3             0                3



Mortality
Did the patient die at the PLC?


                                                                     86.4



                                                                     13.6
n = all patients arriving at PLC
Indicator                     Yes                 No               2006/2007

2006/2007, n = 22             3                   19               %Yes      %No




                                                         - 137 -
Regional Trauma Services                                                                                                                                                                 2006/2007




TRAUMA SUMMARY FOR ROCKYVIEW GENERAL HOSPITAL (RGH)

                                                                    April 1st, 2006 – March 31st, 2007


The major Trauma Population at the RGH is based on capturing cases from the Monthly Injury
Discharge Summaries prepared by Quality Safety Health Information (QSHI). Trauma patients
with an Injury Severity Score (ISS) ≥ 12 were identified through chart audit. ISS is an anatomical
scoring tool that provides an overall score for patients with single system or multiple injuries. The
ISS captured in the Alberta Trauma Registry ranges between 12 and 75; the higher the ISS, the
more serious the injury. The following graphs reflect the major trauma population with an ISS ≥
12, and who are admitted to the hospital or die in the emergency department at the RGH.


Yearly Major Trauma Totals

                                                               33
                       30
                                            28
                                                                                  23              The RGH four year trend demonstrated a
                                                                                                  decrease from 2003/2004 to 2004/2005 (6.67%),
                                                                                                  an increase in 2005/2006 (17.86%) and finally a
                                                                                                  decrease in 2006/2007 (30.30%).



                                                   RGH

  2003/2004                     2004/2005          2005/2006          2006/2007




Monthly Major Trauma Totals


                                      RGH 2006/2007                                                                                     RGH 2005/2006

                                                   4     4
                                                                                                                                               6
   # of patients




                                                                                                # of patients




                                                                            3
                                                                                                                                         4                 4
                            2         2                         2                       2                             3                                                3           3
                   1                         1                        1            1                            2                                    2           2           2
                                                                                                                            1     1
                                 0

                   Apr   May    Jun   Jul    Aug   Sep   Oct    Nov   Dec   Jan   Feb   Mar                     Apr   May   Jun   Jul    Aug   Sep   Oct   Nov   Dec   Jan   Feb   Mar




At RGH in 2006/2007, peaks were seen in September, October and January where as in
2005/2006, peaks were seen in August, September and November. These graphs demonstrate
the unpredictable nature of trauma at these sites. The numbers do not reflect the patients that
arrived in ED and were transferred to the Trauma Centres.




                                                                                              - 138 -
Regional Trauma Services                                                                                                                                  2006/2007




Males/Female


                                       18
                                                                                    16
                         15
                                                                                                                   At the RGH, females outnumbered males at a
                                                                                                                   ratio of 2.3:1 in 2006/2007. In 2005/2006 the
                                                                                                                   ratio was 1.2:1.
                                                                       7




                   RGH 2005/2006                                  RGH 2006/2007

                                                Males       Females




Age Distribution


                                                                                             9




                                                                                                     7             The RGH admitted no major trauma patients
                                                                   6                                     4         < 18 years of age.
                                            5                               5            5

                                                        4
                                                                                                                   In 2003/2004, the majority of the population at
                                                                                                                   RGH was ≥ 65 years (67.86%). This continued
       2                                                                        2                                  to be the case in 2004/2005. In 2005/2006, the
                   1       1           1           1          1
                                                                                                                   higher numbers started at > 55 years of age. In
                                                                                                                   2006/2007, the age distribution was ≥ 65 years
                               0
                                                                                                                   of age (73.91%).
     18-24                25-34        35-44       45-54      55-64         65-74        75-84       > 84


                                            RGH 2006/2007     RGH 2005/2006




Mechanism of Injury (MOI)


                                                        24
                                                                                                                      The MOI is reported by four broad
   # of patients




                                                  18                                                                  categories: transportation, falls, violence
                                                                                                                      and other. These are in keeping with the
                                                                                                                      focus of the Calgary Health Region’s injury
                                                                                                                      control initiatives. Other includes animal
                          3        3                                                                     4
                                                                        1       2                1                    related incidents (for example riding). Falls
                                                                                                                      continued to be the number one
                       Transportation              Falls               Violence                  Other                mechanism of injury at the RGH.

                                       RGH 2006/2007                   RGH 2005/2006




                                                                                                         - 138 -
                                                                                                         - 139 -
                     Regional Trauma Services                                                                                                                               2006/2007




                     Mode of Arrival


                                                21
                                   20


                                                                                                                              The majority of patients were transported
                                                                                       12                                     by EMS to the RGH this year; consistent
                                                                                                                              with 2005/2006.

                                                                                3



                                         EMS                            Private Vehicle/Walk-in


                                        RGH 2006/2007            RGH 2005/2006




                     Discharge Locations

                     The majority of trauma patients in both 2005/2006 and 2006/2007 were discharged “home”. The
                     other/unknown category represents patients discharged to locations other than previously defined
                     or for which no specific discharge location was documented in the chart.


                                RGH 2006/2007                                                                                                 RGH 2005/2006
                13
                                                                                                                        17
                                                                                                  # of Patients
# of Patients




                                           5                                                                                                              6
                                                                                                                                                                                             5

                                                                                                                                              2
                            2                                               2                                                        1                               1         1
                                                          1
                                                                                                                       Home      Acute Care   Died     Nursing      Rehab   Home With   Other/Unknown
                                                                                                                                                     Home/Chronic            Support
                Home       Acute Care          Died   Other / Unknown       Rehab




                                                                                                                  - 138 -
                                                                                                                  - 140 -
   Regional Trauma Services                                                              2006/2007




                                          ROCKYVIEW GENERAL HOSPITAL
                                            PERFORMANCE INDICATORS

                                                 PRE-HOSPITAL PHASE

GCS (Glasgow Coma Scale) ≤ 8 at
Scene / Mechanical Airway
Did the patient with a first recorded scene
GCS ≤ 8 receive a mechanical airway as an                                   0.0
intervention at the scene?
Mechanical airway includes intubation (nasal and oral),
cricothyroidotomy, tracheostomy and laryngeal mask airway
(LMAs).                                                                    100.0

n = all patients with first recorded scene GCS ≤ 8.
      Indicator                     Yes                 No
                                                                         2006/2007
2006/2007, n=2                2 (100%)           0 (0%)
                                                                         %Yes      %No




                                                      IN HOSPITAL CARE

Chart Documentation
Was 1 hour chart documentation present for the
patient beginning with ER, including time in
radiology, up to admission to the OR, ICU, ward,
death or transfer to another hospital?                                     57.1

n = all patients seen in the ED
                                                                           42.9
Indicator                     Yes                No

2006/2007, n=21               9 (42.9%)          12 (57.1%)              2006/2007

                                                                         %Yes      %No




Neurological Documentation
Was sequential neurological documentation present
on the ER record if patient had a diagnosis of skull                        0.0
fracture, intracranial injury or spinal cord injury?


                                                                           100.0
n = all patients seen in the ED with skull fracture, intracranial
injury or spinal cord injury
Indicator                     Yes                No

2006/2007, n = 14             14 (100%)          0 (0%)                  2006/2007

                                                                         %Yes      %No




                                                             - 138 -
                                                             - 141 -
   Regional Trauma Services                                                                       2006/2007




Ambulance Reports
Are all prehospital ambulance reports from all
phases of patient transport present on the medical
record?                                                                        20.0



                                                                               80.0

n = all patients with prehospital care provider(s)
Indicator                     Yes                    No
                                                                             2006/2007
2006/2007, n = 20             16 (80%)               4 (20%)
                                                                            %Yes      %No




Missed Injuries
Did the patient have any new injuries diagnosed 48
hours after arrival to the RGH?


                                                                               90.9
n = all admitted patients who survive at least 48 hours

Indicator                     Yes                    No                                     9.1

2006/2007, n = 22             2 (9.1%)               20 (90.9%)              2006/2007

                              Femur Fracture                                %Yes      %No
                              Rib Fracture




Category 1 Laparotomy
Did the patient require a laparotomy that was not
performed within 1 hour of arrival to ER?

Category 1: Hemorrhagic Shock
Time to laparotomy <1 hour. Patients with a blood pressure,
systolic ≤ 90 in the trauma room, confirmed, or a need for >4              No Cases
units of packed red blood cells in the first hour, for hemorrhage
due to injury.

n = all patients receiving category one laparotomy
Indicator                     Yes                    No

2006/2007, n = 0              0 (0%)                 0 (0%)


   Category 1 Laparotomy:
   Time to laparotomy < 1 hour. Patients with a blood pressure, systolic ≤ 90 in the trauma room,
   confirmed, or a need for > 4 units of packed red blood cells in the first hour, for hemorrhage due
   to injury.




                                                               - 138 -
                                                               - 142 -
   Regional Trauma Services                                                                     2006/2007




Femur Fracture
Did the patient have operative management of
femur fracture within 24 hours of arrival to RGH?


                                                                            100.0


                                                                                          0.0
n = all patients with femur fracture, stable enough for operative
care within 24 hours or who survive at least 24 hours                     2006/2007
Indicator                     Yes                 No
                                                                         %Yes       %No
2006/2007, n = 1              0 (0%)              1 (100%)




Long Bone Fracture
Did the patient with open long bone fracture have
operative management performed within 6 hours
(Grade 3) or 12 hours (Grade 1, 2) of arrival to
RGH?
(The long bones include the radius, ulna, humerus,                       No Cases
tibia, fibula, femur)

n = all patients with open long bone fracture, stable enough for
operative repair in desired time frame or who survived 6 hours
(Grade III) / 12 hours (Grade I or II)
Indicator                     Yes                 No

2006/2007, n = 0              0 (0%)              0 (0%)




Unplanned OR
Was there an unplanned return to OR within 48
hours of the initial procedure?


                                                                            100.0
n = all patients with at least one OR

Indicator                     Yes                 No                                      0.0
                                                                          2006/2007
2006/2007, n = 3              0 (0%)              3 (100%)
                                                                         %Yes       %No




                                                               - 138 -
                                                               - 143 -
   Regional Trauma Services                                                                         2006/2007




ORIF of Major Facial Fractures
If the patient had an ORIF of facial fractures (major
mandible, maxilla, or orbit) was it completed ≤ 7
days of injury?                                                              No Cases



n = all patients with operative repair of major facial fractures
Indicator                     Yes                   No

2006/2007, n = 0              0 (0%)                0 (0%)




Joint Dislocation
If the patient had a joint dislocation (hip, shoulder,
elbow, knee), was there an attempt to reduce it
within one hour of arrival to the RGH at reduction?                          No Cases


n = all patients with joint dislocation with a hospital LOS ≥ 1 hour
and a known reduction time
Indicator                     Yes                   No

2006/2007, n = 0              0 (0%)                0 (0%)




Patient Transferred
Was the patient with an ISS ≥12 transferred from the
RGH to the FMC Trauma Centre?


                                                                                 90.5



                                                                                              9.5
n = all patients admitted to RGH with an ISS ≥ 12
Indicator                     Yes                   No                         2006/2007

2006/2007, n = 21             2 (9.5%)              19 (90.5%)                %Yes      %No




                                                                   - 138 -
                                                                   - 144 -
   Regional Trauma Services                                                       2006/2007




Hospital Admission
Was the patient admitted to a surgeon or an
intensivist at the RGH?

                                                               60.9



                                                               39.1

n = all patients admitted to the RGH
                                                            2006/2007
Indicator                     Yes         No

2006/2007, n = 23             9 (39.1%)   14 (60.9%)        %Yes      %No




ICU Admission
Was there an ICU admission at the RGH?


                                                               78.3



n = all patients admitted to the RGH                           21.7
Indicator                     Yes         No                2006/2007
2006/2007, n = 23             5 (21.7%)   18 (78.3%)
                                                            %Ye s     %No




Unplanned ICU Admission
Was there an unplanned ICU admission at the
RGH?


                                                               95.7



                                                                            4.3
n = all patients admitted to the RGH
                                                            2006/2007
Indicator                     Yes         No

2006/2007, n = 23             1 (4.3%)    22 (95.7%)        %Yes      %No




                                                  - 138 -
                                                  - 145 -
   Regional Trauma Services                                                              2006/2007




CT of the Head
If the patient had a GCS<13 (first recorded GCS at                     0.0
the RGH), was the CT of the head performed within
4 hours of arrival to the RGH?
                                                                      100.0




                                                                    2006/2007
n = all patients with a known RGH ED GCS<13 and a known time
of CT head
Indicator                     Yes             No                    %Yes     %No


2006/2007, n = 2              2 (100%)        0 (0%)




Length of Stay
Did the patient have a RGH ED length of stay ≤ 4
hours at the RGH?

Median: 15.17 hrs
Average: 16.21                                                        94.7
Range: Minimum = 1.53 hrs, Maximum = 46.07 hrs
                                                                                   5.3
n = all patients seen in RGH ED with a known ED LOS. Direct
admissions were excluded                                            2006/2007
Indicator                     Yes             No
                                                                    %Yes     %No
2006/2007, n = 19             1 (5.3%)        18 (94.7%)




Mortality
Did the patient die at the RGH?



                                                                      78.3



n = all patients arriving at the RGH                                  21.7
Indicator                     Yes             No
                                                                    2006/2007
2006/2007, n = 23             5 (21.7%)       18 (78.3%)
                                                                    %Yes     %No




                                                          - 138 -
                                                          - 146 -
  Regional Trauma Services                                                           2006/2007




Mortality within 24 hours
Did the patient die within the first 24 hours of arrival
to the RGH?


                                                                 100.0


                                                                               0.0
n = all patients who died at RGH
                                                               2006/2007
Indicator                    Yes          No

2006/2007, n = 5             0 (0%)       5 (100%)             %Yes      %No




                                                     - 138 -
                                                     - 147 -
         The Imperative for Injury
               Prevention




Prepared by:
Nancy Staniland, Manager
Sherry Elnitsky, Research Project Coordinator
February, 2008

Injury Prevention and Control Services
Healthy Living, Wellness and Citizen Engagement
http://www.calgaryhealthregion.ca/injuryprevetion
Regional Trauma Services                                                                          2006/2007




                                        The Imperative for Injury Prevention
Injuries are a major public health problem that contribute significantly to death,
hospitalization, emergency department visits and lost quality of life in the Calgary Health
Region. Every day at least one region resident dies from an injury, every hour a resident
is hospitalized for an injury and every five minutes a resident visits an emergency
department for treatment of an injury. Weighing this picture against the fact that a huge
majority of all injuries are predictable and therefore preventable, the imperative for a
stronger effort to prevent and reduce injuries is clear.

An overview of the continuum of injury data, in the both Trauma Registry and in the
Profile of Injuries in the Calgary Health Region 2006-07 (the Profile), is discussed within
the context of best practice evidence, current injury prevention activities, and the
potential for enhanced prevention efforts. The Trauma Registry represents the most
severe injuries, as defined by an Injury Severity Score (ISS) > 12, in both the adult and
pediatric populations of the region. The Profile summarizes all injuries in the region,
including the most severe, that are treated in regional emergency departments, urgent
care centres and acute care facilities as well as injury-related deaths.

Assessing the continuum of injuries from mild to severe is important because of the
implications for the provision and utilization of health care resources. Management of
the most severe injuries requires a complex range of services provided through the
tertiary trauma system in the region. Management of less severe injuries requires fewer
resources per individual injury but a significant allocation of resources to handle volume
of cases and the sheer magnitude of the injury problem. The graphic representation
below of an iceberg demonstrates the full scope of injuries across the population in the
Region for 2006-07. For each injury death, there were 17 injury-related hospitalizations,
231 injury-related emergency department visits and an untold number of injuries treated
in outpatient locations, by family physicians or at home.


                  1
            1
                 17
           17
                231

                      Unknown Number:
                                                   Since prevention requires targeted efforts, the
          231
                                                   causes of injury known to contribute extensively to
Unknown
                                                   the overall burden of injury are highlighted. These
Number:
                                                   include unintentional injuries (falls, transportation)
                                                   and intentional injuries (violence and suicide). The
                                                   overall patterns apparent in the data have been
                                                   relatively consistent over the past five years,
                                                   although there have been some statistically
                                                   significant changes between the years 2002-03 and
                                                   2006-07 that are highlighted as significant in each
                                                   section.




                                                      - 150 -
Regional Trauma Services                                                              2006/2007




Unintentional Injuries

Falls
Falls have been the leading cause of injury across all age groups in the Region. In the
most severe cases of injury, falls were the second leading mechanism after
transportation. Fall-related emergency department visits were highest for the youngest
and oldest segments of the population. Males were at greater risk in the younger age
groups while females were more at risk for a fall-related emergency department visit in
the older age groups. Fall-related injuries accounted for 75% of all injury-related
hospitalizations for region residents 65 years of age and older and just over one third of
these were due to a hip fracture. A hip fracture is a very serious and life altering event
for an older adult, but these injuries are not typically represented in the Trauma Registry
due to the nature of the injury severity scoring system. While the hospitalization rate
related to fall injuries is significantly lower in 2006-07 compared to 2002-03, the
emergency department visit rate is significantly higher.

Falls result from a complex interaction of individual behavior in the context of the
physical environment. Young children are particularly at risk due to their developmental
level and the risks of their home and community environments, including the level and
appropriateness of the supervision provided by their caregivers. Youth and adults are
exposed to fall risks in sport and recreational activities as well as in employment
conditions and circumstances. Older adults face a complex array of intrinsic and
extrinsic factors which contribute to an increased risk of falls. As the relative proportion
of individuals over 65 years of age increases in the Region, the burden of fall-related
injuries and requirements for health care services will increase.

Prevention of falls and fall-related injuries is not simple or straightforward but requires a
range of actions across a variety of levels, from public policy through individual behavior
change. For example, buildings that require window guards to prevent young children
from falling out of open windows or from dislodging window screens are important and
have been shown to be effective.1 Playgrounds that require resilient surfacing and a
reduction in the overall height of the play structures also contribute to a reduction in fall
injuries for children.2 Fall risks in the home are also significant and parents and
caregivers require education and support to make the necessary modifications to keep
young children safe through the use of stairgates and other safety equipment.
Supervision of young children is an important fall prevention strategy and studies have
indicated that many parents have unrealistic expectations about the appropriate level of
supervision required.3

Falls and fall-related injury prevention in older adults is an area that has been studied
extensively due to the magnitude and severity of the problem. Research has
demonstrated that an assessment of an individual’s fall risk, fall history and review of
modifiable and non-modifiable fall risk factors followed by a combination of interventions
in an individualized care plan is effective.4 A very effective fall prevention strategy for
independent, community dwelling older adults is the provision of exercise opportunities
to maintain core strength and balance.5 Hip protectors are an important injury
prevention strategy, especially for high risk, institutionalized older adults. Despite the
benefit for older adults in other settings, hip protectors are not are not widely used.6




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                                          - 151 -
Regional Trauma Services                                                              2006/2007




The Region has made a major commitment to fall and fall-related injury prevention in
older adults through the establishment of the Regional Falls Project initiated in 2005.
The project has designed and implemented a series of pilot projects across the
continuum of care for older adults. In acute care, fall risk assessment and individualized
care plans have been developed. In Home Care, a falls team has been established to
provide specialized assessment and follow up for older adults who have experienced a
fall or are at high risk of falling. In the community, core strength and balance exercise
programs are being delivered in partnership with the City of Calgary to isolated, low
income seniors. The Regional Falls Project has had limited capacity to undertake
interventions in regional emergency departments or to support interventions in long term
care settings. Additional funding for the project is required to expand the existing
strategies and to initiate best practices that have not been implemented to date.

