International TraumaCare: Critical Care for Critical Times

ewspapers and television newscasts daily confront us with our community’s latest unfortunate trauma victims. Trauma indiscriminately cuts across all of society, our friends and family members, our children, our grandparents, our prom queens and our quarterbacks — no one is exempt. A small patch of ice or simply being in the wrong place at the wrong time is all it takes to become the latest trauma statistic. Despite this, or perhaps because we are inured, we too often forget that in the United States, trauma is the leading cause of death among those younger than 45 years of age and the third leading cause of death in all ages. Trauma causes more deaths than all other causes combined for those younger than 24 years of age. Although frequently overshadowed by much less common diseases and illnesses, many with telethons, Web sites and supporting organizations, death from injury is the leading cause of years of life lost in the United States — more than twice the number of years of life is lost compared to cancer, the next leading cause, and three times more than heart disease. Trauma accounts for roughly 125,000 deaths per year in the United States. In the developing world, as deaths due to disease decrease, the incidence of death due to trauma grows as motor vehicle use expands exponentially. In many of these countries, the death rate is more than twice that of developed countries. Trauma care requires a multimodal approach to combat this epidemic.

Our Beginnings
International TraumaCare was formed in 1988 as the International Trauma Anesthesia and Critical Care Society (ITACCS) with the specific mission to further the development of anesthesiologists and intensivists as traumatologists, to be a forum to share ideas and techniques, and to provide an educational framework to train and nurture traumatologists, all to improve care for trauma patients. International TraumaCare is the leading international multidisciplinary not-for-profit society dedicated to the worldwide advancement of health care of trauma patients. The term “traumatologist” includes not only trauma surgeons but also anesthesiologists and emergency medicine physicians along with other physician, nonphysician trauma care specialists and even nonclinical personnel. Given the multidisciplinary nature of trauma care, ITACCS evolved into the multispecialty society International TraumaCare for all traumatologists. International TraumaCare counts among its nearly 2,000 worldwide members a variety of specialties, including, but not limited to, anesthesiology, intensive care medicine, emergency medicine and surgery. International TraumaCare has unrivalled capabilities for assembling intellectual resources, marshalling multinational governmental support and concentrating international technology and information transfer to the benefit of various projects. International TraumaCare has a reputation for producing and sponsoring high-quality educational programs and academic and research activities. International TraumaCare has contributed to and/or organized more than 100 major trauma care textbooks and monographs. Among these is the 2007, two-volume Trauma, edited by Wilson, Grande and Hoyt, with contributions worldwide from International TraumaCare faculty. It has received great reviews and is the most up-to-date and definitive trauma textbook.

Projects
International TraumaCare’s dedication to the worldwide improvement of all aspects of trauma care is evidenced in many successful projects. This dedication is further illustrated in the promotion of skills and knowledge of traumatology through an ambitious, comprehensive and complex educational strategy that includes the availability of educational programs pertinent to all who contribute to the care of the trauma victim, encompassing practitioners in trauma centers and in the field. Given that trauma is among the world’s leading causes of mortality and morbidity, it is rare that anyone providing medical care will avoid caring for trauma victims. Practitioners from all backgrounds reap enormous benefits from their involvement with International TraumaCare.

Such involvement is particularly evidenced by one of International TraumaCare’s current efforts, the Sedation and Airway-support For Everyone (SAFE) special project. International TraumaCare recognizes that an increasing number of procedures and minor operations are being performed in the out-of-operating-room setting without the involvement of an anesthesia provider. The SAFE program’s mission is to improve patient safety by creating a standard international training program for procedural sedation and out-of-operating-room airway management. SAFE is targeted to nonanesthesiologist physicians, nurses, physician assistants, medics and other paraprofessional personnel involved in sedation and out-of-operating-room airway management; yet anesthesiologists will find much useful information as well. The training consists of Web-based education followed by simulation training with clinical integration at certified centers throughout the world. A textbook, authored by more than 40 International TraumaCare faculty, has an anticipated publication date of spring 2008. For additional information, please contact the International TraumaCare SAFE special project at itcsedation@google.com.

