Trauma Anesthesiology - American Society of Anesthesiologists

What is trauma anesthesiology?

Statement of Principles: Trauma Anesthesiology

Hot off the press:
Guidelines for the Management of Severe Traumatic Brain Injury, 4th Ed
The Brain Trauma Foundation released its updated Guidelines in September 2016. These evidence-based Guidelines summarize the current recommendations to be used in the development of treatment protocols for patients with severe traumatic brain injury.

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ASPR TRACIE-Mass Burn Event Overview
The Office of the Assistant Secretary for Preparedness and Response (Technical Resources, Assistance Center, and Information Exchange) created this document to provide guidance for health care coalitions, burn centers, state public health professionals, health care entities, and other stakeholders planning for a burn mass casualty incident.

ASPR TRACIE-Post-Mass Shooting Programs and Resources Overview
The Office of the Assistant Secretary for Preparedness and Response (Technical Resources, Assistance Center, and Information Exchange) created this document to provide information on programs and resources available to communities affected by a mass-shooting event.

Stop the Bleed
Launched in October of 2015 by the White House, Stop the Bleed is a national awareness campaign and a call to action. Stop the Bleed is intended to cultivate grassroots efforts that encourage bystanders to become trained, equipped, and empowered to help in a bleeding emergency before professional help arrives. This site contains links to training and other resources. A brief article summarizing the program is available from the April 2017 issue of the ASA Monitor

Trauma Anesthesiology Fellowships:

University of Texas Health Science Center, Houston
The Texas Medical Center is the largest medical center in the world encompassing 700 acres with 42 institutions and 13 renowned hospitals employing over 60,000 people.  Rotations include Emergency Department/Trauma (ATLS certification course included), Shock/Trauma ICU, trauma operating rooms – emergency general surgery, trauma orthopedics, burn, and neuro trauma at one of the busiest level 1 trauma centers in the United States.  

There are numerous elective opportunities including Burn ICU, Neuro IC, regional anesthesia, echocardiography /ultrasound, trauma radiology, hyperbaric medicine; pre-hospital rotations including Memorial Hermann Life Flight – one of the busiest air medical programs in the country and the Houston Fire Department Emergency Medical Services.  We have a strong commitment to clinical and basic science research and require all of our fellows to participate in some form of research.  The world renowned Center for Translational Injury Research at the UT Houston Medical School provides many research opportunities for future academic physicians. We have two one-year clinical fellowship positions and offer a second critical care year to interested applicants.  Combined multi-year programs with anesthesiology subspecialties can be arranged. Applications are considered on a rolling basis with start dates any time during the year.

University of Washington, Harborview Medical Center
The University of Washington offers a faculty fellowship in trauma anesthesiology at Harborview Medical Center in Seattle. The program is designed to offer education and training in perioperative trauma medicine including prehospital care, emergency medicine, anesthesia and intensive care medicine. In the operating room the fellow will be exposed to all types of trauma anesthesia/trauma surgery, including injuries to the head, spine, extremities, chest, and abdomen, with additional emphasis on pediatric trauma, burns, regional anesthesia for trauma, and trauma analgesia. This experience is supplemented with a variety of scheduled conferences and clinical rounds at Harborview Medical Center (HMC), most of which are interdisciplinary and emphasize the importance of the trauma anesthesiologist's role as a member of interdisciplinary trauma team. In addition, opportunities are provided for fellow participation in a variety of ongoing clinical research projects and related academic activities.

University of Maryland, R Adams Cowley Shock Trauma Center
A trauma anesthesiology fellowship at the R Adams Cowley Shock Trauma Center in Baltimore, Maryland consists of 12 months of training split between operating rooms, electives and research.  Fellows also have the opportunity to fly with the Maryland State Police troopers to observe pre-hospital patient care and complete the Advanced Trauma Life Support course.