Transportation
Transportation-related injuries are a significant problem in the Region, especially for
residents between the ages of 15 and 44 years. Males in this age range were at least
twice as likely as females to be hospitalized or visit an emergency department for
transportation-related injuries. While a variety of transportation-related events (motor
vehicle, cycling, pedestrian) contribute to the overall mortality and morbidity, the bulk of
the transportation-related injury burden was due to motor vehicle- related events.
Transportation-related events were the leading cause of the most severe injury and the
second leading cause of injury overall. Utilization of emergency departments for
transportation-related injuries is significantly higher in 2006-07 compared to 2002-03.

Many factors likely contribute to this finding, including the high number of registered
vehicles and drivers in the Region and the impact of motor vehicle use as a component
of economic activity. Calgary and its surrounding municipalities have been growing
steadily over the past several years with rapidly expanding populations and high levels
of economic activity. Safe operation of a motor vehicle is a complex activity where driver
behaviors interact with the physical, social and political environments that influence
traffic safety. Increasing road users and intensity of economic activity, combined with
social and technological influences in the driving environment, such as cell phones,
contribute to the complexity and risk.

There are a number of actions to reduce motor vehicle collisions which, when applied in
combination, have demonstrated a reduction in injuries and deaths. Key strategies are
required at both the policy and environmental level that will subsequently set the context
for changes in individual driver behavior. Leading international examples, achieved
through a combination of aggressive pubic policies, strengthened enforcement efforts,
engineering and road design modifications and intensive public education,7 have
documented a significant reduction in collisions, deaths and injuries.

Policy actions which support safe transportation are a key injury prevention strategy.
Opportunities exist to strengthen legislation around occupant restraints by adding
demerits to seatbelt violations and by passing booster seat legislation. Both of these
policy approaches have been shown to be effective in reducing injuries and deaths
related to motor vehicle collisions.8,9 The Region works with diverse traffic safety
partners in the Alberta Occupant Restraint Program (AORP) to plan and implement
policy strategies. AORP also coordinates broad educational, enforcement and public
awareness strategies in support of occupant restraints and the Region is a key
contributor to these efforts. The level of sustained action on policy priorities amongst the

                                          - 150 -
                                          - 152 -
Regional Trauma Services                                                              2006/2007




traffic safety partners in Alberta has unfortunately not been adequate to make any real
progress in challenging the public policy environment of Alberta. Ironically, the position
paper produced by AORP in support of booster seat legislation was successfully utilized
in the effort by Prince Edward Island to implement booster seat legislation in that
province which came into effect on January 1, 2008.

An important opportunity at the provincial level, that would impact the burden of
transportation injuries in the Region, is the potential to strengthen Graduated Driver
Licensing (GDL), introduced in Alberta in 2003. There has been a documented
reduction in collisions and injuries involving new, young drivers since the legislation was
introduced.10 The national Traffic Injury Research Foundation (TIRF) has conducted
extensive research into the impact of various GDL configurations and has established
criteria for best practice in this area.11 A comparison of Alberta’s current GDL legislation
with the best practices established by TIRF, completed by the Alberta Centre for Injury
Control and Research (ACICR),12 has revealed that the current provincial legislation is
lacking in following three key areas:
     o a minimum number of supervised hours of driving practice in the Learner Phase
     o a passenger restriction in the Probationary Phase
     o a nighttime driving restriction in the Probationary Phase.

Implementation of strengthened GDL in Alberta is an important step towards maximizing
the safety environment for new, young drivers in Alberta and an opportunity to achieve a
further reduction in injuries and deaths. The Region has engaged with other health
regions across the province and other injury prevention stakeholders to mobilize around
enhanced GDL. A briefing document has been prepared on this issue for consideration
by the newly established Regional Advocacy Advisory Committee. Injury Prevention and
Control Services, part of Health Living, is leading the push for formalization of the
regional support to strengthen GDL legislation in Alberta through development of a
regional position paper and communication from the region to the provincial government.

The Region has recently joined a growing number of organizations who have adopted
policies banning the use of cell phones or other communication devices, including hands
free devices, while driving on organizational business. The region’s Cellular and
Cordless Telephone and Two Way Radio Use policy was updated January 1, 2008 to
prohibit use of cellular telephone or PDA use by staff, either hand-held or hands-free,
while driving a motor vehicle in the performance of their duties. This is an important
achievement and sets the stage for further transportation safety related actions by the
region.

The Region is also working with provincial counterparts to implement the Alberta Traffic
Safety Plan developed in 2006. As part of the plan, the provincial government has
allocated resources for the establishment of a provincial Office of Traffic Safety and for
the hiring of regional traffic safety coordinators in all health regions across the province
and for First Nations and Metis Settlements. The Region has taken on the host
organization role for the regional traffic safety coordinator position for the Calgary region.
This new position will be overseen by the Office of Traffic Safety and will work closely
with existing traffic safety stakeholders and networks in the region. Opportunities to
advance the priorities of the Traffic Safety Plan in the Calgary region will be the focus of
this new role.



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                                          - 153 -
Regional Trauma Services                                                             2006/2007




Intentional Injuries

Violence
Interpersonal violence is a significant injury mechanism in both the Trauma Registry and
in the Regional Profile of Injuries. Violence is the third leading mechanism of injury
resulting in an emergency department visit in the region and the fourth leading reason
for hospitalization due to injury. Violence-related injuries were highest for residents
between the ages of 15 and 44. Compared to females between 15 and 44 years of age,
males were three to nine times more likely to be hospitalized for a violence-related injury
and two to three times more likely to be seen in the emergency department for an injury
resulting from violence. There is a significant increase in these injuries treated at
emergency departments between 2002-03 and 2006-07.

Calgary is growing into a major urban centre with a rapidly expanding population and
there is increasing evidence of the social issues and pressures that accompany large
cities. An increase in interpersonal violence is not necessarily surprising or unexpected.
The economic surge of the Calgary and region economy is beneficial to many, but it also
tends to widen the gap between the most and the least affluent members of the
population. The increasing cost of some of the basic necessities of living, such as
housing and food, make them unattainable for those living at the lowest economic level.
Indicators such as the level of homelessness, poverty, use of shelters and food banks
are all showing an upward trend.13 Another impact of the size of the city and the health
of the economy is the attraction to known criminal elements that rely on the availability of
disposable income to support illegal activities, such as the trafficking and sale of street
drugs. Youth experience many influences through the media and popular culture and
this may be contributing to the ‘normalization’ of interpersonal violence.

Action across all sectors is needed to address the prevention of violence, including such
areas as justice, policing, social services, infrastructure, education and health. There
are many promising initiatives currently being undertaken such as the Calgary Police
Service’s Gang Life Prevention Campaign, the WAIT initiative led by a group of high
school students who are challenging their peers to Walk Away, Insure Tomorrow, school
based initiatives aimed at identifying and eliminating bullying and urban planning
initiatives that work to create safer environments through proactive urban design. The
potential to prevent interpersonal violence, especially amongst youth and young adults,
may be further strengthened through public policy initiatives which address the
availability and consumption of alcohol through such measures as increasing the legal
drinking age, controlling hours of operation of bars, nightclubs and liquor stores and the
establishment of minimum drink prices.14 Evidence for the effectiveness of these
measures has not been firmly established but definitely warrant further research and
review.

Suicide
In 2006-07, suicide was the second leading cause of injury-related death for region
residents up to age 44 and the leading cause of injury-related death for region residents
45 years and over. Males were three times more likely than females to die by suicide.
But suicide attempts that required emergency department visits or hospitalizations were
higher among females, unlike the gender pattern seen in the other major causes of
injury. There is a significant decrease in the use of emergency departments and
hospitals for suicide-related injuries between 2002-03 and 2006-07.


                                         - 150 -
                                         - 154 -
Regional Trauma Services                                                              2006/2007




Suicide is a complex issue and a wide variety of factors such as substance abuse,
addiction, mental health issues, sexual orientation, culture and family history can all
contribute to the risk for suicide in any given individual. The Alberta Suicide Prevention
Strategy was developed in 2005 to provide the framework for coordinated action across
multiple sectors and with many diverse stakeholders. The strategy identifies eight broad
goals which reflect the best evidence for development of a comprehensive system to
prevent and limit the impact of suicide across the province. Key goal areas include
activities to enhance mental health, improved intervention and treatment for those at risk
of suicide or affected by suicide, increasing effort to reduce access to lethal means of
suicide and increased research and surveillance.15

The Region has undertaken a number of key initiatives which align with the provincial
suicide prevention strategy, including a major focus on suicide postvention and support
for survivors. Research indicates that those who have lost a loved one through suicide
are at risk for complicated grieving and are themselves at higher risk for suicide.16
Postvention protocols for follow up with survivors are in place within the Mental Health
Program areas. A number of resources have been developed such as Hope and
Healing: A Practical Guide for Survivors of Suicide which has also been redeveloped into
an aboriginal version entitled Healing Your Spirit: Surviving After the Suicide of a Loved
One. Processes and connections with key community partners such as bereavement
support groups and the medical examiner’s office have been established to facilitate
distribution of the postvention support materials. Another current regional focus is on
men at risk for suicide, based on the evidence that men complete suicide at a much
higher rate than women and also that they do not readily seek help for mental or
emotional health issues through the typical channels.17

Other opportunities exist for the region to create a more supportive environment for
suicide prevention and intervention, including enhanced screening for suicide risk across
all care settings of the region. Availability and accessibility of mental health services,
treatment for addictions, affordable counseling and follow up of individuals at risk is a
persistent challenge and strategies to increase the system capacity must be found.

Conclusion and Recommendations
The development and release of the Alberta Injury Control Strategy18 was the
culmination of many months of consultation with a broad range of stakeholders across
many sectors. It consolidates the evidence on prevention and control of injuries and
provides wide sweeping recommendations for coordinated provincial action on injuries.
Since the document was released in June 2003, several attempts have been made to
have the strategy formally endorsed at the provincial government level. To date, this
endorsement has not been achieved. The document outlines seven strategic goals with
corresponding objectives and recommended actions. There are also key responsibilities
for the various sectors outlined, including specific responsibilities for health authorities.
The Region has made a significant and sustained commitment to injury prevention and
control over many years and is fulfilling many of the responsibilities outlined in the
strategy, including programs and services to prevent, treat and rehabilitate injuries.
There are, however, some responsibilities that the region has not yet undertaken in a
significant way.




                                          - 150 -
                                          - 155 -
Regional Trauma Services                                                             2006/2007




The cost of preventing injuries is small compared to the staggering cost of treating and
rehabilitating them but preventing injuries cannot be achieved without resource
allocation beyond the current level. With the increasing demand for emergency and
acute care services in the region and the escalating costs associated with these areas,
the region has a prime opportunity to review if the existing investments being made to
prevent and limit injuries are adequate for the size and impact of the problem. Based on
the Alberta Injury Control Strategy, some distinct areas of responsibility for the region
that could reduce the demand on services are as follows:
1. Establish a regional agenda for advocacy on key public policies that would strengthen
   injury prevention efforts and link these to appropriate municipal, provincial and federal
   levels of government.
2. Evaluate opportunities to engage in new partnerships and new funding approaches
   which focus resources on limiting the circumstances that create injury (e.g., joint
   strategies to reduce impaired driving in collaboration with enforcement groups).
   Allocate additional financial and human resources to provide effective injury
   prevention programs in collaboration with other community based injury prevention
   stakeholders. (e.g., expand the provision of fall prevention exercise programs at the
   community level for older adults).
3. Evaluate opportunities to integrate primary and secondary injury prevention
   information and resources into all clinical practice areas and interactions, including
   injury risk screening and appropriate referral. Formalization of an injury prevention
   program at the Alberta Children’s Hospital would be an important first step. Another
   example is the funding and establishment of a Brief Intervention Program on FMC
   Trauma Unit for the screening for alcohol related injury risk. This program is called
   “Alcohol Screening and Brief Intervention”, from the National Institute on Alcohol
   Abuse and Alcoholism, USA and is designed to help patients related alcohol use to
   the trauma event they have experienced. This type of screening is an accreditation
   standard for Level 1 Trauma Centres, under the Trauma Association of Canada
   guidelines.
4. Educate and train the Region workforce to integrate injury prevention strategies into
   their workplaces, methods of working and personal lives.
5. Engage the evaluation and research resources of the region and of community
   partners to monitor progress on injury prevention priorities.




                                         - 156 -
                                         - 150 -
Regional Trauma Services                                                               2006/2007




                                         References
    1
         Pressley, J and Barlow, B. (2005). Child and adolescent injury as a result of falls
           from buildings and structures. Injury Prevention: 11 (5), 267-73.
    2
         Laforest, S., Robitaille, Y., Lesage, D., Dorval, D. (2001). Surface characteristics,
           equipment height, and the occurrence and severity of playground injuries.
           Injury Prevention: 7 (1), 35-40.
    3
         Morrongiello, Barbara (January 2008). Child Injuries are Not “Accidents”: Parent
           and Child Factors Affect Risk of Unintentional Injury. Teleconference
           presentation on unpublished research findings as part of the ACICR
           teleconference series, January 8, 2008.
    4
         Campbell, A.J. & Robertson, M.C. (2007). Rethinking individual and community
           fall prevention strategies: A meta-regression comparing single and
           multifactorial interventions. Age and Ageing: 36, 656-662.
    5
         Ibid.
    6
         Holzer, G. & Holzer, L.A. (2007). Hip protectors and prevention of hip fractures in
           older persons. Geriatrics: 62 (18), 15-20.
    7
         Alberta Government (October 2006). Alberta Traffic Safety Plan: Saving Lives on
            Alberta’s Roads.
    8
         Alberta Occupant Restraint Program (AORP). (December 2005). The Introduction
            of Demerit Points to Increase Compliance with Seat Belt and Child Safety Seat
            Legislation in Alberta.
    9
         Weber, K. (2000). Crash protection for child passengers: A review of best
           practice. UMTRI Research Review: 31(3).
    10
         Alberta Infrastructure & Transportation. (2007). Collision Statistics, 2000 through
            2006. Retrieved February 1, 2008 from http://www.acicr.ualberta.ca.
    11
         Alberta Centre for Injury Control and Research. (2007): Comparison of Alberta’s
            GDL Program with Recommended Best Practices. Retrieved February 1, 2008
            from http://www.acicr.ualberta.ca
    12
         Alberta Centre for Injury Control and Research (2007). Call to Action: Improve
            Alberta’s GDL Program. Retrieved February 1, 2008 from
            http://www.acicr.ualberta.ca.
    13
         Vibrant Communities Calgary (2008). Winter 2008 Newsletter. Volume 4, Issue 1
    14
         Vingilis E. (2007). Limits on Hours of Sales and Service: Effects on Traffic Safety.
            Transportation Research Circular: E-C123, 120-129.
    15
         Alberta Mental Health Board. (2005). A Call to Action: The Alberta Suicide
            Prevention Strategy.

                                            - 150 -
                                            - 157 -
Regional Trauma Services                                                            2006/2007




    16
         Ibid
    .
    17
         Centre for Suicide Prevention. (2007). Men and Suicide, Part 1: Risk Factors.
           SIEC Alert #65, April.
    18
         Alberta Centre for Injury Control and Research. (2003). Alberta Injury Control
            Strategy.




                                          - 150 -
                                          - 158 -
The City of Calgary
Emergency Medical Services




       Trauma Report
   January 1, 2006 – December 31, 2006
Regional Trauma Services                                                       2006/2007




Introduction
The City of Calgary Emergency Medical Services (Calgary EMS) is committed to
the highest levels of patient care. To that end it regularly reviews the care that it
provides to the community, including those that suffer traumatic injury.

Calgary EMS is a municipally operated single tiered Advanced Life Support
ambulance service that is responsible for responding to all 911 calls within The
City of Calgary municipal boundary, Tsuu T’ina Nation, Town
                                                                Major Trauma:
of Chestermere, and certain areas in the Municipal District of A Pre-Hospital Index of ≥ 4.
Rockyview. It operates a total of 47 emergency vehicles at
peak times, which are deployed from 28 EMS stations located Minor Trauma:
throughout the city.                                            A Pre-Hospital Index of ≤ 3.

This report includes a descriptive analysis of traumatically See Appendix A – Pre-
                                                                Hospital Index.
injured patients responded to by Calgary EMS (Section 1)
and a follow-up to a focused audit of major trauma patients
not transported to the designated trauma centre (Section 2) reported in the 2006
Trauma Report.


Section 1: Descriptive analysis of traumatically injured patients
responded to by Calgary EMS

Background
In addition to providing pre-hospital care and transport of the
                                                                          Events
sick and injured, Calgary EMS actively communicates with the             N = 86,594
community through a dedicated Public Education Officer (PEO).
A key mandate of the PEO is supporting the prevention of
disease and injury through public education. Descriptive
analyses are important background information to create key
messaging and target specific sub-populations, both for public             Trauma
                                                                          n = 15,814
education and response strategies.                                          (18%)

Methodology
Data from January 1st, 2006 to December 31st, 2006 were
downloaded from the Calgary EMS Computer Aided Dispatch                 Major Trauma
                                                                        n=1,173 (7%)
database into STATA (v. 8.0, STATA Corporation, College
Station, Texas) for analysis.

                                                                  Figure 1: Population and
                                                                            Sample.




                                      - 161 -
Regional Trauma Services                                                                  2006/2007




         Results

A total of 86,594 unique events were recorded in this database. A total of 15,814
unique events (18%) yielded at least one assessment on a patient meeting either
major or minor trauma criteria; of these events 1,173 unique events (7%) yielded
at least one assessment on a patient meeting major trauma criteria (Figure 1).

A total of 1,149 major trauma events recorded the age of the patient (24 events
missing data). The mean age of patients assessed with major trauma was 37.4
years (SD=19.7 years). The majority of patients assessed were adults between
the ages of 25 and 64 (Figure 2).

The majority of patients are male (69.6%).
                                                2006

                                Young Adults
                                  (16 - 24)
                                   26.5%

                           Children
                           (1 - 15)
                            4.5%                            Adults
                                                           (25 - 64)
                           Infants
                                                            56.7%
                             (< 1)    Seniors
                            0.4%       (≥ 65)
                                      11.7%



                     Figure 2: Proportion of Major Trauma Patients’ Age
                               Categories (n=1,149).



The most common dispatch codes for major trauma in 2006 were Traffic/
Transportation Collision (42.7%), Fall (16.1%), and Stab / Gunshot / Penetrating
Trauma (12.6%) (Table 1).

Table 1: Frequency and Relative Proportion for the Six                    Dispatch Code: A
Most Common Dispatch Codes in 2006 (n=1,279).
                                                                          standardized code used by
                                                2006 Frequency            EMS dispatch to categorize
               Dispatch Code                                              the nature and seriousness
                                                      (%)
Traffic/Transportation Collision                  546 (42.7%)             of an event (Medical Priority
Fall                                              206 (16.1%)             Dispatch System®).
Stab/Gunshot/Penetrating Trauma                   161 (12.6%)
Assault/Sexual Assault                             81 (6.3%)
Traumatic Injuries (Specific)                      62 (4.9%)
Unknown Problem (Man Down)                         54 (4.2%)



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There are a total of 10 unique Patient Diagnostic Codes (PDCs) that were
categorized as major trauma. The most common major trauma PDCs in 2006
were, Motor Vehicle Collision (28.2%), Fall (20.3%), and Stabbing (13.7%)
(Table 2).