Educational Meetings
The hallmark of International TraumaCare has always been its educational endeavors. International TraumaCare is accredited by the Accreditation Council for Continuing Medical Education to offer continuing medical education (CME) for physicians. International TraumaCare’s annual scientific meeting is the international forum for all traumatologists and includes current practice, basic science and clinical research. Internationally recognized faculty present cutting-edge topics for all members of the trauma team. TraumaCare 2007, the 20th Annual TraumaCare Symposium, was a wonderful success last May 14-16 in Las Vegas. Traumatologists from around the world met and discussed advances in the care of trauma victims. The educational and patient benefits derived from these diverse interactions are enormous. TraumaCare 2008 (www.traumacare2008.com) will be held jointly with the Japanese Society of Anesthesiologists Annual Meeting on June 11-13, 2008, in Yokohama Japan. As is International TraumaCare’s custom, the annual meeting rotates annually among the continents whenever possible. In addition to TraumaCare 2008 in Yokohama, please mark your calendars for TraumaCare 2009 (www.traumacare2009.com) in Ulm, Germany, TraumaCare 2010 (www.traumacare2010.com) in Delhi, India, and TraumaCare 2011 in Buenos Aires, Argentina. All are invited!

International TraumaCare’s educational endeavors do not end with the annual trauma care scientific meetings. The organization provides a large number of trauma care CME symposia (www.itaccs.com/programs/index.htm) throughout the world. The diverse faculty brings a great depth of experience to these trauma team seminars, which results in successful programs. “Trauma: The Team Approach” seminars are exceptionally popular, reaching a large and varied audience.

Trauma care encompasses mass casualty situations as well as the more common single victim or several victims, including but not limited to natural disasters, mass transit accidents and the unleashing of chemical and biological weapons. International TraumaCare recognized the need for a special program to assist in gaining expertise in managing mass casualty situations and developed the International Chief Emergency Physician (ICEP) course (www.
icep-itaccs.com). International TraumaCare has been organizing ICEP since 1997. The objective of the ICEP course is to teach physicians already knowledgeable in prehospital emergency medicine how to manage and integrate with emergency services the medical care of casualties from a mass casualty incident. The basic curriculum is adaptable to meet the requirements of the participants. The ICEP course trains participants as leaders within a local command structure to manage all medical aspects of mass casualty incidents and disasters. Participants learn how to define medical priorities and analyze and organize key issues such as triage of victims, medical care (and its limitations), prehospital care, and transportation at mass casualties and disasters. The course is principally for physicians likely to be responders in mass casualty incidents but will benefit all prehospital physicians, air emergency physicians, emergency medicine specialists, general and trauma surgeons, anesthesiologists and rural general practitioners.

Another avenue International TraumaCare utilizes for education and the dissemination of information is TraumaCare. Now in its 18th year, this peer-reviewed journal provides current information to the multidisciplinary International TraumaCare membership. All traumatologists and any others involved with the trauma patient care will find articles of interest and immediate application in TraumaCare. TraumaCare offers a forum for sharing ideas and techniques for managing trauma patients and provides an educational framework to train and nurture traumatologists. Published quarterly, TraumaCare features current developments in the field, such as articles on clinical practice, research, case reports, book reviews, meeting reports, product news and more. TraumaCare also offers the opportunity for trauma CME credits. There is no better intersection of trauma, anesthesia and critical care than TraumaCare. The journal is Web-based and can be found at www.itaccs.com/traumacare/index.htm.

Research Support
International TraumaCare also supports the advancement of trauma care through research. Its Research Award Program (www.itaccs.com/research/index.htm) and Trauma and Resuscitation International Group for Experimentation and Research (TRIGER) (www.itaccs.com/triger/index.htm) are part of ongoing efforts to bring trauma care on par with the same level of development as other medical specialties. International TraumaCare recognizes that access to peer-reviewed funding is enhanced by evidence of successful prior experimentation. The Research Award Program is intended to provide initial support for investigators who seek to obtain further support for the continuation of their projects. Awards are made within the general field of perioperative trauma, anesthesia, emergency medicine and critical care, including basic science or clinical research, clinical management, education or administration.