The main objective of the STC Anesthesia Fellowship is to gain exposure to a variety of medical and surgical conditions encountered in acutely injured patients.  Our goal for the Anesthesiology Fellow is to become an expert in the field of trauma/critical care and excel in the management of difficult traumatic airways, complicated patients, and novel techniques of resuscitation.

University of California, San Francisco
The Trauma Anesthesiology Fellowship curriculum provides in-depth training in all anesthesia relevant aspects of trauma and acute care surgery. It is a one-year non-ACGME program intended for physicians that have completed their residency in anesthesiology. The goal is to reach a level of competency and governance in trauma and emergency acute care surgery that enables the graduates to take on a leadership role in the respective field. Fellows will work as a clinical attending on average 2 days per week, with the additional 3 days per week devoted to the fellowship program much of which will involve clinical care. Fellows will take on average two nights of call per month. This will provide salary support during the clinical year.

University of Alabama
The UAB Department of Anesthesiology and Perioperative Medicine is a large and successful organization with over 250 employees and a budget exceeding $19 million annually. The department and its affiliates provide anesthesia services for five hospitals (UAB, VA, Highlands, Children’s, and Callahan Eye Foundation) and one freestanding one-day surgical center (Children’s South Pediatric Outpatient Center). The department has recently expanded to include the Division of Community Anesthesiology providing anesthesia services at St Vincent’s Hospital, a large private practice community hospital.

The University of Alabama Hospital is the primary training site for the Anesthesia Trauma and Acute Care (ATAC) fellowship. It is a 1,046 bed tertiary care facility providing more than 25,000 surgical procedures annually. This parent institution is well recognized nationally in several subspecialty areas, including trauma.

UAB Hospital is the only ACS accredited Level I Trauma Center in Alabama, and as such has a huge catchment area, placing it among the busiest trauma centers in the nation.

The program consists of 12 months of post-graduate training after successful completion of an accredited residency program in Anesthesiology. The core rotations include: ED Trauma Bay, OR Trauma, Trauma and Burns ICU. Numerous electives are available: pre-hospital care (Life Saver helicopter transport), ECHO (TTE and TEE), Critical Care Transport (ground and jet), Blood Banking, Emergency Radiology, and Emergency Medicine, just to name a few. The program allows for specific interests to be developed and works diligently to provide new rotations as requested.

The department also ranks in the top 10 in the nation among anesthesia departments in NIH funded research. Our ATAC fellows are encouraged to become involved in research but it is not required.

The UAB Department of Anesthesiology and Perioperative Medicine utilizes an innovative digital dashboard to give rapid feedback and information regarding each provider’s individual metrics. As part-time faculty members in this system, the ATAC fellows are able to use this system to learn valuable skills of supervision and ownership of outcomes.

Washington University School of Medicine in St. Louis
The trauma anesthesia fellowship will consist of 7 months of OR anesthesia with the trauma service, focusing on patient care, supervision of residents in anesthesiology, and management of the OR case flow. While in the ORs, the fellow in trauma anesthesiology will have 16 clinical shifts per month, each a 12-hour shift. In addition, we offer four months of elective rotations during the fellowship, which include 2 months of ICU (SICU/Neuro ICU), trauma radiology, Echo for the trauma anesthesiologist, advanced regional anesthesia for extremity trauma, and blood bank/transfusion medicine. It is expected that the trauma fellow will have obtained ATLS certification at both the provider and instructor level and can be eligible to obtain basic echocardiography certification. Additionally, the fellow will participate in departmental grand rounds and trauma service lectures and conferences, as well as actively participate in the education of medical students and residents about trauma anesthesia.

Trauma Anesthesiology Curriculum:
The Committee on Trauma and Emergency Preparedness has collaborated on the creation of model curriculum goals and objectives for trauma anesthesiology that could be inserted into existing training programs. Individuals and programs are free to modify this curriculum as needed to meet their own objectives based on their training requirements and limitations.