Table 2: Frequency and Relative Proportion for the 10 Major
Trauma Patient Diagnostic Codes (PDCs) (n=1,279).
                                                                  Patient Diagnostic Code
                                                       2006       (PDC): A proprietary
                           PDC
                                                  Frequency (%)   system used by Calgary
Motor Vehicle Collision                            361 (28.2%)    EMS to categorize the type
Fall                                               259 (20.3%)    of trauma or medical
Stabbing                                           175 (13.7%)
                                                                  condition. The PDC is
Assault/Blunt Trauma                                111 (8.7%)
Struck by Vehicle                                   107 (8.4%)    determined by the attending
Pediatric ≤ 14 Years (Major)                        82 (6.4%)     paramedic upon completion
Motor Bike Collision                                67 (5.2%)     of the call.
Traumatic Arrest Resuscitation Attempted             48 (3.8%)
Other                                               46 (3.6%)
Gunshot                                             22 (1.7%)



Discussion and Limitations
The proportion of events that record a trauma PDC is less than 20% of all annual
events. This estimate is more than likely low, as patients are assigned a single
diagnostic code, not secondary or tertiary codes. A fall, for example, that may
have been caused by a syncopal episode may be recorded with a syncope PDC,
not a trauma PDC. Therefore trauma injuries that may have occurred due to a
medical etiology may not be included in this report, resulting in an underestimate
of the true prevalence of traumatic injury in the Calgary EMS patient population.

It is possible that there is a variation in the application of PHI criteria amongst
Calgary EMS staff, and therefore patients may be classified as major trauma
even though the PHI is less than or equal to three. Further assessment is
required to determine if the 1,173 events that recorded a major trauma PDC may
be an overestimate.

The crude gender results suggest that males account for more trauma patient
assessments than females (69.6% and 30.5% respectively). When gender is
stratified by age category, male patients had a greater representation than
females in all age categories except seniors. Amongst male patients, the most
represented age categories were young adults and adults (77.6% and 71.3%
respectively). Amongst female patients, the most represented age categories*
were children and seniors (34.6%, and 54.8% respectively) (Figure 3).

*N.B. Infant category not included as n=4




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                                                                                          2006

                                                                                   Female         Male
        Proportion of Patient Assessments


                                            100%
                                             90%
                                                                                                                                              Crude
                                                                                                 77.6%
                                            80%                                                                  71.3%
                                                                           65.4%
                                            70%                                                                                               69.6%
                                            60%    50.0%                                                                 54.8%
                                                           50.0%
                                            50%                                                                                  45.2%
                                                                   34.6%
                                            40%                                          22.4%           28.7%
                                            30%                                                                                               30.5%
                                            20%
                                            10%
                                             0%
                                                     Infants        Children             Young Adults      Adults         Seniors
                                                       (< 1)        (1 - 15)               (16 - 24)      (25 - 64)        (≥ 65)
                                                        n=4          n=52                   n=303          n=652           n=135
                                                                                     Age Category
     Figure 3: Crude Proportion of Trauma Patients by Gender, and Proportion of Trauma Patients Stratified
               by Age Category and Gender (n=1,146).

Dispatch codes can be regarded as what the public perceive is the reason for
calling an ambulance. PDCs can be regarded as what the attending paramedic
has determined to be the nature of the patient condition. It is interesting to note
that the top four dispatch and PDCs describe the same mechanism of injury. This
suggests that EMS callers for major trauma are correct with respect to the
mechanism of injury the majority of the time.

When dispatch code is stratified by gender, the top four codes are the same for
males      and       females      (Traffic/Transportation    Collision,   Fall,
Stab/Gunshot/Penetrating Trauma, Assault/Sexual Assault). The cumulative
proportion of these top four codes are 80.1% and 76.3% respectively for males
and females. These data suggest that in the 2006 calendar year males and
females shared similar mechanisms of injury for the majority of major trauma
events.

When age category is stratified by dispatch code, common age category specific
mechanisms are identified. The most common dispatch code for all age
categories, except seniors, is Traffic/Transportation Collision. Moreover, the
Traffic/Transportation Collision dispatch code accounts for a sizeable proportion
of all major trauma patient assessments for children, young adults, and adults
(38.5%, 48.9%, and 43.3% respectively). The most common dispatch code for
the elderly was Fall; this accounted for 45.2% of all patient assessments in this
age category.

*N.B. Infant category n=3

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The second most common dispatch code for children and adults was Fall (21.2%
and 16.4% respectively). This was not the case, however, for young adults where
the second most common dispatch code was Stab/Gunshot/Penetrating Trauma
(21.0%). For the elderly, the second most common dispatch code was
Traffic/Transportation Collision (22.2%).

Conclusions
The prevalence of major and minor traumatic injury in the Calgary EMS patient
population, when compared to other types of clinical conditions, is sizeable and
may be underestimated.

Care strategies such as medical control protocols, and continuing medical
education for prehospital practitioners should focus on the assessment and
treatment of traffic/transportation collisions and fall specific injuries in all age
categories, and stab/gunshot/penetrating trauma in young adults.

On-going public continuing education programs should be focused on the
reduction of the aforementioned injuries with a particular focus on males between
the ages of 16 and 64 years.




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Section 2: Follow-up to a focused audit of major trauma patients
not transported to the designated trauma centres.

Background
In the Calgary Health Region certain medical conditions and injuries must be
transported to specialized acute care facilities. To that end, Calgary EMS
paramedics adhere to a hospital destination policy that describes the optimal
destination for specific clinical presentations. The decision to adhere to this
policy, however, remains with the lead paramedic (Crew Chief), as there may be
situations that are encountered which are not explicitly covered by the policy. The
Hospital Destination Policy mandates that all patients who are considered a
major trauma by mechanism of injury (MOI) must be transported to Foothills
Medical Centre (FMC) if greater than or equal to 16 years old, or Alberta
Children’s Hospital (ACH) if less than or equal to 15 years old (Appendix B). Data
reported in the 2004/2005 Regional Trauma Services Annual Report suggests
that there were 61 instances where patients who were subsequently found to
have an Injury Severity Score (ISS) of greater than or equal to 12 were
transported to a facility other than FMC and subsequently transferred. In the
2006 Trauma Report, Calgary EMS conducted an audit, which concluded that 6
patients may have been inappropriately transported to a destination other than
the designated trauma centre. These six cases were followed-up to determine if
they subsequently met criteria for entrance into the Calgary Health Region (CHR)
trauma database.

Methodology
Based on results from the audit reported in the 2006 Trauma Report, six patients
were identified as meeting criteria for transport to the trauma centre, but were not
transported initially to the trauma centre.

The surname, given name, location of transport, and date of transport of these
patients were used to search the CHR trauma database.

Results
Zero of the six patients were located in the CHR trauma database.

Conclusions
Based on the criteria described in the audit reported in the 2006 Trauma Report,
six Calgary EMS patients were identified as receiving inappropriate transport to a
facility other than the trauma centre; none of these patients were subsequently
registered in the CHR trauma database. This suggests that they did not meet
major trauma criteria as outlined by the CHR (Injury Severity Score≥12), and
were likely able to be treated appropriately at the original transport destination.




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      Appendix A: Pre-Hospital Index.

    COMPONENTS                                   VALUE                               SCORE
BLOOD PRESSURE                   > 100                                                 0
                                 86 – 100                                              1
                                 75 – 85                                               2
                                 0 – 74                                                5

PULSE                            >120                                                  3
                                 51 – 119                                              0
                                 < 50                                                  5

RESPIRATIONS                     Normal                                                0
                                 Laboured                                              3
                                 < 10 min                                              5

CONSCIOUSNESS                    Normal                                                0
                                 Confused/Combative                                    3
                                 No Intelligible Words                                 5

MECHANISM OF INJURY                                                                    4
 a)    MVC: Pt ejection/rollover with unbelted passengers.
 b)    MVC: Death of other occupant in same vehicle.
 c)    MVC: Steering wheel deformity or interior intrusion > 50 cm ( > 20 inches).
 d)    Pedestrian/cyclist struck at velocity > 15 km/hr.
 e)    Falls > 5 meters (15 feet).
 f)    Penetrating injuries to Head, Neck, Chest, Abdomen or Groin.
 g)    Motorcycle victims ejected at > 30 km/hr.
 h)    Suspected Spinal Injuries with sensory/motor changes.
 i)    Critical burns (as per burn algorithm).
  j)   Crush injury to abdomen/thorax.
TOTAL SCORE




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Appendix B: HOSPITAL DESTINATION POLICY

                                                                       CALL TYPE
  1.     Pediatric (< 15 years): serious or life-threatening condition                                                                                                                       D9
         Exception: inability to control airway                                                                                                                                       D4, D5, D7, D9
  2.     Major trauma – Adult (see *)                                                                                                                                                        D4
  3.     Neuro trauma (head injury): regardless of PHI, suspected head injury with ALOC (use AVPU**)                                                                                         D4
  4.     Neuro trauma (spinal injury): regardless of PHI, traumatic mechanism of injury to cervical, thoracic, or lumbar spine with subjective                                               D4
         or objective findings of cord injury
  5.     Headache: sudden severe headache with no past history of headaches with or without neurologic findings                                                                              D4
  6.                                                       Sudden LOC with neurologic findings                                                                                               D4
  7.     Stroke: onset of neurologic deficits < 6 hours                                                                                                                                      D4
  8.     Sexual assault or suspected sexual assault (age ≥ 14 yrs)                                                                                                                           D7
  9.     Obstetrical patients:                                                                                                                                                          D4, D5, D7
         • Stable or unstable (< 20 weeks or > 32 weeks)                                                                                                                              D4, D5, D7, D9
         • Stable or unstable (20 to 32 weeks)                                                                                                                                               D4
         • Trauma - PHI ≥ 4                                                                                                                                                                  D4
 10.     When geoposts not covered, stable patients transported at crew chief’s discretion                                                                                            D4, D5, D7, D9
 11.     Minor trauma or medical patient with no admission required transported at crew chief’s discretion                                                                            D4, D5, D7, D9
 12.     Burns
         • Airway compromise                                                                                                                                                          D4, D5, D7, D9
         • Adult Critical Burn                                                                                                                                                               D4
         • Pediatric Critical Burn                                                                                                                                                           D9


 *        Triage major trauma for pediatrics and adults by mechanism of injury on the      **         AVPU = Patient’s best response: Alert, Verbal stimuli, Painful stimuli, Unresponsive
 PHI guide found on back cover.
                                                                                                                               If in doubt, PATCH
 Avoidance No ambulances to the requesting facility other than destination                               Full                No ambulances, including destination policy patients, to
                     policy patients. Judgement is exercised by Crew Chief, and                                              requesting facility unless it is unsafe to transport a critically ill
                     transports are avoided if no negative impact is anticipated to                     Diversi              patient to another facility. All resources in the ED are beyond
                     the patient’s condition or to EMS’ response status.                                                     capacity.
                     The Deputy Chief of Operations is to be notified.                                   ons                 The Deputy Chief of Operations, the Chief, & the Medical
                                                                                                                             Director are to be notified.




                                                                                        Page 9 of 9
     Shock Trauma Air Rescue Society (STARS)

                          2006/2007




Prepared by:

Michael J. Betzner MD FRCPc
Senior Medical Director STARS
Emergency Physician, CHR

Data mining by:

Matthew Pittet
STARS data analyst
Regional Trauma Services                                                                        2006/2007




Shock Trauma Air Rescue Society (STARS)

       The Alberta Shock Trauma Air Rescue Society (STARS) provides critical care level rotary
       wing transport for trauma patients throughout Alberta and south eastern BC. Two pilots, a
       paramedic and a nurse are ready 24 hours a day, seven days a week at both bases to
       provide care and transport to critically ill and injured patients. A referral emergency
       physician accompanies patients on the helicopter on about 25% of the missions and is
       available and provides online medical supervision and control throughout all missions.
       STARS is fully Accredited through the Commission on Accreditation of Medical Transport
       Systems (CAMTS).

       The STARS Emergency Link Centre (ELC) is an advanced 24-hour communications centre
       providing one-call access to a variety of resources. Around the province, the ELC plays
       several important roles. These roles range from receiving the first call for help from an
       organization or individual, to being called by a partner in the “Chain of Survival” for
       assistance with an emergency. In all cases, the ELC's primary job is to connect all of the
       emergency and medical services into a single conversation to determine the most effective
       medical response for the patient and the particular situation. This includes the immediate
       co-ordination of medical advice and transportation as required (regardless of whether rotary
       resources are used for any particular mission). This "One Call Does it All" is being used by
       the Calgary Health Region's Rapid Access Line in Calgary providing physicians from rural
       communities with quick access to patient referral and specialist advice in affiliation with the
       ELC. In the past year, the communication facilitation available within the ELC, has been
       further complemented by an excellent working and logistical arrangement with the Southern
       Alberta Regional Coordination Centre or SARCC (a Calgary Health Region referral,
       transport, and bed utilization communication service). SARCC helps to make sure patients
       and consultants are linked together in a fashion that maximizes utilization of available
       operating room, bed, and critical care resources. This information is now immediately
       available to assist STARS’ Referral Emergency Physicians in making sure patients are
       transported to the facility best able to look after them. This has been a very positive
       development within our health region.

       The STARS Quality Management Program (medical component) includes rigorous review
       of patient care records for appropriateness of patient care and documentation including
       secondary screens of any patient transport which involves airway management, blood
       administration, high risk obstetrics, pediatric patients, patients who arrest while in the care
       of STARS, or does not meet the utilization review criteria. All transports are monitored for
       adherence to response time thresholds. Any event which meets the criteria in the risk
       analysis template for moderate to high risk events undergoes a Sentinel Event Review.

       The STARS Human Patient Simulator (HPS) Program is the first mobile program of its kind
       in North America. The HPS is a dynamic, interactive, computerized mannequin. It is used
       for very specific, guided, intensive contact and analysis of Advanced Medical Care (AMC)
       critical thinking skills. The HPS mannequin simulates complex medical and traumatic
       problems over and over again, offering medical personnel an opportunity to test and
       practice their reactions and skills leading to a high degree of familiarity and confidence. In
       addition, patient care scenarios in our aircraft mock-up enhance the experience and better
       prepare our AMC for actual air medical transport events. Our mobile program also allows
       us to deliver advanced medical care training to rural health providers that use our services.
       It is an excellent means of ensuring our teams work towards the common goal of superb
       patient care. We are currently exploring an expanded partnership with a new Calgary
       Health Region simulation initiative which may allow for an expanded array of training for our
       colleagues both locally and rurally.

       STARS transports trauma patients based on standards and utilization guidelines arrived
       upon by local consensus and research. All major trauma patients are taken to the Foothills

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        Hospital Medical Centre or the Alberta Children’s Hospital depending on the age of the
        patient. One primary response aircraft is based in Calgary, Edmonton, and now Grande
        Prairie with two back up helicopters available for maintenance periods. Our new Grande
        Prairie base, which has just celebrated its’ one year anniversary, has allowed us to extend
        our reach into areas of northern Alberta and north-eastern BC, that are very remote and
        difficult to reach by other means. The activity in Alberta’s oil patch both at the work sites
        themselves as well as on the highways, exposes workers at times to significant trauma.
        We are already seeing the benefit of our Grande Prairie base in serving this patient
        population.

        Response time thresholds are as follows:
    •     Scene Response - 8 minutes from dispatch to launch for scene calls (up to 12 minutes if
          extra fuel or supplies are required for longer scene response).
    •     Interfacility Transport - 10 minutes from dispatch to launch (up to 15 minutes for weather
          checks, fuelling or addition of supplies).
    •     Interfacility Transport with Physician – 20 minutes from dispatch to launch.
        We reach these thresholds more than 80% of the time. The most common reasons for
        delay include difficulties associated with weather, delays related to finishing with another
        recent mission, and delays inherent to the vital physician-to-physician consultation process.

        The following graphs provide a breakdown of our trauma related activities over the past
        year. Approximately 43% of our overall trauma related calls are direct to the trauma scene.
        The rest represent interfacility transports.



        Figure 1 – Trauma related transports over the last 12 months in adult patients:




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    Figure 2 - Trauma related transports over the last 12 months in pediatric patients:




    Figure 3 – Trends in Adult Trauma transported by STARS into the CHR over 3 years




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Figure 4 – Trends in Pediatric Trauma transported by STARS into the CHR over 3 yrs




    As is evident in the graphical representations, traffic accidents, wilderness and recreation
    activities, and falls continue to be significant mechanisms of trauma in our society. We’re
    also seeing a very concerning rising incidence of assault related traumas. Continued
    education of the public in the prevention of injuries of this nature is warranted.



    Prepared by:

    Michael J. Betzner MD FRCPc
    Senior Medical Director STARS
    Emergency Physician, CHR

    Data mining by:

    Matthew Pittet
    STARS data analyst




                                             - 172 -
                                             - 175 -
JUSTICE




                      Report From the
           Office of the Chief Medical Examiner
                     Edmonton, Alberta




Data submitted by:
Barb Hinman
Medical Examiner’s Office
7007 – 116th Street
Edmonton, Alberta T6H 5R8

(780) 427-4987

Calgary & South Rural Trauma Deaths
                                                                 st
Preliminary Data from the Medical Examiner’s Data Base (January 1 /2008)

Report reviewed by:
Dianne Dyer, Regional Manager, Trauma Services
Barb Hinman Medical Examiner’s Office
Regional Trauma Services                                                                       2006/2007




Report from the Office of the Chief Medical Examiner (OCME)


The OCME is managed from two regional offices, one located in Edmonton and the other in
Calgary. The Edmonton office administers all investigations in the northern part of the province,
while the Calgary office administers the geographic area south of a line extending from Jasper to
Hobbema and down to Provost. This report provides data related to trauma deaths for the
Calgary and South rural areas. The MEDIC database is designed to collect location information
on place of injury, circumstances of the death as well as place of death.

Traumatic injury deaths include:
- Suicides
- Homicides
- Unintentional intent
- Undetermined intent

Excludes: natural causes of death.

Definitions:

Suicide: Death from intentional, self-inflicted injury; includes poisonings except those that are
"unclassified"; the majority of the poisonings are unclassified.

Homicide: Death purposefully inflicted by other persons without regard to culpability; fatal
injuries inflicted by another with the intent to injure or kill by any means, including child battering
or other maltreatment, and criminal neglect (e.g. abandonment of children or other helpless
persons, the death of an assailant killed in a pursuit by police is homicide).

Unclassified: Death in which evidence of alcoholism or any drug misuse is a direct part of the
primary medical cause of death; as stated in Part I of the Medical Certificate of Death.

Undetermined:
   (a) The medical cause of death is unknown (the cause is anatomically and toxicologically
       unascertainable) or
   (b) It is not known if the death was unintentional intent, suicidal, or homicidal, that is there is
       not enough information to determine the manner of death (e.g. a self inflicted gun-shot
       wound while hunting may be unknown if it was unintentional intent or suicidal in manner).

Unintentional intent: deaths due to unintentional or unexpected injury, including death due to
external causes including environmental factors ('act of God') and other misadventures.