TRIGER is an extension of the original mission of International TraumaCare. International TraumaCare recognizes that extramural funding is increasingly difficult to obtain and increasingly complex to administer. These difficulties are exacerbated by increasing demands on clinician scientists along with diminishing nonclinical time. Just as trauma medicine encompasses diverse fields of medicine, TRIGER is committed to an interdisciplinary approach to trauma research. This approach fosters interactions between traumatologists in a variety of fields and connects trauma medicine to industry. TRIGER provides an institutional infrastructure that encourages and supports its physician scientists by serving as an interface between clinical investigators and sponsors of clinical trials of drugs and devices, outcomes/quality improvement and quality of life studies. TRIGER is able to conduct and administer both federallyfunded clinical trials and industry-sponsored trials through research, education, intervention and health promotion, applying the highest ethical and scientific standards. As a central clearinghouse, TRIGER facilitates communication within the trauma community. TRIGER offers online research information and direct technical support for the clinical investigative community. TRIGER is able to provide a high level of support services for clinical trials to help investigators meet the demands of industrial sponsors and provides the infrastructure necessary to support clinical research. By fostering academic collaboration, effecting communication with industrial sponsors, and promoting a focused and structured administrative process, TRIGER is able to conduct research and translate the resulting information into treatment modalities that improve patient care and health. TRIGER is able to coordinate developments in trauma care research, identify gaps in scientific knowledge, stimulate and monitor extramural research, keep abreast of scientific developments and public policy as they pertain to trauma care, and disseminate service-based information to the public, media and policymakers. TRIGER improves health and quality of life by facilitating trauma research, with particular emphasis on multicenter studies.

As International TraumaCare looks forward, improving trauma care in developing nations is an important component of its mission. International TraumaCare has assisted national and international organizations in developing functional trauma care guidelines, educational programs and trauma systems. A variety of educational and supportive programs are in place to assist countries in providing outstanding trauma care to their citizens. As part and parcel to these efforts, International TraumaCare is proud of its reinvigorated South American component with the creation of the Latin American Trauma Anesthesia and Critical Care Society (www.lataccs.com.ar), a component society dedicated to the advancement of trauma care in the Spanish-speaking world. Chile welcomed International TraumaCare and hosted a wonderfully received TraumaCare 2006 in Santiago. Other successful trauma programs have taken place in Latin America since that meeting. More are planned in the near future. Many are taught in both Spanish and English. Additionally, International TraumaCare is looking forward with great anticipation to TraumaCare 2011 in Buenos Aires, Argentina, International TraumaCare’s next annual meeting in Latin America.

International TraumaCare is a recognized leader in trauma care. Multidisciplinary traumatology is a broad field encompassing overlapping practices of medicine. International TraumaCare promotes the development of traumatologists, providing a forum for sharing ideas and techniques for the management of trauma patients and an educational framework to train and nurture trauma care specialists. The breadth of International TraumaCare is one of its major strengths. Sharing ideas and experiences with those around the world gives International TraumaCare a unique perspective as a truly international organization. Discussions among international colleagues with diverse backgrounds and experiences invariably lead to new and exciting ideas and solutions. International TraumaCare continues its mission to ensure excellence in trauma care through educational, research and supportive endeavors.

The upcoming years present numerous challenges for traumatologists. We must provide trauma care leadership in our hospitals and communities to ensure safety for our friends and family in these uncertain times. International TraumaCare enhances the opportunity for excellence in trauma care. For more information, please visit www.itaccs.com.

James G. Cain, M.D., is Director of Trauma Anesthesiology, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and Associate Professor, University of Pittsburgh. He is Immediate Past President of the West Virginia State Society of Anesthesiologists.

Christopher M. Grande, M.D., M.P.H., is Executive Director, Trauma International, Baltimore, Maryland.