Links of Interest:

Summer and the Trauma Anesthesiologist
A short editorial on the importance of being prepared for trauma during the summer months.

The Ryder Cognitive Aid Checklist for Trauma Anesthesia
This recently developed checklist provides perioperative recommendations and guidance in the management of the severely traumatized patient. It is based on work done at the Ryder Trauma Center in Miami. This short video describes the checklist and how best to employ it in your practice. The checklist can be downloaded as a printable poster here.

Trauma Anesthesiology Society
The Trauma Anesthesiology Society has brought together over 100 academic and community practice anesthesiologists with a passion for care of the traumatized patient. A Google Group discussion has fostered discussion on topics ranging from vasopressors in trauma, to the optimal approach to regional/neuraxial anesthesia in trauma, to the ideal anesthesiology staffing model for trauma centers. Individuals can join the group by following the link above.

Sociedad Mexicana de Anestesiologia en Trauma (SOMAT; Mexican Society of Trauma Anesthesiology)
The Sociedad Mexicana de Anesthesiologia en Trauma was established in 2013 to provide education, research, and clinical education support for anesthesiologists involved in the care of the traumatized patient. Their activities include an annual meeting.

American College of Surgeons Committee on Trauma 
The mission of the American College of Surgeons Committee on Trauma is to develop and implement meaningful programs for trauma care in local, regional, national, and international arenas. These programs must include education, professional development, standards of care, and assessment of outcomes.

Trauma.org
Trauma.org is an independent, non-profit organization providing global education, information and communication resources for professionals in trauma and critical care.

National Trauma Institute
The National Trauma Institute (NTI) is a 501 (C) (3) nonprofit organization dedicated to funding projects with the promise to advance clinical trauma practice, save lives and reduce disability

Borden Institute
The Borden Institute publishes and maintains the Textbooks of Military Medicine. The volumes in the series constitute a comprehensive treatise on the art and science of military medicine, covering such diverse topics as biological and chemical warfare, military preventive medicine, military medical ethics, combat behavioral health, harsh environments, and care of combat injuries.

Special Operations Medical Association
Founded in 1987, the Special Operations Medical Association (SOMA) is the only medical association in the world that brings together the unique blend of pre-hospital, tactical, wilderness, austere, disaster and deployed medicine. Our primary goal is to advance the art and science of special operations medical care through the education and professional development of special operations medical providers. SOMA provides a forum for military and civilian medical providers, academia and industry from around the world to meet and exchange ideas in our Scientific Assembly, through our official publication, the Journal of Special Operations Medicine (JSOM), and our Mini-SOMA Conferences. SOMA advances the science, technology and skills of unconventional medicine.
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JTS CPGs
The Joint Theater Trauma System (JTTS) Clinical Practice Guidelines (CPGs) can be found at the webpages below. To the greatest extent possible, JTTS CPGs are evidenced-based. Where evidence is lacking or unclear, but where the need for a CPG is paramount, guidelines were developed based on the best available data and subject matter expert (SME) consensus. Routine updates of CPGs occur on approximately an annual basis. Additionally, based on new evidence or prevailing SME input, CPGs are updated in whole or part whenever the need arises. SMEs include, but are not limited to, military and civilian experts, deployed clinicians, Service trauma/surgical consultants, and other military trauma system personnel. This is a public website, no access codes required.

Tactical Combat Casualty Care (TCCC) Resources
The Committee on Tactical Combat Casualty Care (CoTCCC) provides resources for physicians and medical officer who provide oversite to unit medical training and protocols. Available resources include medical literature references supporting TCCC concepts as well as CoTCCC meeting minutes and deliberation on techniques used in TCCC. This area also includes Depart of Defense and Service policies on TCCC training and equipment. The TCCC Quick Reference Guide is available here.

American Society of Anesthesiologists, Committee on Patient Blood Management 
The ASA Committee on Patient Blood Management has produced several updates on blood product usage relevant to management of the traumatized patient.

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