Children: less than 18 years of age

Note: 60% of the deaths that involve notification to a medical examiner in a year are due to
natural causes.

All unnatural, unexpected or unexplained deaths in Alberta are investigated by a medical
examiner as stated in the Fatality Inquiries Act. If a person dies in hospital, under circumstances
or manner of death, which would meet the criteria for a medical examiners investigation, the case
is included in the database. In the case of a sudden death of an infant, a full autopsy would be
performed. Regardless of whether an external exam or autopsy is completed, the case is
included as a medical examiner’s case. If a person is transported to a facility; the place of death
is the facility and if the person is determined to have died and is not transported to a facility then
the cases is considered death at the scene or enroute.




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The Office of the Chief Medical Examiner must be notified when a death is:
   1. An unexplained natural death,
   2. An unexpected natural death, when the decedent appeared to be in good health,
   3. A natural death where the decedent did not have a physician or had not been seen by a
        physician within the last 14 days,
   4. A death that occurs during an operative procedure or within 10 days of an operative
        procedure,
   5. A violent or unnatural death,
   6. A death which is alleged to be a result of negligence,
   7. A death in custody,
   8. A death of an involuntary patient or "ward" of the government, and
   9. A maternal death.

If a death occurs unexpectedly at home the local police department should be called. The police
will contact the Office of the Chief Medical Examiner.

When a death occurs suddenly or cannot be explained, the Office of the Chief Medical Examiner
conducts an investigation. All such deaths in Alberta are investigated under the authority of the
Fatality Inquiries Act. The investigation is held to determine:
    • Who died?
    • Where did they die?
    • When did they die?
    • Why did they die?
    • How did they die?

In some cases, a public fatality inquiry is held and recommendations are made to help prevent
similar deaths.

Data Summary

The numbers of traumatic deaths reported by the Office of the Chief Medical Examiner for the
fiscal years 2003/04 to 2006/07 are shown in Figure 1. From 2004/05 to 2005/06, there was an
11% increase in the number of these deaths (from 606 to 672). A greater increase was observed
among children (16%) relative to adults (10%). The numbers stabilized in 2006/07, when a small
overall decrease of 1% was observed. This overall decrease was driven by a 28% reduction in
the number of pediatric deaths; the number of adult deaths actually increased by 2% in this fiscal
year.

The case characteristics for the deaths are shown in Table 1. For all trauma deaths combined,
males consistently accounted for a higher proportion of the cases than females, though the
proportion of females increased to 33% in 2006/07 from 27% to 28% in the previous years. In all
years, just under half of the deaths occurred in the city of Calgary. Similarly, the proportions of
deaths occurring in-hospital (vs. at the scene or en route) have remained fairly constant, from
27% to 31%.

Unintentional deaths accounted for more than half of the deaths in all years. Suicide was
consistently the second most common manner of death, accounting for 31% to 37% of the deaths
across the years. Homicides and injuries of undetermined intent were the third and fourth most
common, accounting for about 4%-6% and 2%-3% of the deaths, respectively.

 Pediatric deaths consistently accounted for about 6% to 8% of all the traumatic deaths. Slightly
higher proportions of in-hospital deaths were noted when compared with all deaths (27% to 31%
for all deaths compared with 37% to 41% for pediatric deaths). Unintentional deaths accounted
for most deaths among children, ranging from a low of 61% in 2005/06 to a high of 78% in


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2006/07. The relative burden of suicides in this age group decreased from 32% in 2005/06 to 7%
in 2006/07, though this comparison warrants cautious interpretation given the small numbers of
cases.

For the15 in-hospital pediatric deaths in 2003/04, 7 occurred at the Alberta Children’s Hospital
(ACH), 4 occurred at the Foothills Medical Centre (FMC) and the remaining 4 occurred at four
other hospitals outside of the city. In 2004/05, 10 of the 20 in-hospital pediatric deaths occurred
at ACH, 4 occurred at FMC and the remaining 6 occurred at five other hospitals outside of the
city. In 2005/06, 7 of the 23 in-hospital pediatric deaths occurred at ACH, 6 occurred at FMC, 2
occurred at the Peter Lougheed Centre, two occurred at the Rockyview General Hospital and 6
occurred at four other hospitals outside of the city.




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Figure 1. Traumatic Deaths in Calgary and the South Rural Area Reported by the Office of the Chief Medical Examiner
(2003/04 to 2006/07)


                                                          Traumatic Deaths Reported by the Office of the Chief Medical Examiner

                                       700                                                                     672                  667
                                                                                                                                           626
                                                                          606                                         615
                                             602
                                       600
                                                    561                          557


                                       500
                    Number of Deaths




                                       400



                                       300



                                       200



                                       100
                                                                                          49                                   57
                                                             41                                                                                     41


                                        0
                                                   2003/04                      2004/05                              2005/06              2006/07
                                                                                                 Fiscal Year

                                                                             All deaths        Adult deaths      Pediatric deaths




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             Table 1. Case Characteristics of the Traumatic Deaths in Calgary and the South Rural Area Reported by
                                the Office of the Chief Medical Examiner (2003/04 to 2006/07)
                                                           All Trauma Deaths                                   Pediatric Trauma Deaths
                                                          (Pediatric and Adult)                                      ( <18 years)
                                                        Calgary and South Rural                                Calgary and South Rural

                                                                                 Fiscal Year (April 1 - March 31)

                                             2003-04      2004-05       2005-06       2006-07      2003-04       2004-05      2005-06      2006-07
Case Characteristic
                                             (N=602)      (N=606)        (N=672)      (N=667)       (N=41)       (N=49)           (N=57)    (N=41)

                                                                  n (%)                                                   n (%)
Gender
  Male                                      439 (72.9) 438 (72.3) 487 (72.5) 446 (66.9)
  Female                                    163 (27.1) 168 (27.7) 185 (27.5) 221 (33.1)
Injury Location
  City of Calgary                           291 (48.3) 247 (40.8) 312 (46.4) 321 (48.1)
  Other                                     311 (51.7) 359 (59.2) 360 (53.6) 346 (51.9)
Place of Death
  In hospital                               163 (27.1) 190 (31.4) 208 (31.0)                      15 (36.7)     20 (40.8)     23 (40.4)
  At the scene or en route                  439 (72.9) 416 (68.6) 464 (69.0)                      26 (63.4)     29 (59.2)     34 (59.6)
Manner of Death
  Unintentional Intent                      334 (55.5) 341 (56.3) 413 (61.5) 382 (57.3)            27 (65.9)    31 (63.3)     35 (61.4)    32 (78.0)
  Injury / Undetermined Intent               18 (3.0)      12 (2.0)       15 (2.2)   18 (2.7)           -        3 (6.1)       1 (1.8)      1 (2.4)
  Homicide                                   34 (5.6)      27 (4.5)       38 (5.7)   38 (5.7)       7 (17.1)     5 (10.2)      3 (5.3)      5 (12.2)
  Suicide                                   216 (35.9) 222 (36.6) 206 (30.7) 229 (34.3)             7 (17.1)    10 (20.4)     18 (31.6)     3 (7.3)
  Pendinga                                       -           4 (0.7)         -           -              -           -             -            -
a
  Pending cases are cases that are not closed at the time of this report.
Note: Data for gender and injury location (pediatric deaths) and place of death (2006/07) not available.




                                                                      - 183 --
Regional
Department of
Emergency
Medicine Report
2006-2007



Submitted by:

Regional Emergency Services
Calgary Health Region
Regional Trauma Services                                                                  2006/2007




                                            Overview

The Calgary Health Region’s urban Emergency Departments play an integral role in providing
emergency care to residents of Region 3, Southern Alberta, Southeastern British Columbia,
Southwestern Saskatchewan and out of province visitors. A population of nearly 1.5 million is
served. The Emergency Departments (EDs) provide a unique service to the community and to the
hospitals, caring for a large number of patients with diverse and complex health concerns. A full
scope of service is provided and ranges from resuscitation to the treatment of patients with non-
urgent conditions. The EDs play a key role in partnering with Trauma Services to effectively
manage the population of trauma patients. For many trauma patients, the Emergency Department
is their first major point of entry to the health care continuum.

The Regional Department of Emergency Medicine (RDEM) Services is responsible for the
operations of the three urban adult Emergency Departments within the Calgary Health Region
including the Foothills Medical Centre (FMC), Peter Lougheed Centre (PLC) and the Rockyview
General Hospital (RGH). There are over 200,000 emergency visits each year among these three
sites. While the Emergency Department at the Alberta Children’s Hospital (ACH) is administered
under the Child & Women’s Health Portfolio, there is a close working relationship with (RDEM).
ACH receives approximately 45,000 patient visits each year. The FMC and ACH are the
designated adult and pediatric tertiary trauma centres for Southern Alberta respectively, but the
PLC and RGH also receive and treat trauma patients as well.

 The EDs provide 24-hour access to health care for individuals of all ages who have unscheduled
health care needs. In order to manage this diverse patient population, all Calgary Health Region
EDs use the nationally recognized, standardized triage-scoring system known as the Canadian
Triage Acuity Scale (CTAS). Experienced and highly trained ED Nurses assign each patient a
priority level based on how they present upon arrival to the ED. The CTAS ratings include 1
(resuscitation), 2 (emergent), 3 (urgent), 4 (semi-urgent) and 5 (non-urgent). It is important to
note that the CTAS score is reflective of how the patient presents upon arrival and that their
condition may improve or worsen over the course of their ED visit.

The following information was excerpted from “Implementation Guidelines for The Canadian
Emergency Department Triage and Acuity Scale (CTAS)” which is endorsed by the Canadian
Association of Emergency Physicians (CAEP), the National Emergency Nurses Affiliation of
Canada (NENA), and L’association des medcins d’urgence du Quebec (AMQU). Please note that
we have only presented CTAS Level classification information as it applies to trauma patients.
There is a wide range of other types of patients that fall within each CTAS category as well.

Trauma patients presenting to the ED are classified as follows:

CTAS Level 1 Resuscitation
•   Major trauma: severe injury of any single body system or multiple system injury, Head injury
    with Glasgow Coma Scale < 10, severe burns, chest/abdominal injury with any or all of:
    altered mental state, hypotension, tachycardia, severe pain, respiratory signs or symptoms

CTAS Level 2 Emergent
•   Head injury: This problem appears in several triage levels. The more severe or high-risk
    patients require a rapid MD assessment, to determine the requirements for airway
    protection/CT scanning or neurosurgical intervention. These patients usually have an altered
    mental state (Glasgow Coma Scale ≤ 13). Severe headache, loss of consciousness,
    confusion, neck symptoms and nausea or vomiting can be expected. Details regarding the
    time of impact, mechanism of injury onset and severity of symptoms and changes over time
    are very important.
•   Severe trauma: These patients may have high-risk mechanisms and severe single system
    symptoms or multiple system involvement with less severe signs and symptoms in each.
    Generally the physical assessment of these patients should reveal normal or nearly normal

                                            - 186 -
Regional Trauma Services                                                                     2006/2007




    vital signs (Abnormal VS are CTAS level 1). These patients may have moderate to severe
    pain and normal mental status (or meet the criteria outlined for level II head injuries).

CTAS Level 3 Urgent
•   Head injury: these patients may have had a high-risk mechanism. They should be alert (GCS
    15) moderate pain (< 8/10) and nausea or vomiting. Should be changed to level 2 if
    deteriorating or just appears unwell.
•   Moderate trauma: Patients with fractures or dislocations or sprains with severe pain (8-
    10/10). Nursing intervention with splinting/analgesics making it reasonable to have some
    delay in time to physician assessment/intervention. Dislocations should be reduced within
    one hour, so physician assessment should occur in ≤ 30 minutes. Patients are “stable”
    (normal or near normal vital signs).

CTAS Level 4 Semi-Urgent
•   Head Injury: Minor head injury, alert (GCS 15), no vomiting or neck symptoms and normal
    vital signs. May require brief period of observation, depending on time of injury in relation to
    ED visit. If time interval from accident > 4-6 hours and has remained free of symptoms, a
    neuro check and head routine sheet may be all that is necessary. The age of the patient and
    characteristics of the care provider/support at home may also influence the disposition
    decision or observation period.
•   Minor trauma: minor fractures, sprains, contusions, abrasions, and lacerations, requiring
    investigation or intervention. Normal vital signs, moderate pain (4-7/10).

CTAS Level 5 Non-Urgent
    •    Minor trauma: contusions, abrasions, minor lacerations (not requiring closure by any
         means), overuse syndromes (tendonitis), and sprains. Nursing interventions, splinting,
         cleansing, immunization status, minor analgesics are all expectations of patients in this
         category.

                           Trauma Patient Quality Improvement Practices

A series of treatment protocols, standards and guidelines have been developed for managing
trauma patients in the ED in close collaboration with the Regional Trauma Services team. Quality
Improvement processes are established to monitor and evaluate compliance. The RDEM
participates actively on the Calgary Health Region Trauma Committees, which facilitate open
communication, collaboration and problem solving. Protocols, standards and policies related to
managing trauma patients are reviewed annually and on an ad hoc basis based on current
research evidence.

The following standards, guidelines, and protocols are monitored by Trauma Services:
    •    Trauma Team activation based on activation criteria
    •    Trauma Team Leader (TTL) response time </= 20 minutes from patient arrival.
    •    Compliance with Spinal Clearance Protocol based on the Canadian C-spine study
    •    Documentation of vital signs qhour for all trauma patients in the ED
    •    Documentation of sequential neurological vital signs as appropriate
    •    ED length of stay </= 4 hours
    •    Admission of major trauma patients to a non-surgeon or non-intensivist
    •    Use of mechanical airway in ED for patients with a first recorded GCS </= 8
    •    Attempts at relocation of joint dislocations less than 1 hour of arrival
    •    Time to CT of the head for patients with a GCS < 13 (standard is < 4 hours)
    •    Time to craniotomy for patients with epidural or subdural brain hematoma
    •    Time to laparotomy for patients with suspected or confirmed intra-abdominal injury



                                              - 186 -
                                              - 187 -
Regional Trauma Services                                                                  2006/2007




Note: Regional Trauma Services collects data in the Alberta Trauma Registry on all major trauma
patients with an ISS >/= 12 who are admitted to hospital or die in the Emergency Department.
ISS is an anatomical scoring tool indicating severity of injury.

In addition to the above, Emergency Nurse Clinicians have been working closely with Trauma
Services to understand the importance of thorough documentation and the subsequent impact on
Trauma Registry data. It is also Emergency Department practice for any unusual matters to be
brought to the attention of the Trauma Clinical Nurse Specialist.

The Emergency Department actively participates in a wide range of Quality Improvement
projects, most of which will positively impact the care of all emergency patients, including those
who are trauma victims. Some examples include:
    • Enhanced triage staffing at all sites and implementation of triage guidelines regarding
        reassessment of waiting room patients according to CTAS level.
    • Credentialing of ED physicians under the Canadian Association for Emergency
        Physicians (CAEP) to perform FAST (Focused Assessment with Sonography for Trauma)
        ultrasound in the department for conditions including pericardial tamponade, intrauterine
        pregnancy, abdominal aortic aneurysm, abdominal trauma and cardiac standstill. FAST is
        an extension of the clinical assessment and most helpful in trauma patients in shock. A
        FAST protocol was developed, in conjunction with Trauma Services and Diagnostic
        Imaging for trauma patients. The credentialed ED physicians and trauma surgeons
        perform FAST as part of the trauma patient assessment.
    • Developing an alphanumeric, one-call paging system to improve timely response from,
        and communication with, the trauma team.
    • Participating in a spinal management project that examined, and aimed, to improve and
        standardize practices, processes and safe care for patients in the Emergency
        Department and in the Diagnostic Imaging Department.
    • Participating in a review of the equipment/protocol for treatment of hypothermia.
    • Reviewing trauma patient cases that were identified by Trauma Registry as meeting the
        Trauma Team Activation criteria but the team was not activated at the discretion of the
        emergency physician. Some cases were flagged and reviewed at the FMC Trauma
        Clinical Safety meetings to identify issues.




                                            - 186 -
                                            - 188 -
Regional Trauma Services                                                                                              2006/2007




                                                              Conclusion



                         Emergency Department Annual Registered Visits- Urban Sites
                265000

                                                                                                              258789
                260000
                                                         254241                                                         254040
                255000                                                                    253118
                                                                        251217                       251764
                                               249045
   ED Visit




                250000
                                     245251                                      245136
                245000     242503


                240000

                235000

                230000
                           97/98      98/99    99/00     00/01          01/02    02/03       03/04   04/05    05/06      06/07




                                         Annually ED Trends Since 2000/01 by Site
                                     ata               E IS
                                    D since 03/04 fromR D
                   80000
                   75000
                   70000
                   65000
     ED Visit




                   60000
                   55000
                   50000
                   45000
                   40000
                   35000
                               01/02             02/03              03/04            04/05            05/06            06/07

                    ACH        45963             45735             47726             46370            48336            50104
                    FMC        66577             63165             62836             64298            68129            66537
                    PLC        68214             67687             73547             74212            76254            72776
                     G
                    R H        70463             68549             69009             66884            66070            64623




       The volume of Emergency Department patient visits decreased by approximately 2.5% in
2006/2007 when compared to 2005/06.

         The profile of the patients presenting to the Emergency Departments by age did not
statistically change over the last year.




                                                              - 186 -
                                                              - 189 -
Regional Trauma Services                                                                                                     2006/2007




                                         Proportions of ED Visits by Age Group at Adult Sites
                                35%
                                30%
  Percentage (%)

                                25%
                                20%
                                15%
                                10%
                                 5%
                                 0%
                                         0 - 14       15 - 34      35 - 49         50 - 64    65 - 74      75 - 84    85 and over

                              2003/04    6.5%         34.4%        23.9%           15.0%       8.0%         7.9%         3.6%
                              2004/05    5.8%         34.3%        23.9%           15.7%       8.0%         8.2%         3.9%
                              2005/06    5.7%         34.1%        23.6%           16.2%       7.9%         8.3%         4.1%
                              2006/07    4.8%         34.9%        23.6%           16.6%       7.7%         8.2%         4.2%
                                                                           Age Group (Years)




                                 Proportion of Emergency Department Visits by Canadian Triage Acuity Scale
                                                         (CTAS) Level - Adult Sites
                                                  2003/04               2004/05              2005/06               2006/07
                                  60%

                                  50%
             Percentage (%)




                                  40%

                                  30%

                                  20%

                                  10%

                                   0%
                                             CTAS1              CTAS2              CTAS3          CTAS4              CTAS5

                               2003/04        1.1%              17.5%              52.7%           24.5%             4.3%
                               2004/05        1.0%              20.2%              51.5%           24.0%             3.4%
                               2005/06        1.0%              22.5%              51.7%           21.8%             3.0%
                               2006/07        1.0%              26.3%              51.1%           18.8%             2.8%




The average length of stay (ALOS) in ED for all patients requiring admission to hospital increased
at all sites reflecting in part the lack of inpatient capacity within the acute care sites. The ALOS
for patients discharged from Emergency increase slightly.




                                                                         - 186 -
                                                                         - 190 -
Regional Trauma Services                                                                  2006/2007




                  Length of Stay in the Emergency Department for Admitted and
                             Discharged Patients (Average) Annually
                      14.0
                      12.0
                      10.0
        Hours

                       8.0
                       6.0
                       4.0
                       2.0
                       0.0
                             2002/03      2003/04       2004/05       2005/06   2006/07

        FMC Adm it            10.99       10.60          10.05         11.20    13.11
        RGH Adm it            8.98        10.30          9.98          10.16    12.94
        PLC Adm it            8.08         8.75          9.13          10.19    11.38
        Adult- Discharge      4.03         4.22          4.40           4.70     5.34



The standard for length of stay for major trauma patients in ED is ≤ 4 hours.

For 2006/2007, the FMC ED LOS for major trauma patients was ≤ 4 hours 31.7% of the time (322
patients); > 4 hours 63.3% of the time (693 patients). This increased from 2005/2006 (4 hours
36.7% of the time). The median LOS was 5.6 hours. (5.3: 2005/2006)
ACH ED LOS was ≤ 4 hours 66.7 % of the time (44 patients);> 4 hours 33.3% of the time (22
patients). Direct Admits or patients with Unknown LOS were excluded. This was an improvement
from 2005/2006 (≤ 4 hours 62.1% of the time). The median ED LOS was 2.7 hours (2.95:
2005/2006).




                                             - 186 -
                                             - 191 -
P.A.R.T.Y.
PROGRAM
(Prevent Alcohol Related Trauma
in Youth)


2006 -2007


Submitted by:
Lynda Vowell, RN BN
P.A.R.T.Y. Coordinator
Emergency Services
Calgary Health Region
Regional Trauma Services                                                                     2006/2007




Goals and Objectives

    •    Reduce the incidence of risk related trauma in youth.

    •    Provide youth with positive alternatives and strategies to encourage smart choices.

    •    Expose youth to potential psychosocial and physical impacts that result from traumatic
         injury, using reality education.

    •    Encourage youth to directly apply strategies learned at PARTY.

    •    Empower youth to recognize risk and make informed, safe choices.

    •    Identify potentially dangerous situations and behaviors through personal testimony, multi-
         media presentation and active participation.

    •    Increase awareness of personal responsibility for choices.

    •    Encourage youth to examine their attitudes, decisions and behaviors.

    •    Increase knowledge of the impact of serious injury on quality of life for the individual and
         community.

    •    Encourage youth to think about potential loss of independence, friends, self-esteem and
         control of their body, as a result of injury.

    •    Identify the differences between injury recovery and permanent disability.

    •    Expose youth to a variety of disability issues in the community.

    •    Promote injury prevention initiatives.

    •    Demonstrate PARTY Programs’ active participation in promotion of injury prevention
         initiatives at a local, provincial, national and international level.




                                              - 195 -
Regional Trauma Services                                                                  2006/2007




2006/2007 P.A.R.T.Y PROGRAM

This year marks the 19th year of P.A.R.T.Y Calgary. We continue to be a highly sought after
dynamic injury awareness - health promotion program targeting youth in Calgary and surrounding
communities since 1988. Our in-hospital presentations reached over 7000 grade nine students,
with an additional 6000 attending outreach sessions. On-site programs are offered at the Foothills
Medical Centre North Tower in Calgary. Waiting list numbers are consistent from year to year at
3000; (does not include students/schools that have not applied for or requested the program).

Our aim is to inform and educate students about the perils of poor choices, risk-taking behaviors,
and the consequences that can occur with them. One of the most powerful sessions of the
program was at the end of a busy day, when students heard from young people who had been
injured through their or someone else’s poor choice. They shared their tragic stories hoping that
the choices leading to their event and the horrific consequences might help others make different
choices. At the same time their stories left the students in the program, speechless and
thoughtful. While the program aimed to ensure that many elements had an impact on these
teenagers, it was in fact the personal stories that were often cited by the students as the most
powerful and impacting element of the program; they made real all the information the students
received during the day. Our grade 12 ‘After the Party’ program gains momentum as we deliver a
reinforcing message to senior students around Grad time.

The success of this program is inherent on the diverse group of over one hundred dedicated
individuals. This group includes volunteers, various professional groups within the Calgary
Health Region, as well as Calgary City Police, Calgary Emergency Medical Services, Calgary Fire
Department, and a group of injury survivors who share their stories on a regular basis. Robyn
Regehr, a defenseman with the Calgary Flames, is our celebrity spokesperson. Students from the
Master of Teaching faculty spent time with us in the fall term, as part of their community work
place experience

Funding for this program is coordinated through the efforts of Calgary Health Trust with
operational funding from the Calgary Health Region and ING Foundation with a 3 year funding
commitment to increase our outreach component. This donation successfully provided the
opportunity to continue to offer outreach sessions to those schools not accommodated in the
regular classes due to lack of physical resources. We continue to deliver our rural outreach in
High River, offering a full day program in their community utilizing their local resources.

Evaluation of the program is on-going with completion of questionnaires by all participants at the
end of each session; with on-going analysis and reporting of results to support quality
improvements to the program. In 2005/2006, the P.A.R.T.Y. Advisory Committee was reactivated.
This committee consisted of various representatives from organizations and groups actively
involved in the program including EMS, the Calgary City Police, the Calgary Fire Department, the
Calgary Health Trust, the Director of Emergency Services/Urgent Care Services/Health Link, the
FMC Emergency Department Patient Care Manager, the Regional Trauma Services Manager,
Emergency Physician Representatives, Volunteer Resources and Communications. The focus of
this committee was to provide an advisory and support role to the program for quality and change
if required.


Submitted by:
Lynda Vowell RN BN
Program Coordinator




                                            - 195 -
                                            - 196 -
Calgary
Firefighters Burn
Treatment Centre
Report
Project Leads:
   • Ms. Christi Findlay, Data Analyst
       Regional Trauma Services

   •   Ms. Maria Vivas, Data Analyst
       Regional Trauma Services

   •   Reviewed by Ms. Lucy Weir, Patient Care Manager
       PCU 31/32 (Burn Unit)
  Regional Trauma Services                                                                                        2006/2007




  BURN REPORT

  The Calgary Firefighters Burn Treatment Centre at the Foothills Medical Centre serves as the
  tertiary care facility for adults of Southern Alberta, Southwest Saskatchewan and Southeast
  British Columbia. Patients with other diagnoses such as frostbite and exfoliative disorders
  including toxic epidermal necrolysis may be managed in the Burn Unit. Those requiring ventilatory
  support are treated in the Intensive Care Unit at FMC.
  The Calgary Firefighters Burn Treatment Centre opened in 1987, and renovated in November
  2003. The unit is an up-to-date physical facility for the comprehensive multi-disciplinary care of
  the acutely burned, non-ventilator dependent adult burn patient.
  A multidisciplinary team, whose members include plastic surgeons, nurses, physiotherapists,
  occupational therapist, nutritionists, social workers, and a psychiatric team, has been developed
  to care for the particular needs of this group of patients. The team meets weekly to discuss
  clinical issues, to address social concerns, to conduct educational sessions, and to engage in
  quality review procedures. Upon discharge, follow-up is arranged in outpatient clinics within the
  Rehabilitation Department at FMC, thus providing a degree of continuity of care during, the often
  lengthy, process of rehabilitation.
  The following is a summary of patients arriving at the Foothill Medical Centre with a diagnosis of
  burn, smoke inhalation, hypothermia or frostbite, comparing April 1, 2006 to March 31, 2007 with
  previous fiscal years.




                           Admissions                                                Hospital Days (Total)

                               93                                                               2216
                     83
                                                        72
                                           65                               1497      1536                          1588
    57                                                                                                    1444
                     73
                               69
                                                        55
    45                                   47


                      10      24          18
         12                                             17
                                                                          2002/2003 2003/2004 2004/2005 2005/2006 2006/2007
 2002/2003     2003/2004    2004/2005   2005/2006   2006/2007
              Male           Female             Total




      2006/2007 male to female ratio: 3.2:1                               2006/2007 Median length of stay (LOS): 20
There has been a 10.8% increase in admissions                                Average LOS: 23           Range: 1 - 112
              since 2005/2006.




                                                                - 199 -
Regional Trauma Services                                                                                                           2006/2007




                                                   Month of Admission
                                                             2006/2007


                                                    13

                                  8                                              8                       8            8
        6                                                          5
                   3                         3                                               3                                     4           3



      April      May             June     July      Aug           Sept         Oct         Nov         Dec           Jan       Feb            Mar



                                          Month of Admission by Fiscal Year
                   Apr           May     June      July       Aug          Sept         Oct         Nov           Dec        Jan       Feb         Mar
2006/2007              6           3          8     3             13           5            8            3           8        8         4              3
2005/2006              8           3          5     7             4            2            3          10            8        8         4              3
2004/2005              10          7          5     15            8            10           2          11            6        9         7              4


                                                     Age Distribution



                                                             20
                                             16
                            10                                                  11
        6                                                                                          5
                                                                                                                      2                 2


     < / = 20           21-30             31-40           41-50                51-60             61-70               71-80             > 81

                                                                       2006/2007

2006/2007 median age: 44, average age: 43                                          2005/2006 median age: 38, average age: 37



                                              Age Distribution by Fiscal Year
                    </= 20              21-30       31-40                41-50            51-60              61-70           71-80             >81
2006/2007                  6             10          16                   20                11                5               2                    2
2005/2006               14               13              9                15                 8                5               0                    1
2004/2005                  7             24          10                   24                12                5               6                    5
2003/2004                  9             17          17                   26                 8                3               1                    2
2002/2003               10               9           11                   13                 7                1               3                    3


The age distribution shows the characteristic peak in young adults sustained into mature
adulthood and also involves a growing number of senior citizens, groups of the population whose
vulnerabilities differ, but nevertheless render them susceptible to thermal injury.


                                                             - 199 -
                                                             - 200 -
Regional Trauma Services                                                                                                        2006/2007




                                                     Place of Occurrence


                                            40
                                                             35
         29                                                       29 29                           33             30
                                  27                                                                                       27
                                                                                      20
                                       16
               13 15                                                                         12
                                                                                                                      15




            2002/2003             2003/2004                  2004/2005                    2005/2006               2006/2007


                                             Home       Worksite       Other / Unknown




   20.8% (15/72) sustained injuries in work related incidents 2006/2007
   18.4% (12/65) sustained injuries in work related incidents 2005/2006


An increase in the number of burn cases may be linked to inadequate training and manpower
demands in the workplace. 31.2% of incidents resulting in injury occurred in the workplace in
2004/2005 and 18.5% in 2005/2006. In 2006/2007, 20.8% of injuries occurred in the workplace.




                                                 Mechanism of Burn Injury


                                                        56                          55
                            52                                                                                  51
  43



                                                                  14
                                            17                              15                                                  14
                                                                                                      9
              5 4 5               5 5                         4         4                                                  6
                                                 3                                                        1                           1
        0                                                                                  0 0                        0

       2002/2003                 2003/2004                   2004/2005                    2005/2006                  2006/2007



       Flame/Contact with Hot Object   Chemical      Electrical   Frostbite/hypothermia     Other (e.g. smoke inhalation) / Unknown




                                                             - 199 -
                                                             - 201 -
Regional Trauma Services                                                                                             2006/2007




                 ICU Admissions                                                Operative Intervention

                                                                                                               157           151
                                                                         138

       62                                                                                         97
                           55                                                         85
                                          53
                                                                                 42          44           36            44
                                                                    27
            26                                 19
                                10
                                                                 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007

   2004/2005         2005/2006         2006/2007
                                                                                       Patients    Procedures
         No ICU Admission            ICU Admission




                                                    Mortality Rate


                      7.0%                                                                        6.9%
                                                          5.4%

                                                                               3.1%
                                        2.4%




                   2002/2003         2003/2004         2004/2005           2005/2006          2006/2007

                                                         Mortality Rate




Coincident smoke inhalation injury has a major effect on morbidity and mortality in burn patients.
The age of the patient and the percentage of total body surface involved has a correlation with
survival rate. Increased age and increased percentage of total body surface results in a decrease
in burn survival rate. Functional impairment may often be a contributory factor; particularly with
burn incidents in the home. Impairment, temporary or chronic due to neurological disease or old
age, may relate to substance abuse, physical or mental disability with an inability to predict and
prevent an incident.


Until the past three years, the number of admissions has remained relatively stable, reflecting a
balance of general decline in burn injury incidence seen across North America. The pattern
however has been fluctuating recently in the Calgary Health Region. A 30% increase was
recorded in 2003-2004, an increase again in 2004/2005 and then a decrease in 2005/2006.
2006/2007 had a 10.8% increase over 2005/2006. The numbers are unpredictable and clearly it
is difficult to forecast resource needs. Further analysis of the data is underway to determine the
factors responsible and to forecast future needs.




                                                      - 199 -
                                                      - 202 -
Tertiary
Neurorehabilitation
Program
(Patient Care Unit FMC 58)

♦ Traumatic Brain Injury
  Population
♦ Traumatic Spinal Cord Injury
  Population

April 1, 2006 to March 31, 2007




Submitted by:
Luchie Swinton, B.Sc.O.T.
Neuro Rehabilitation Program Facilitator
Regional Trauma Services                                       2006/2007




                             Tertiary Neuro Rehabilitation
                           Traumatic Brain Injury Population


                                      2006/2007




                                      Prepared by:

                          Luchie Swinton, B.Sc.O.T.
                    Neuro Rehabiltation Program Facilitator
                             November 20, 2007




                                        - 206 -
Regional Trauma Services                                                 2006/2007




Tertiary Neuro Rehabilitation
Traumatic Brain Injury (TBI) Population: Fiscal Year 2006-2007

Demographics
                               2006-2007        2005-2006        2004-2005
 Total
 number of
 Clients                           48               53              43
 Age                 Average       43               42              37
                     Median        39               46              26
 Sex                 Male          39               42              34
                     Female         5               11              9
 Region of
           Calgary-
 Residence
           Urban                   32               38              35
           Calgary-
           Rural                    6                4
           Other
           Alberta                  6                9              7
           Non-Alberta              4                2              1
 Admission FMC Acute
 Source    Care                    47               48              36
           Other
           Hospital
           Acute Care               1                1              4
           Home                     0                4              2
           Continuing
           Care                     0                0              1




                                    - 206 -
                                    - 207 -
Regional Trauma Services                                                        2006/2007




Cause of Injury (2006-2007)

                           Cause of Injury (n=48)




              29%                                     MVC
                                                      Assault
                                      49%             Pedestrian
                                                      Sports Related
              6%
                                                      Falls
                 8%
                           8%



Almost half of the population acquired their brain injury from a motor vehicle-
related event (MVC), with falls being the second highest cause of injury.


Categorization of Traumatic Brain Injuries by Admission Glasgow Coma
Scale (2006-2007)


           Admission Glasgow Coma Scale (GCS) n=40




                                         23%
                                                              Mild (13-15)
                                                              Moderate (9-12)
        54%
                                                              Severe (3-8)
                                            23%




GCS was reported on only 40 of the 48 TBI patients. Based on their GCS at
admission, about half of the population for whom GCS was reported sustained a
severe brain injury. Slightly less than a quarter sustained a mild injury and a
similar percentage was in the moderate category.




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Level of Cognitive Function at Admission and Discharge (2006-2007)

                                             Rancho Los Amigos Scale
                     Level*             Admission Score    Discharge Score
                        V                      4                  1
                       VI                     16                  2
                      VII                     18                  9
                      VIII                     4                 19
                       IX                      2                 10
                        X                      0                  1

                 Unreported                        4                                6
              * Refer to www.northeastcenter.com/rancholosamigosrevised.htm for a description of the levels.

Level of Cognitive Function is measured at admission and discharge from the
Tertiary Neuro Rehabilitation Unit using the Rancho Los Amigos Scale*.
Function scores ranged from Level V to IX on admission and from Level V to X at
discharge. Only 33 of the 42 patients for whom admission and discharge scores
were reported demonstrated an improvement. Greater than half of these,
however, improved by more than a single level.


Pre-injury Profiles

The literature indicates that individuals with a lower level of education, a history
of drug/alcohol use, a criminal record, and those with a pre-existing learning
disability or previous history of brain injury have a greater predisposition for a
traumatic brain injury. The table below indicates the number of individuals for
whom these indicators were present.

Of these, there were only 2 patients for whom more than one indicator was
present.

                   Characteristic                                             # of patients
                   Education at Grade 12 or less                                     18
                   Criminal Record                                                    1
                   Learning Disability                                               1
                   Alcohol/Drug Use                                                  21
                   Previous TBI                                                       1




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Other Brain Injury Rehabilitation Indicators

                                          Mean              Median                Range
                       TM1
    Admission FIM            Scores
                                            96                100                18 - 119
                      TM
    Discharge FIM          Scores
                                           113                117                25 - 124
    % change in FIMTM Scores
                                                             15%               0% to 137%
    Acute LOS                                                 28                  6 - 133
    Rehab LOS                                                 34               8 - 187 days

    Total LOS*                                                 61             25 – 302 days

Note: Means not reported for % change in FIMTM scores, acute LOS, rehab LOS or total LOS due
to skewing in the data.
* Only patients referred from FMC acute units were included in this total.

From admission to discharge on the Tertiary Neuro Rehabilitation Unit, the
median change in FIMTM Scores1 for patients with traumatic brain injury was 15%.
For those referred from a Foothills Medical Centre acute unit, the median total
length of hospital stay from acute to tertiary rehabilitation was 61 days.




1
  The FIMTM trade mark is owned by Uniform Data System for Medical rehabilitation, a division of U B
Foundation Activities, Inc. FIM - The Functional Independence Measure (FIM) is an 18 item rating scale
that includes 6 activities of daily living items, 2 bladder and bowel function items, 5 mobility and 5
cognitive/social interaction items.



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Services received in rehabilitation


                                                       Rehabilitation Resources Utilization (n=48)
   N u m b er o f p a tien ts rece ivin g


                                                                                                                                           Greater than 93% of the
                                            50                                                                                             patients participated in
                                            40                                                                                             OT, PT, Recreation
                  se rvic e




                                            30                                                                                             Therapy and SLP
                                            20    47         47          46          45             39                           33        treatment. Half of the
                                            10                                                                       24
                                                                                                                                           patients received services
                                             0                                                                                             from the psychologist.
                                                                                                                                           Eighty-one percent
                                                           PT
                                                 OT




                                                                     cT



                                                                                 P


                                                                                             SW




                                                                                                                               n
                                                                                                                i st
                                                                                SL




                                                                                                                            i t ia
                                                                                                                                           received SW services and
                                                                    Re




                                                                                                              lo g


                                                                                                                          et
                                                                                                                          Di
                                                                                                                                           about 2/3 received




                                                                                                          ho
                                                                                                         yc
                                                                                                     Ps
                                                                                                                                           services from the dietitian.



Three quarters of the patients went on weekend passes while almost all of them
participated in day passes as part of their inpatient rehabilitation. Only about a
fifth met with the team in a family conference. Only 10% were provided with a
home visit. Almost ¾ of the patients were referred to physiatry for follow up.


                                                                              Other Services (n=44)
         Percent Receiving Services




                                       100%
                                            80%
                                            60%
                                            40%                                                          90%
                                                                              75%                                                                 71%
                                            20%
                                                          19%                                                                        10%
                                             0%
                                                         Family      Weekend Pass                   Day Pass                Home Visit       Clinic Follow-up
                                                       Conference




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Discharge arrangements

                                 Level of Supervision at Discharge (n=42)


                                7%
                                                          29%
                                                                     Independent (1-2)
                                                                     Overnight Supervision (3)
                                                                     Part Time Supervision (4-7)
                                                                     Full Time Indirect Supervision (8-9)
                                                            5%
                   59%




At discharge, the level of supervision that was required by patients was described
using the Supervision Rating Scale (SRS). Only 42 patients had a reported SRS
Score. Greater than half required part time supervision while almost a third
required no supervision at all.

                                     Discharge Destination (n=48)


                           9%        2% 2%
                     4%                                                                  Home
                   2%
                                                                                         Board and Care
                                                                                         Acute Other Facility
                                                                                         Rehab Facility
                                                                                         Assisted Living
                                                                                         Other
                                                          81%




                       Living Arrangements Among Those Discharged Home (n=44)




                            18%                     14%

                                                                            Alone
                                                                            Family/Relatives
                                                                            Friends

                                             68%




Almost all (91%) of the population returned home. Of these, 30 went home to
live with family and 6 returned home to live alone.


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                         Tertiary Neuro Rehabilitation
                    Traumatic Spinal Cord Injury Population


                                       2006/2007




                                      Prepared by:

                              Luchie Swinton, B.Sc.O.T.
                           Neuro Rehabilitation Program Facilitator




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Tertiary Neuro Rehabilitation
Traumatic Spinal Cord Injury Population (FY 2006-2007)

Demographics

                                                          2006-07   2005-06   2004-05
 Total number of
 Clients
                                                            25        20           27
 Age
                            Average                         40        44           39

                            Median                          34        42           35
 Gender
                            Male                            19        14           20

                            Female                           6         6           7

                            Calgary - Urban                 13        11

                            Calgary - Rural                  4         1           21
 Region of Residence
                            Other AB                         5         6           5

                            Non-AB                           3         2           1
 Admission Source
                            FMC Acute Care                  22        19           26

                            Other Hospital Acute Care        1         1           1

                            Continuing Care                  1         0           0

                            Other                            1         0           0

Cause of Injury

                                   Cause of Injury (n=25)
                                    8%

                           16%                      32%
                                                                           MVC
                                                                           Fall
                                                                           Sports related
                                                                           Other


                                    44%


Almost half of the patients were injured as a result of a fall while a third were
involved in a motor vehicle collision.

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                                 Level and Type of Injury (n=25)


                   20%                     8%
                                                                         Cervical Complete
                                                              28%        Cervical incomplete
                                                                         Cervical Unreported ASIA
                                                                         T-L Complete
             28%                                                         T-L Incomplete
                                                16%



The distribution of those who sustained paraplegia or quadriplegia was almost
equal. However, only 8% of the patients with cervical injuries had a complete
injury, compared with 28% for those with a thoraco-lumbar injury. Type of injury
is assessed using the American Spinal Injury Association (ASIA) Impairment
Scale.

Spinal Cord Injury Rehabilitation Indicators
                       Average      Median                Range

    Admission
    FIMTM*                 78         71                  39-121
    Scores
    Discharge
    FIMTM Scores           103        106                 48-126
    % change in
    FIMTM Scores           39%       25%              -9% - 141%
    Acute LOS
                           35         28                  13-107
    Rehab LOS
                           74         50                  6-284
    Total LOS**
                       112          97             21-369
** Only patients referred from FMC acute care units were included in this total.

From admission to discharge on the Tertiary Neuro Rehabilitation Unit, patients
with traumatic spinal cord injury generally improved an average of 39% in their
FIMTM Scores2. For those referred from a Foothills Medical Centre acute unit,
their average total length of hospital stay from acute to tertiary rehabilitation was
112 days, 20 days (15%) less than last fiscal year’s average total LOS. There



2
 The FIMTM trade mark is owned by Uniform Data System for Medical rehabilitation, a division of
U B Foundation Activities, Inc. FIM - The Functional Independence Measure (FIM) is an 18 item
rating scale that includes 6 activities of daily living items, 2 bladder and bowel function items, 5
mobility and 5 cognitive/social interaction items.


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appears to be a trend of decreasing total LOS for patients receiving acute and
tertiary rehabilitation care at FMC in the last 3 years.

7 patients were reported to have had a delay in discharge as they awaited
transfer to continuing care or a local hospital or while waiting for their home
situation to be fully prepared for their needs. Wait for discharge ranged from 1-
15 days. The longest wait was for completing home renovations.

Services received in rehabilitation


                                                      Utilization of Rehabilitaiton Services (n=25)
     Number of patients




                          30

                          20
                          10

                               0




                                                                                                                                                      Dietitian
                                                                       Recreation
                                                          Physical
                                       Occupational




                                                                                          Pathology




                                                                                                                                Psychology
                                                                                          Language




                                                                                                       Social Work
                                                          Therapy




                                                                                           Speech-
                                                                        Therapy
                                         Therapy




Almost all of the patients received occupational, physical and recreation therapy.
Greater than ¾ of the patients were seen by the social worker. The psychologist
saw over half while the dietitian provided services to just under half the total
number of patients.


                                                                Other Services Received (n=25)
   No. of patients receiving




                               25
                               20
            service




                               15
                               10
                                   5
                                   0
                                            Family              Weekend Pass              Home Visit                 Day Pass                Clinic Follow-up
                                          Conference



About 80% of the patients went on passes – weekend or day passes. About 60%
were referred for follow-up at Physiatry Clinics, and 40% were provided a home
visit. Only 4 (16%) participated in a family conference with the team.




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Discharge arrangements


                                Discharge Disposition (n=25)


                           4%   4%
              16%                                              Home
                                                               Acute - FMC
                                                               Acute - other Facility
           4%                                                  Rehabilitation Facility
                                                    72%        Alternate Level of Care




Greater than ¾ of the patients returned home. Of these, 16 went home to live with
family and 2 returned home to live alone.




                                          - 214 -
                                          - 218 -
2006 - 2007 REPORT
Appendices
APPENDIX A : TRAUMA RESEARCH
PUBLICATIONS

APPENDIX B: TRAUMA RESEARCH
FUNDING SUMMARY

APPENDIX C: PROFILE OF INJURIES IN
THE CALGARY HEALTH REGION
REPORT
Regional Trauma Services                                                                 2006/2007




TRAUMA RESEARCH PUBLICATIONS (2006-2007)                                            Appendix A

REFERREED PUBLICATIONS

•   Ball C.G., Nicol AJ, Beningfield SJ & Navsaria PH. Emergency room arteriography: An
    updated digital technology. Scandinavian Journal of Surgery. 96(1):67-71, March, 2007.

•   Ball C.G., Hameed SM, Navsaria P, Edu S, Kirkpatrick AW & Nicol AJ. Successful damage
    control of complex vascular and urological gunshot injuries. Canadian Journal of Surgery.
    49(6):437-438, December, 2006.

•   Ball C.G., Kirkpatrick AW, Mulloy RH, Gmora S, Findlay C & Hameed SM. The impact of
    multiple casualty incidents on clinical outcomes. Journal of Trauma. 61(5):1036-1039,
    November, 2006.

•   Ball C.G., Kirkpatrick AW, Karmali S, Malbrain M, Gmora S, Mahabir RC, Doig C & Hameed
    SM. Tertiary abdominal compartment syndrome in the burn patient. Journal of Trauma.
    61(5):1271-1273, November, 2006.

•   Ball C.G., Ranson K, Rodriguez-Galvez M, Lall R & Kirkpatrick AW. Sonographic depiction of
    a post traumatic alveolar-interstitial disease: A hand-held diagnosis of a pulmonary
    contusion? Journal of Trauma, 2007 (In-Press).

•   Ball C.G., Kirkpatrick AW & McBeth P. Updates for the Surgeon: Secondary Abdominal
    compartment syndrome. Canadian Journal of Surgery, 2007 (In-Press).

•   Ball C.G., Keaney MA, Kirkpatrick AW, Tyssen M, Groleau M, Grenon M, McBeth P,
    Campbell M & Broderick T. Abdominal wall behavior in microgravity: A parabolic flight model.
    In: Aviation, Space, and Environmental Medicine: 2007 Abstracts of the AsMA Scientific
    Sessions, New Orleans, LA, 2007.

•   Ball CG, Hameed SM, Navsaria P, Edu S, Kirkpatrick AW, Nicol AJ. Successful Damage
    Control of Complex Vascular and Urological Gunshot Injuries. Canadian Journal of Surgery,
    2006; 49:437-438.

•   Ball CG, Kirkpatrick AW, Smith M, Mulloy RH, Anderson IB. Traumatic injury of the superior
    mesenteric vein: Ligate, repair or shunt? European Journal of Trauma, 2006 (In Press).

•   Ball C.G., Kirkpatrick AW, Yilmaz S, Monroy M, Nicolaou S & Salazar A. Renal allograft
    compartment syndrome: An underappreciated post-operative complication. American Journal
    of Surgery, 2006; 191:619-624.

•   Ball CG, Lord J, Laupland KB, Gmora S, Mulloy RH, Ng AK, Schieman C, Kirkpatrick AW.
    Chest tube complications: How are we training our residents? Canadian Journal of Surgery,
    2006 (In press).

•   Ball CG, Kirkpatrick AW, Fox DL, Laupland K, Andrews G, Kortbeek JB, Litvinchuk S,
    Nicolaou S. Are Occult Pneumothoraces Truly Occult or Simply Missed? Journal of Trauma,
    2006; 60(2):294-299.

•   Ball CG Kirkpatrick AW, Mackenzie S, Bagshaw SM, Pets AD, Temple WJ, Boiteau P.
    Tension Pneumothorax Secondary to Colonic Perforation during Diagnostic Colonoscopy:
    Report of a Case. Surgery Today, 2006; 36:478-480.

•   Ball CG, Kirkpatrick AW. Progression towards the minimum: The importance of standardizing
    priming volume during the indirect measurement of intra-abdominal pressures. Critical Care
    2006; 10:153.

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•   Ball CG, Kirkpatrick AW, Fox D, Louis L, Laupland K, Kortbeek J, Litvinchuk L, Hameed SM,
    Nicolaou S. Occult or missed? A retrospective re-review of post-traumatic “occult”
    pneumothoraces. J Trauma 2006;60:294-299.
•   Ball CG, Ball JE, Kirkpatrick AW, Mulloy RH. Equestrian injuries: Prevalence, injury patterns
    and risk factors for 10 years of major traumatic injuries. Am J Surg 2007;193:636-640.
•   Bhidhatghan A, Katz NR, Hudon M, Clark AW, Hurlbert RJ, Zochodne DW. Primary angiitis
    of the spinal cord presenting as a conus mass: long-term remission. Surg Neurology 66: 622-
    626, 2006.
•   Buckley,R. Canadian Orthopaedic Trauma Society – Reamed versus Unreamed
    Intramedullary Nailing in the Femur: Comparison of the rate of ARDS in multiple injured
    patients. Journal of Orthopaedic Trauma, 2006, 20(6), p 384-387.
•   Cafferty WB, Yang SH, Duffy PJ, Li S, Strittmatter SM. Functional axonal regeneration
    through astrocytic scar genetically modified to digest chondroitin sulfate proteoglycans. J
    Neurosci. 2007 Feb 28; 27(9), p 2176-2185.
•   Canadian Orthopaedic Trauma Society – Open Reduction Internal Fixation Compared with
    Circular Fixator Application for Bicondylar Tibial Plateau Fractures: Results of a Multi-Centre,
    Prospective Randomized Clinical Trial. JBJSW(A), 2006, 88A, p 2613-2623.
•   Dvorak MF, Collins JB, Murnaghan L, Hurlbert RJ, Fehlins MG, Fox R, Hedden D,
    Ramspersaud YR, Bouchard J, Guy P, Fisher CG. Confidence in Spinal Training among
    senior neurosurgical and orthopaedic residents. Spine 31(7): 831-837, 2006
•   Fong SY, duPlessis SJ, Casha S, Hulbert RJ. Design limitations of Bryan disc arthroplasty.
    The Science Journal 6:233-241, 2006.
•   Goecke ME, Kirkpatrick AW, Laupland KB, Bicanic M, Findlay C. Characteristics and
    conviction rates of injured alcohol-impaired drivers admitted to a tertiary care Canadian
    trauma centre. Clin Investigative Med (in press).
•   Harrop JS, Vaccaro AR, Hurlert RJ, et al. Intra-rater and inter-rater reliability and validity in
    the assessment of the mechanism of injury and integrity of the posterior ligamentus complex:
    a novel injury severity scoring system for thoracolumbar injuries. J of Neurosurgery Spine
    4:118-122, 2006.
•   Hui C, Jorgensen I, Buckley R, Fick G. Incidence of intramedullary nail removal after femoral
    shaft fracture healing. Can J Surg. 2007 Feb; 50(1), p. 13-18.
•   Hurlbert RJ. Strategies of medical intervention in the management of acute spinal cord injury.
    Spine 31(11) suppl: S16-S21, 2006
•   Hurlbert RJ. The impact of methylprednisolone on lesion severity following spinal cord injury:
    Point of View. Spine 32(3): 379-380, 2007.
•   Hurlbert RJ: Point of View (The impact of methylprednisolone on lesion severity following
    spinal cord injury). Spine 32(3): 379-380, 2007.
•   Karmali S, Evans D, Findlay C , Bergeron E, Laupland KB, Charyk T, Parry N, Khetarpal S,
    Kirkpatrick AW for the Canadian Trauma Trials Collaborative (CTTC). To close or not to
    close, that’s one of the questions: Perceptions of Trauma Association of Canada Member
    surgeons regarding the open abdomen management. J Trauma 2006;60:287-293.
•   Kirkpatrick AW, Laupland KB, Karmali S, Bergeron E, Charyk Stewart, Findlay C, Parry N,
    Khetarpal S, Evans SD. Spill your guts! Perceptions of the Trauma Association of Canada
    member surgeons regarding the open abdomen and the abdominal compartment syndrome.
    J Trauma 2006;60:279-286.

•   Kirkpatrick AW, Ball CG, Nicolaou S, Ledgerwood A, Lucas C. Ultrasound detection of right
    sided diaphragmatic injury; The “Liver Sliding” sign. Am J Emerg Med (first & corresponding
    author)(Am J Emerg Med 2006;24:251-252).

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•   Kirkpatrick AW, Balogh Z, Ball CG, Ahmed N, Chun R, McBeth P, Kirby A, Zygun D. The
    secondary abdominal compartment syndrome: Iatrogenic or unavoidable? J Am Coll Surg
    (first & senior author) (2006;202:668-679).
•   Kirkpatrick AW, Ball CG, D’Amours SKD, Zygun D, Chun R, Kortbeek JB, Hameed SM. Acute
    resuscitation of the unstable adult trauma patient: Bedside diagnosis and therapy. Can J Surg
    (in press).
•   Kirkpatrick AW, Melton S, Hamilton DR, Jones J, Campbell MR, Nicolaou S, Dulchavsky S,
    Beck G, Sargsyan A. Evaluating trauma sonography for operation use in the microgravity
    environment. Aviat Space Environ Med (in press).
•   Kirkpatrick AW, Colistro R, Fox DL, Laupland KB, Konkin D, Kock V, Mayo JR, Nicolaou S.
    Renal arterial resistive index response to intra-abdominal hypertension in a porcine model.
    Crit Care Med(in press)
•   Kirkpatrick AW, vanWijngaarden-Stephens M, Fabian T. Evidence based reviews in surgery
    A collaborative project of The Canadian association of General Surgeons & The American
    College of Surgeons: Treatment of occult pneumothoraces from blunt trauma. Can J Surg
    2006;49:358-361.
•   Kirkpatrick AW, Ball CG, Rodriguez-Galvez M, Chun R. Sonographic depiction of the needle
    decompression of a tension hemo/pneumothorax. J Trauma (in press).
•   Kirkpatrick AW. Clinician-performed focused trauma sonography for the resuscitation of
    trauma. Crit Care Med (in press).
•   Kirkpatrick AW, Blaivas M, Sustic A. Introduction to the use of ultrasound in critical care
    medicine. Crit Care Med 2007;35:S123-125.
•   Kirkpatrick AW, Laupland KB. “The higher the abdominal pressure the less the secretion of
    urine”: Another target disease for renal ultrasongraphy? Crit Care Med 2007;35:S206-S207.
•   Laupland KB, Zuege D, Kirkpatrick AW, Kortbeek JB. Long-term mortality outcome
    associated with prolonged admission to the intensive care unit. Chest 2006;129:954-959.
•   Laupland KB, Karmali S, Kirkpatrick AW, Crowshoe L, Hameed SM. Distribution and
    determinants of critical illness among status Aboriginal Canadians. A population-based
    assessment. J Crit Care 2006;21:243-247.
•   Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z,
    Leppaniemia A, Olvera C, Ivatury R, DiAmours S, Wendon J, Hillman K, Johansson K,
    Kolkman K, Wilmer A. Results from the International Conference of Experts on Intra-
    abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Int Care
    Med 2006;32:1722-32.
•   Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z,
    Leppaniemia A, Olvera C, Ivatury R, DiAmours S, Wendon J, Hillman K, Johansson K,
    Kolkman K, Wilmer A. Results from the International Conference of Experts on Intra-
    abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Int
    Care Med 2007 (Epub Mar 22).
•   Lim MR, Vaccaro AR, Lee JY, Zeiller S, SanFilippo J, Hurlbert RJ, et al. The throacolumbar
    injury severity scale and score (TLISS): inter-physician and inter-disciplinary validation of a
    new paradigm for the treatment of thoracolumbar spine trauma. Coluna/Columna 5(3):157-
    164, 2006.;1-10, 2006.
•   McBeth PB, Zygun DA, Widder S, Cheatham M, Zengerink I, Glowa J, Kirkpatrick AW. The
    effect of patient positioning on intra-abdominal pressure monitoring.    Am J Surg
    2007;193:644-647.
•   Schieman C, Ball CG, Boucher P, Dixon E, Kirkpatrick AW. Extravasation of intravenous
    contrast into the mediastinum. Injury Extra 2006;37:173-175.


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  Regional Trauma Services                                                                    2006/2007




  •   Schneidereit N, Simons RK, Nicolaou S, Brown DR, Kirkpatrick AW, Redekop G, McKevitt E,
      German E. Utility of screening for blunt vascular neck injuries with computed tomographic
      angiography. J Trauma 2006;60:209-216.
  •   Vaccaro AR, Lim M, Hurlbert RJ, et al. Surgical decision making for unstable thoracolumbar
      spine injuries: results of a consensus panel review by the spine trauma study group. Journal
      of Spine Disorders and Techniques 19(1)2006.
  •   Xie J, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion
      and instrumentation: a perspective randomized study. Neurosurgery 61(1):107-117, 2007.

  BOOKS

  Book Editor
  •  AO Manual of Fracture Management – Internal Fixtures. Author: Michael Wagner, Co-Editor:
     Richard Buckley Emanual Gauthier, Michael Schutz, Christoph Sommer. Thieme Publishing
     with A Publishing, 2006.

  Section Editor
  • The Secondary Abdominal Compartment Syndrome. In: Ivatury R, Chang M, Cheatham M,
     Malbrain M, Sugrue M (Editors). The Abdominal Compartment Syndrome, Landes
     Bioscience, Georgetown TX 2006.

      Chapters
  •   AO Principles of Frcture Management. Buckley R, Nork S. Thieme Publishing, 2006. Chapter
      Title “Calcaneal and Talar Fractures.
  •   AO Principles of Frcture Management. Buckley R, Johnson E.Thieme Publishing, 2006.
      Chapter Title: Chronic Infection.
  •   Casha S, Silvaggio J, Hurlbert RJ. Pharmacotherapy for spinal cord injury in Surgical
      Management of Spinal Cord Injury: Controversies and Consensus, Amar AP (ed). Blackwell
      Futura, Malden Mass., 18-33, 2007.
  •   Kirkpatrick AW, Salazar A, Elliot D, Nicolaou S. The renal allograft compartment syndrome in
      perspective: An organ specific compartment syndrome with illustrative pathophysiology. In:
      Ivatury R, Chang M, Cheatham M, Malbrain M, Sugrue M (Editors). The Abdominal
      Compartment Syndrome, Landes Bioscience, Georgetown, TX, 2006: 203-209.


PUBLISHED ABSTRACTS

Abstracts of Papers presented at the Annual Scientific Meeting of the Trauma Association of
Canada (May 10-12, 2007)

Journal of Trauma March 2007 (63:3 pp.787-804)

  •      Dyer DM, Findlay C. Trauma Registry: A data source for economic and resource
         predictions. [abstr] Journal of Trauma, 2007; 62: 804.
  •      Litvinchuk S, Jackson B, Serra K, Taillefer S. Treatment and follow-up of mild traumatic
         brain injuries – How do we treat patients with a negative CT? [abstr] Journal of Trauma,
         2007: 62: 798.
  •      Widder S, Zygun D, Ranson K, Knox L, Laupland K, Laird P, Ball C, Kirkpatrick A. Use of
         near-infrared spectroscopy as a physiologic monitor for intra-abdominal hypertension.
         [abstr] Journal of Trauma, 2007; 62: 795.
  •      Zengerink I, McBeth P, Zygun D, Ranson K, Widder S, Ball C, Kirkpatrick A. An abnormal
         continuous intra-abdominal pressure measurement should be confirmed when the
         abdominal compartment syndrome is suspect. [abstr] Journal of Trauma, 2007; 62: 791.



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TRAUMA RESEARCH FUNDING SUMMARY (2006/2007)                                                                                                            APPENDIX B

Dept – TS: Trauma Surgery, EMS: Emergency Medical Services; OS: Orthopaedic Surgery; CC: Critical Care; EM: Emergency Medicine; GS: General Surgery; CH: Community Health
Science; NS: Neurosurgery; FM: Family Medicine
 Dept            Principal           Co-investigators                         Title                        Funding Source               Time Period          Grant amount
               Investigator                                                                                                              Start/End           in dollars ($)
CC         Clifton G. (Lead PI)     Kirkpatrick AW           National Acute Brain Injury Study:        University of Texas                Jan 2005 -          $148, 347.00
           Zygun D. (Centre PI)                              Hypothermia II                            Houston Texas
CC/TS      Zygun.D. (Lead PI)       Kirkpatrick, AW          National Acute Brain Injury Study:        University of Texas                2005-2006            $103,384.26
                                                             Hypothermia IIR                           Houston Texas
EMS        Anton, Andy              Stiell, Ian and          Pre-hospital Validation of the            Calgary EMS                    Jul 1, 2003 - Jul 1,         N/A
                                    Vaillencourt,            Canadian C-spine Rule                                                            2006
                                    Christian
NS         Midha, R                                          Strategies to Enhance Peripheral          Alberta Heritage Fund for         2005 - 2007           $250,000.00
                                                             Nerve Regeneration                        Medical Research
NS         Sutherland, Garnette     Duncan N, Kopp G,        Project NeuroArm: MR Compatible           Canadian Foundation for           2004 - 2008         $10,499,339.00
                                    Louw D, Mesana T,        Image Guided Robot for                    Innovation (CFI)
                                    Mitchell R, Pittman Q,   Microsurgery. Hotchkiss Brain
                                    Ronsky J, Wyvill B,      Institute: Frontiers in Innovative
                                    Anvari M, Dort J,        Robotic Surgical Technology.
                                    Eliasziw M, Fielding
                                    T, Forsyth P,
                                    Gregoris D, Hoult D,
                                    Hu R, Jennett P,
                                    Kirkpatrick AW,
                                    McBeth P, Sean G,
                                    Sensen C, Sevick R,
                                    Sharpe J, Smith K,
                                    Sun Q, Tomanek B
NS         Hurlbert, John           Casha, A                 Metalloproteinase Inhibition &            Hotchkiss Brain Institute         June 2004 –         PVA - $50,000
                                    Zygun, D                 Perfusion Pressure in Acute Spinal        Paralyzed Veterans of              Dec. 2008
                                    duPlessis, SJ            Cord Injury: A Pilot Study                America
                                    McGowan, D
                                    Yong, VW
NS         Hurlbert, John           Fox, R                   Management of Type II Odontoid            Sonntag Award,                    2003 -2010            $30,000.00
                                    duPlessis, SJ            Fractures: A Prospective                  AANS/CNS Joint Spine                                    $24,000.00
                                    Casha, A                 Randomized Comparison of Primary          Section Center for
                                    Broad, R                 Anterior Screw Fixation versus Halo       Advancement of Health
                                    France, J                Vest Immobolizations




                                                                               - 227 -
Regional Trauma Services                                                                                                               2006/2007




 Dept            Principal     Co-investigators                      Title                         Funding Source        Time Period   Grant amount
               Investigator                                                                                               Start/End    in dollars ($)
OS         Buckley, Richard   Sidky, Adam            The Incidence of Tibial Medullary Nail   Calgary Surgical           2005 - 2006     $1,000.00
                                                     Removal after Healing                    Research Development
                                                                                              Fund
OS         Buckley, Richard   Wagg, James            The Biomechanical Strength of            Calgary Surgical
                                                     Locking Plates versus Standard           Research Development       2005 - 2006     $1,000.00
                                                     Fixation in Fibular Fractures            Fund
OS         Buckley, Richard   McCormack, Bob,        Prospective Randomized Trial:
                              Royal Columbian        Prophylaxis of Deep Vein Thrombosis      Pfizer                     2001 - 2006    $330,000.00
                              Hospital, Vancouver    in Patients with Fractures of the
                              Abselth, Greg,         Lower Extremity Distal to the Knee
                              Rockyview Hospital
OS         Buckley, Richard   Johnston, Kelly        Prospective Randomized Trial for
                                                     Sanders IV Calcaneal Fractures:          OTA                        2004 – 2007     $25,000.00
                                                     Operative Reduction versus Primary                                  2004 – 2006      $2,500.00
                                                     Subtalar Fusion                                                     2004 – 2006      $3,000.00
OS
           Buckley, Richard   Canadian               Sanders IV Calcaneal Fractures, Fix-     Hip-Hip Hooray             2004 - 2006    $2,500.00
                              Orthopaedic Trauma     Fuse?
                              Society

OS         Buckley, Richard   Canadian               Sanders IV Calcaneal Fractures, Fix-
                              Orthopaedic Trauma     Fuse?                                    AO                         2004 - 2006     $3,000.00
                              Society
OS         Buckley, Richard   Canadian               Sanders IV Calcaneal Fractures, Fix-
                              Orthopaedic Trauma     Fuse?                                    OTA                        2004 - 2006     $25,000.00
                              Society
OS         Buckley, Richard   McCormack, B           Prospective Randomized Trail:            Pfizer
                              Abelseth, G            Prophylaxis of Deep Vein Thrombosis                                 2001 - 2006    $330,000.00
                                                     in Patients with Fractures of the
                                                     Lower Extremity Distal to the Knee
OS         Buckley, Richard   Canadian               Canadian Orthopaedic Resident            Stryker, Merck, Synthes,
                              Orthopaedic Resident   Forum                                    Zimmer, Sofamore-Danek        2006         $53,000.00
                              Forum
OS         Buckley, Richard   Dhaliwal, Gurpreet     Inter-observer and Intra-observer        COREF
                                                     reliability of Bohler’s angle            Calgary Research &         2006 – 2007       $700.00
                                                     measurement                              Development Fund                            $1,000.00
OS         Buckley, Richard                          Orthopaedic Trauma Research              Anonymous Donation (in     2006 – 2007     $50,000.00
                                                                                              perpetuity)




                                                                      - 228 -
Regional Trauma Services                                                                                                                      2006/2007



 Dept            Principal      Co-investigators                        Title                           Funding Source       Time Period      Grant amount
               Investigator                                                                                                   Start/End       in dollars ($)
OS         Weber, Don          Buckley, Richard        Prospective Study Examining the
                                                       Effect of Timing to Definitive             Zimmer Canada             June 2003 - Dec     $10,000.00
                                                       Treatment on the Rates of Non-union                                       2005
                                                       and Infection in Open Fractures
OS         International Hip   Buckley, R.             Fixation using Alternative Implants for    N/A                      2007 Onward             N/A
           Fracture Research   Duffy, P.               the Treatment of Hip Fractures: A
           Collaborative       Puloski, S.             multi-centre randomized trial
           (Bhandari –         Korley, R.              comparing sliding hip screws and
           McMaster)                                   cancellous screws on revision
                                                       surgery rates and quality of life in the
                                                       treatment of femoral neck fractures
                                                       (FAITH)
OS         International Hip   Buckley, R.             Hip Fracture Evaluation with               N/A                            2006              N/A
           Fracture Research   Duffy, P.               Alternatives of Total Hip Arthroplasty
           Collaborative       Puloski, S.             versus Hemi-Arthroplasty: A multi-
           (Bhandari –         Korley, R.              centre randomized trial comparing
           McMaster)                                   total hip arthoplasty and hemi-
                                                       arthroplasty on revision surgery and
                                                       quality of life in patients with
                                                       displaced femoral neck fractures
                                                       (HEALTH)
TS         Kirkpatrick, AW                             Management of Occult
                                                       Pneumothoraces in Mechanically             Canadian Trauma Trials      2005-2006         $5,000.00
                                                       Ventilated Patients                        Collaborative
TS         Kirkpatrick, AW     Marilyn Keaney, Mark    Gasless laparoscopy in weightless
                               Campbell, Tim           conditions during parabolic flight         Canadian Space Agency       2006-2007
                               Broderick, Chad Ball,                                                                                            $50,000.00
                               Kent Ranson

TS         Hameed, M,          Kirkpatrick, AK, Dyer   Societal Determinants of Trauma
           Crowshoe, L         D, Findlay C,           Risk and Outcome : Calgary Team
                               Meadows L.,             Focus is Determinants of severe            Canadian Institute of       2006-2007         $99,000.00
                               Laupland K. Kortbeek    trauma in Alberta Status Aboriginal        Health Research                             (BC & Alberta)
                               J, Ranson K, Philips,   Populations: an Observational Study
                               L, van Wijngaarden-     (includes social determinants and
                               Stephens, M             geographic mapping)
TS         Kirkpatrick, AW     Chun R, Clarkson        Intra-abdominal hypertension with          Calgary Surgical
                               CA, Laupland KB,        severe sepsis and septic shock             Research Development          2005-           $1320.00
                                                                                                  Fund




                                                                         - 229 -
    Regional Trauma Services                                                                                                                2006/2007



     Dept            Principal     Co-investigators                     Title                      Funding Source          Time Period      Grant amount
                   Investigator                                                                                             Start/End       in dollars ($)
    TS         Kirkpatrick, AW    Laupland KB, Zygun     Management of Occult                   Canadian Intensive Care
                                  D, Chun R, Ball CG,    Pneumothoraces in Mechanically         Foundation                  April 2006-       $16,000.00
                                  Kortbeek JB, Lall R.   Ventilated Patients
    TS         Kirkpatrick AW     Turner C, Hall R,      Telesonography for Trauma Initiation   Canadian Space Agency     December 2006 -    Project Grant:
               Dyer D             Ranson K, Lautner D    of a Pilot Study for the Terrestrial                                                 $185,000 +
                                                         Evaluation of a Space-Initiated                                                    $32,000 In Kind
                                                         Technology                                                                          Calgary/Banff
                                                                                                                                            Funds $28,000




•     Total funds dedicated and received to support trauma related research: $12,369,090.26




                                                                         - 230 -
           Profile of Injuries in the
           Calgary Health Region
                          April 2006 to March 2007




Prepared by:
Nancy Staniland, Manager
Sherry Elnitsky, Research Project Coordinator
February, 2008

Injury Prevention and Control Services
Healthy Living, Wellness and Citizen Engagement
http://www.calgaryhealthregion.ca/injuryprevetion
Regional Trauma Services                                                                                      2006/2007




                                Profile of Injuries in the Calgary Health Region
                                            April 2006 to March 2007

Injuries contribute significantly to the mortality and morbidity of region residents and have a significant impact
on health care utilization and quality of life. Injury prevention is a priority of the Healthy Living business unit of
the Southeast Community Portfolio. The Injury Prevention and Control Services team works across a number
of regional programs and services and with diverse community partners to reduce the likelihood, frequency
and severity of injuries in the Calgary Health Region. The profile of injuries in the Calgary Health Region
(CHR) is updated annually in order to provide timely injury surveillance and to monitor the profile over time.

The profile of injuries focuses on population based injury mortality and morbidity data (hospitalizations and
emergency department visits). The profile provides an analysis of cause specific injury data by age and
gender but underestimates the total burden of injury because it is based only on the most serious of injuries
– those resulting in an emergency department visit, hospitalization or death. Data are not available for
injuries that are presented at physicians’ offices and clinics or that are treated at home.
                           1
Methodological Notes

    •    All data are based on the regional boundaries as of December 2003 and were selected using ICD-
         10-CA codes.
    •    The most recent injury mortality data available from Alberta Health & Wellness Vital Statistics are for
         the calendar year 2005. The data include deaths to region residents.
    •    Injury morbidity data were obtained from CHR Health Records and include hospital and emergency
         department visits at all regional facilities by regional residents for the period April 2006 to March
         2007.
    •    Hospital utilization is defined as the number of discharges or separations from acute care facilities.
         Emergency department utilization is defined as the number of admissions to emergency departments
                                                       th    th
         and, since 2003-04, urgent care visits to 8 & 8 Health Care Centre have been included. Urgent
         care visits to South Calgary Health Centre are also included after 2004-05.
    •    Hospital and emergency department data sets are not mutually exclusive. If a visit to an emergency
         department results in admission to hospital, that visit will be counted in both data sets.
    •    Workplace injuries are identified by method of payment (i.e., Worker’s Compensation Board
         payment). As such, workplace injuries are also included in the overall analysis of injury cause.
    •    Injury rates for 2006-07 are based on projected population estimates because actual population data
         for this period are not yet available. All rates based on previous fiscal years are defined using Alberta
         Health and Wellness population registry data.
    •    Additional historical data (mortality and utilization) are presented where possible. These comparisons
         are based on age adjusted rates that are calculated using the same standard population (provincial
         population for the period 2003-04) to reduce the potential confounding effect of age over time. The
         most recent year is compared statistically to the baseline year of 2002-03.




                                                        - 233 -
Regional Trauma Services                                                                                                                                                                               2006/2007




                                                                         Injury Profile Highlights
Injury Mortality
    • In 2005, there were 460 injury-related fatalities in the Calgary Health Region so that for every
        100,000 regional residents, 39 died from an injury. The 2005 age adjusted mortality rate is not
        statistically different from the 2002 rate.
    • 8% of all deaths that occurred in the region in 2005 were injury-related. This means that there
        was more than one injury death per day.
    • Overall, males were more than twice as likely as females to die from an injury and, between the
        ages of 25 and 44, males were four times as likely to die from injury.
    • Another way to assess the impact of injury is by considering the potential years of life lost
        (PYLL); that is, the number of years of life lost when a person dies prematurely (in this case,
        before age 80). PYLL highlights the loss to society of early deaths.
                                                                                                                                                                               1,2
                                     Injury-Related Mortality, Calgary Health Region Residents, 2002-2005
                                                                                                  Injury Mortality

                                 N Injury                         Age Adjusted                                      Injury

    Calendar                      Related        % All                Mortality                                     Related               % All             Age Adjusted

           Year                   Deaths        Deaths                   Rate   2
                                                                                               95% CI                PYLL                 PYLL               PYLL Rate3                95% CI

           2002                      416         7.7%                     38.3                   ±3.7                14,459                23%                    1313.7                  ±21.4

           2003                      420         7.7%                     37.6                   ±3.6                14,177                23%                    1259.3                  ±20.7

           2004                      440         7.9%                     38.7                   ±3.6                15,103                25%                    1325.7                  ±21.1

           2005                      460         8.2%                     39.5                   ±3.6                15,098                24%                    1302.9                  ±20.8

       1
           The data have been updated based on December 2003 regional boundaries.
      2
           2002 is considered the baseline year.
      3
           Per 100,000 Calgary Health Region residents.

           •        In 2005, there were a total of 15,098 PYLL due to injury for a crude rate of 1,318 injury-related
                    PYLL per 100,000 Calgary Health Region residents. There is no statistical difference between
                    the 2005 age adjusted rate of injury-related PYLL compared to 2002 (baseline).

                                Proportion of Injury-Related Deaths by Age and Cause, Calgary Health Region Residents, 2005


    100%                                                                                                                                                            All other injuries^ (V90-V99, W20-X39,
                                                                                                                                                                    X50-X59, Y10-Y36, Y85-Y87, Y89)
      90%

      80%                                                                                                                                                           Poisoning (X40-X49)
      70%

      60%                                                                                                                                                           Falls (W00-W19)
      50%

      40%
                                                                                                                                                                    Violence (X85-Y09)
      30%

      20%
                                                                                                                                                                    Suicide (X60-X84)
      10%

       0%
                                 Under 25                     25 to 44                             45 to 64                               65+                       Transportation (V01-V89)
% of all deaths due to injury
                                  (n=77)                      (n=146)                              (n=125)                              (n=112)
                                  36%                           53%                                  12%                                  3%
                                                                             Age Grouping
 ^The most common injury causes in the All Other Injuriescategory by age group are: Under 25: drowning (5%) and fire (3%) ; 25 to 44: drowning (3%); 45 to 64: fire (3%). The other injury causes in each age group
 were relatively infrequent (less than 3%) or unspecified.

           •        The three leading causes of death for residents up to 44 years of age were transportation,
                    suicide and violence. The leading causes of death for residents over the age of 44 were
                    suicide, transportation and falls. Regardless of age, males were five times more likely than

                                                                                               - 234 -
Regional Trauma Services                                                                                                                                                                                                                                        2006/2007



                                   females to die from violence-related injuries and three times more likely to die from suicide and
                                   transportation-related injuries.

Injury Morbidity
All Injuries

                        •          About eight out of every 100 hospitalizations were injury-related and one in four emergency
                                   department visits was injury-related in 2006-07.
                    Hospitalizations and Emergency Department Visits by Injury Cause, Calgary                                                                Hospitalization and Emergency Department Visit Crude Rates by Injury Cause per
                    Health Region Residents, 2006-07                                                                                                         100,000 Calgary Health Region Residents, 2006-07
                                      109,867
        110,000                                                                                                                                            10,000
                                                                                                                                                                             9092
        100,000                                                                                                                                             9,000
                                                                                               Hospitalization                                                                                                                     Hospitalization Rate
                    90,000                                                                     Emergency Department Visits                                                                                                         Emergency Department Visit Rate
                                                                                                                                                            8,000

                    80,000
                                                                                                                                                            7,000
                    70,000
                                                                                                                                                            6,000
                    60,000
                                                                                                                                                            5,000
                    50,000
                                                                                                                                                            4,000
                    40,000
                                                     30,980
                                                                                                                                                            3,000                            2564
                    30,000

                    20,000                                                                                                                                  2,000
                                                                      10,271                                                                                                                                      850
                                 7,746                                                                                                                      1,000      641
                    10,000                                                                               4,894
                                                 3,584                                                                      3,985                                                      297
                                                                  1,097            473 1,314       421                365                                                                                    91              39 109         35   405                330
                                                                                                                                                                                                                                                               30
                           0                                                                                                                                   0
                                 All Injuries^     Falls        Transportation      Suicide         Violence          Poisoning                                       All Injuries^      Falls         Transportation        Suicide        Violence       Poisoning
                               (V01-Y36, Y85-    (W00-W19)        (V01-V89)        (X60-X84)       (X85-Y09)          (X40-X49)                                     (V01-Y36, Y85-     (W00-W19)         (V01-V89)          (X60-X84)      (X85-Y09)       (X40-X49)
                                 Y87, Y89)                                                                                                                            Y87, Y89)
                                                                       Injury Cause                                                                                                                                Injury Cause
      ^ This category includes Falls, Transportation, Suicide, Violence, Poisoning and all other injuries.                                            ^ This category includes Falls, Transportation, Suicide, Violence, Poisoning and all other injuries.


                        •          There were 7,746 injury-related hospitalizations,ii a rate of 641 per 100,000 regional residents.
                                   This means that there were 21 injury-related hospitalizations in an average day.
                        •          There was a total of 109,867 injury-related emergency department visitsiii resulting in a rate of
                                   9,092 per 100,000 regional residents. That means, on average, a Calgary Health Region
                                   resident was admitted to an emergency department for an injury-related event once every five
                                   minutes.
                        •          Rates for fall-related injuries were higher than all other injury causes for both hospital and
                                   emergency department utilization.
                    Injury-Related Hospitalizations: Age and Gender Specific Utilization Rate per                                                          Injury-Related Emergency Department Visits: Age and Gender Specific Utilization
                    100,000 Calgary Health Region Residents, 2006-07                                                                                       Rate per 100,000 Calgary Health Region Residents, 2006-07
                                                                                                                 Female     Male                                                                                                                       Female        Male
                    7000                                                                                                                                   20000

                                                                                                                                                           18000
                    6000

                                                                                                                                                           16000

                    5000
                                                                                                                                                           14000
 Number of Events




                                                                                                                                        Number of Events




                                                                                                                                                           12000
                    4000

                                                                                                                                                           10000
                    3000
                                                                                                                                                           8000


                    2000                                                                                                                                   6000

                                                                                                                                                           4000
                    1000
                                                                                                                                                           2000

                       0                                                                                                                                       0
                                0-4       5-14    15-24       25-34       35-44   45-54    55-64     65-74        75-84      85+                                      0-4       5-14    15-24        25-34        35-44^   45-54   55-64    65-74      75-84         85+
                               (1%)      (19%)    (16%)       ( 6%)       (10%)   (12%)    (9%)      (7%)         (10%)     (15%)                                   (19%)      (40%)    (37%)       ( 30%)        (28%)    (24%)   (19%)    (14%)      (14%)        (18%)

                                                                          Age Groups                                                                                                                         Age Groups
                                                  (% of all hospitalizations that are injury-related)                                                                                     (% of all emergency department visits that are injury-related)
                                                                                                                                                              ^Gender is missing for 2 cases.




                                                                                                                            - - 234 -
                                                                                                                              235 -
Regional Trauma Services                                                                                                                                                                                                   2006/2007



                      •       Injury-related hospitalizations increased with age. Males were at higher risk for hospitalization
                              up to age 54. As age increased, however, females experienced a greater risk for injury-related
                              hospitalization, particularly from age 75 on.
                      •       Injury accounted for a larger proportion of all hospitalizations in children, young adults and the
                              most senior residents.
                      •       Emergency department utilization rates were higher for younger age groups but rates for those
                              85+ were also high. Males were at higher risk for injury-related emergency department visits,
                              particularly between the ages of 15 and 44. As with hospitalizations, the risk for an injury-
                              related emergency department visit was higher for females at older ages.
                      •       Injury accounted for over a third of all emergency department visits in 5-14 years olds and 15-
                              24 year olds and over a quarter of all visits in 25-34 and 35-44 year olds.
                    Age Adjusted Injury-Related Hospitalization Rate per 100,000 Calgary Health                                         Age Adjusted Injury-Related Emergency Department Visit Rate per 100,000
                    Region Residents, 2002-03 to 2006-07                                                                                Calgary Health Region Residents, 2002-03 to 2006-07


                      740                                                                                                                10000

                                                                                                                                          9000
                      720

                                                                                                                                          8000
                      700
                                                                                                                                          7000




                                                                                                                     Number of Events
                      680
 Number of Events




                                                                                                                                          6000


                      660                                                                                                                 5000

                                                                                                                                          4000
                      640

                                                                                                                                          3000
                      620
                                                                                                                                          2000

                      600
                                                                                                                                          1000

                      580                                                                                                                   0
                                2002-03           2003-04            2004-05             2005-06   2006-07*                                           2002-03            2003-04           2004-05            2005-06   2006-07

                                                                       Year                                                                                                                  Year

                            *Statistically different from the 2002-03 rate (p ≤ 0.05).                                                           *Statistically different from the 2002-03 rate (p ≤ 0.05).


                      •       Overall, injury-related hospitalization rates have declined. The rates in 2006-07 are statistically
                              lower than 2002-03.
                      •       Injury-related emergency department visit rates, however, have increased. Compared to 2002-
                              03, the rate in 2006-07 was statistically higher.

                                             Injury-Related Hospitalization Rate by Injury Cause: Age Adjusted Rate
                                                    per 100,000 Calgary Health Residents, 2002-03 to 2006-07
                                                                                                         Age Adjusted Rate per 100,000 (95% CI)
                                                    Injury Cause
                                                                                         2002-03          2003-04                                 2004-05                    2005-06                     2006-07

                                                 Falls                            337 (±11.2)        339 (±11.1)                            310 (±10.4)                  298 (±10.0)                 *305 (±10.0)

                                                 Transportation                     92 (±5.6)          88 (±5.5)                                 87 (±5.4)                 89 (±5.4)                     90 (±5.3)

                                                 Suicide                            59 (±4.5)          48 (±4.0)                                 41 (±3.7)                 37 (±3.5)                   *39 (±3.5)

                                                 Violence                           33 (±3.3)          32 (±3.3)                                 28 (±3.1)                 36 (±3.4)                     35 (±3.3)

                                                 Poisoning                          21 (±2.8)          24 (±2.9)                                 31 (±3.2)                 29 (±3.1)                   *30 (±3.1)

                                                 Workplace                          21 (±2.8)          24 (±3.0)                                 17 (±2.4)                 15 (±2.3)                     20 (±2.6)

                                               *Statistically different from the 2002-03 rate.


                      •       Hospitalization rates due to fall-related and suicide-related injuries were statistically lower in
                              2006-07 compared to 2002-03, however, the rate for poisoning-related injuries was statistically
                              higher.



                                                                                                         - - 234 -
                                                                                                           236 -
Regional Trauma Services                                                                                                                                                                                                2006/2007



                                           Injury-Related Emergency Department Rate by Injury Cause: Age Adjusted Rate
                                                  per 100,000 Calgary Health Residents, 2002-03 to 2006-071
                                                                                                        Age Adjusted Rate per 100,000 (95% CI)
                                            Injury Cause
                                                                           2002-03                  2003-04                                   2004-05                  2005-06                       2006-07

                                         Falls                      2,207 (±28.1)              2,426 (±29.1)                                2,297 (±28.0)           2,565 (±29.2)            *2,624 (±29.2)

                                         Transportation                 773 (±16.3)                 817 (±16.6)                              786 (±16.2)             862 (±16.8)              *854 (±16.5)

                                         Suicide                        122 (±6.4)                  114 (±6.2)                               104 (±5.9)              106 (±5.9)               *108 (±5.8)

                                         Violence                       316 (±10.4)                 353 (±10.9)                              349 (±10.8)             374 (±11.0)              *405 (±11.3)

                                         Poisoning                      274 (±9.7)                  334 (±10.9)                              334 (±10.5)             315 (±10.1)              *329 (±10.2)

                                         Workplace                      543 (±13.5)                 636 (±14.5)                              658 (±14.6)             774 (±15.7)              *897 (±16.7)

                                        * Statistically different from the 2002-03 rate.


                      •     Emergency department visit rates for suicide-related injuries were statistically lower in 2006-07
                            compared to 2002-03. But rates for all other injury causes were statistically higher in 2006-07
                            compared to 2002-03.
Unintentional Injury
Falls
                    Fall-Related Hospitalizations: Age and Gender Specific Utilization Rate per                                     Fall-Related Emergency Department Visits: Age and Gender Specific Utilization
                    100,000 Calgary Health Region Residents, 2006-07                                                                Rate per 100,000 Calgary Health Region Residents, 2006-07
                                                                                            Female    Male                                                                                                     Female    Male
                    6000                                                                                                            14000



                    5000                                                                                                            12000



                                                                                                                                    10000
                    4000
                                                                                                                 Number of Events
 Number of Events




                                                                                                                                     8000
                    3000

                                                                                                                                     6000

                    2000
                                                                                                                                     4000


                    1000
                                                                                                                                     2000



                      0                                                                                                                0
                           0-4   5-14      15-24   25-34   35-44   45-54    55-64   65-74   75-84     85+                                     0-4   5-14    15-24    25-34   35-44   45-54   55-64     65-74   75-84     85+
                                                           Age Groups                                                                                                        Age Groups




                      •     Fall-related hospitalization rates were highest in the older population, particularly after age 65.
                            Females were more vulnerable than males to a fall-related injury resulting in hospitalization.
                      •     The risk of a fall-related emergency department visit was highest for the youngest and oldest
                            segments of the population. Males were at greater risk in younger age groups while females
                            were more at risk for a fall-related emergency department visit in older age groups.
                      •     Fall-related injury visits accounted for 75% of all injury-related hospitalizations and 61% of all
                            emergency department visits for residents 65 and older. Just over a third (38%) of these fall-
                            related hospitalizations were due to a hip fracture while 12% of the fall-related emergency
                            department visits involved a hip fracture.




                                                                                                     - - 234 -
                                                                                                       237 -
    Regional Trauma Services                                                                                                                                                                                         2006/2007



                                    Fall-Related Hip Fracture Hospitalization: Age Adjusted Rate per
                              100,000 Calgary Health Region Residents Aged 65+ Years, 2002-03 to 2005-06
                                                                                      Fall-Related Hip Fracture Hospitalization:1,2

                                                             Year                         Age adjusted Rate per
                                                                                                                                                                    95% CI
                                                                                      100,000 Residents Aged 65+

                                                       2002-03                                                 625                                                  ±49.81

                                                       2003-04                                                 690                                                  ±51.21

                                                       2004-05                                                 646                                                  ±48.41

                                                       2005-06                                                 570                                                  ±44.23

                                                       2006-07                                                 565                                                  ±43.28

                                             1
                                                 ICD-10-CA codes: S72.0-S72.2
                                             2
                                                 Includes utilization in both rural and urban facilities, based on December 2003 regional boundaries.

•   Hip fractures cause disability or death and can have a major effect on independence and on quality of
    life. The hospitalization rate for hip fractures due to falls for those 65 years and older is an indicator
    used in the Regional Falls Project, initiated in 2004-05. Although the rate in 2006-07 was slightly lower
    than both the baseline year of 2002-03 and the year the project was initiated, these differences were
    not statistically significant.
    Transportation
                        Transportation-Related Hospitalizations: Age and Gender Specific Utilization Rate                              Transportation-Related Emergency Department Visits: Age and Gender Specific
                        per 100,000 Calgary Health Region Residents, 2006-07                                                           Utilization Rate per 100,000 Calgary Health Region Residents, 2006-07
                                                                                               Female    Male                                                                                               Female    Male
                        250                                                                                                            2000


                                                                                                                                       1800


                        200                                                                                                            1600


                                                                                                                                       1400
                                                                                                                    Number of Events
     Number of Events




                        150                                                                                                            1200


                                                                                                                                       1000


                        100                                                                                                             800


                                                                                                                                        600


                         50                                                                                                             400


                                                                                                                                        200


                          0                                                                                                               0
                               0-4    5-14   15-24   25-34    35-44   45-54   55-64    65-74   75-84     85+                                  0-4    5-14   15-24   25-34   35-44   45-54   55-64   65-74   75-84     85+
                                                              Age Groups                                                                                                    Age Groups



•   Transportation was the second leading cause of injury-related hospitalization and emergency
    department utilization and was a particular concern among residents between 15-24 and 25-34 years
    of age. Males in these age groups were at least twice as likely as females to be hospitalized or visit an
    emergency department for transportation-related injuries.




                                                                                                        - - 234 -
                                                                                                          238 -
    Regional Trauma Services                                                                                                                                                                                        2006/2007



    Attempted Suicide
                    Suicide-Related Hospitalizations: Age and Gender Specific Utilization Rate per                                    Suicide-Related Emergency Department Visits: Age and Gender Specific
                    100,000 Calgary Health Region Residents, 2006-07                                                                  Utilization Rate per 100,000 Calgary Health Region Residents, 2006-07

                                                                                              Female     Male                                                                                               Female    Male

                         300                                                                                                           1200




                         250                                                                                                           1000




                         200                                                                                                            800
     Number of Events




                                                                                                                   Number of Events
                         150                                                                                                            600




                         100                                                                                                            400




                          50                                                                                                            200




                           0                                                                                                              0
                                0-4    5-14   15-24   25-34   35-44   45-54   55-64   65-74   75-84     85+                                   0-4    5-14   15-24   25-34   35-44   45-54   55-64   65-74   75-84    85+
                                                              Age Groups                                                                                                    Age Groups




•   Attempted suicide was the third leading cause of injury-related hospitalizations and the fourth leading
    cause of emergency department visits. Rates were highest for 15-24 year olds but, unlike the other
    injury causes, females were at greater risk. Females aged 15-24 were almost twice as likely as males
    at this age to be hospitalized and almost three times as likely to be seen at an emergency department
    for a suicide-related injury. This gender difference, though less extreme, is maintained across most of
    the lifespan.
    Violence
                        Violence-Related Hospitalizations: Age and Gender Specific Utilization Rate per                               Violence-Related Emergency Department Visits: Age and Gender Specific
                        100,000 Calgary Health Region Residents, 2006-07                                                              Utilization Rate per 100,000 Calgary Health Region Residents, 2006-07

                                                                                              Female     Male                                                                                               Female    Male
                         180                                                                                                           2000


                         160                                                                                                           1800


                                                                                                                                       1600
                         140

                                                                                                                                       1400
                         120
                                                                                                                   Number of Events
     Number of Events




                                                                                                                                       1200
                         100
                                                                                                                                       1000
                          80
                                                                                                                                        800

                          60
                                                                                                                                        600

                          40
                                                                                                                                        400

                          20                                                                                                            200


                           0                                                                                                              0
                                0-4    5-14   15-24   25-34   35-44   45-54   55-64   65-74   75-84     85+                                   0-4    5-14   15-24   25-34   35-44   45-54   55-64   65-74   75-84    85+
                                                              Age Groups                                                                                                    Age Groups



•   Violence-related injuries requiring hospitalization or an emergency department visit were highest for
    residents 15-24, 25-34, and 35-44 years of age, particularly males.
•   Compared to females between 15 and 44 years of age, males were three to nine times more likely to
    be hospitalized for a violence-related injury and two to three times more likely to be seen in the
    emergency department for an injury due to violence.




                                                                                                       - - 234 -
                                                                                                         239 -
Regional Trauma Services                                                                                                                                                                                                                     2006/2007



Poisoning
                    Poisoning-Related Hospitalizations: Age and Gender Specific Utilization Rate per                                           Poisoning-Related Emergency Department Visits: Age and Gender Specific
                    100,000 Calgary Health Region Residents, 2006-07                                                                           Utilization Rate per 100,000 Calgary Health Region Residents, 2006-07
                                                                                                    Female     Male                                                                                                                Female     Male

                    160                                                                                                                        700


                    140                                                                                                                        600


                    120
                                                                                                                                               500
 Number of Events




                                                                                                                            Number of Events
                    100
                                                                                                                                               400

                     80

                                                                                                                                               300
                     60

                                                                                                                                               200
                     40


                                                                                                                                               100
                     20


                     0                                                                                                                           0
                             0-4      5-14   15-24   25-34      35-44   45-54      55-64   65-74   75-84       85+                                       0-4           5-14   15-24   25-34     35-44   45-54      55-64   65-74   75-84       85+
                                                                Age Groups                                                                                                                      Age Groups

                         •     In general, poisoning-related hospitalization increased with age. Males aged 85 and older were
                               particularly vulnerable for a poisoning-related hospitalization.
                         •     Rates for poisoning-related emergency department visits were highest for both males and
                               females between the ages of 0-4 and 15-24 years.
Workplace Injuries
                    Workplace-Related Hospitalizations: Age and Gender Specific Utilization Rate per                                            Workplace-Related Emergency Department Visits: Age and Gender Specific
                    100,000 Calgary Health Region Residents, 2006-07                                                                            Utilization Rate per 100,000 Calgary Health Region Residents, 2006-07

                                                                                                    Female         Male                                                                                                            Female      Male
                    70                                                                                                                         3,500



                    60                                                                                                                         3,000



                    50                                                                                                                         2,500
 Number of Events




                                                                                                                          Number of Events




                    40                                                                                                                         2,000



                    30                                                                                                                         1,500



                    20                                                                                                                         1,000



                    10                                                                                                                          500



                     0                                                                                                                               0
                              15-24          25-34           35-44         45-54           55-64           65-74                                               15-24          25-34           35-44        45-54           55-64           65-74
                                                               Age Group                                                                                                                          Age Group


                         •     For residents between the ages of 15 and 74, there was a total of 220 workplace-related
                               injuries that required hospitalization. This represents a rate of 18 workplace injury-related
                               hospitalizations per 100,000 residents aged 15-74.
                         •     In this same age range, there were 11,099 emergency department visits involving a workplace-
                               related injury at a rate of 918 workplace injury-related emergency department visits per
                               100,000 regional residents.
                         •     Overall, males were seven times more likely than females to experience a workplace-related
                               injury that resulted in hospitalization. This gender difference increased depending on age.
                               Males under age 55 were between three and 13 times more likely than females to be
                               hospitalized for a workplace-related injury. Though much less extreme, this gender difference
                               was maintained between the ages of 55 and 74.
                         •     Regardless of age, males were four times more likely to visit the emergency department for a
                               work-related injury. Males under the age of 45 were between four and five times more likely
                               than females to visit the emergency department for an injury sustained in the workplace.


                                                                                                              - - 234 -
                                                                                                                240 -
1
ii
      This represents 82% of all injury-related hospitalizations in regional facilities; 16% were to non-
      residents of the region and 2% had no information about regional status.
iii
      This represents 90% of all injury-related visits to regional facilities; 9% were to non-residents of the
      region and 1% had no information about regional status.

								
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