Strategic proposal for a national trauma system in France - 17/03/19

Doi : 10.1016/j.accpm.2018.05.005

Tobias Gauss ^a, Paul Balandraud ^b, Julien Frandon ^c, Julio Abba ^d, Francois Xavier Ageron ^e, Pierre Albaladejo ^d, Catherine Arvieux ^d, Sandrine Barbois ^e, Benjamin Bijok ^f, Xavier Bobbia ^g, Jonathan Charbit ^h, Fabrice Cook ⁱ, Jean-Stephane David ^j, Guillaume De Saint Maurice ^k, Jacques Duranteau ^l, Delphine Garrigue ^f, Emmanuel Gay ^d, Thomas Geeraerts ^m, Julien Ghelfi ^f, Sophie Hamada ^l, Anatole Harrois ^l, Hicham Kobeiter ⁿ, Marc Leone ^o, Albrice Levrat ^p, Sebastien Mirek ^q, Abdel Nadji ^q, Catherine Paugam-Burtz ^r,^s, Jean Francois Payen ^d, Sebastien Perbet ^t,^u, Romain Pirracchio ^v, Isabelle Plenier ^g, Julien Pottecher ^w, Sylvain Rigal ^b, Bruno Riou ^x, Dominique Savary ^e, Thierry Secheresse ^y,^z, Karim Tazarourte ^aa, Frederic Thony ^d, Jerome Tonetti ^d, Christophe Tresallet ^ab, Pierre-Francois Wey ^ac, Julien Picard ^d, Pierre Bouzat ^d,^⁎
for the
Groupe d’intérêt en traumatologie grave (GITE)
^a Department of anaesthesia and intensive care, Beaujon hospital, hôpitaux-Paris-Nord-Val-De-Seine, AP–HP, 92110 Clichy, France
^b Department of Surgery, French Military Medical Academy, école du Val-de-Grâce, 75000 Paris, France
^c Department of radiology, Nîmes University Hospital, 30029 Nîmes, France
^d Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
^e Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny–Annecy, France
^f Emergency department, Lille university hospital, 59000 Lille, France
^g Department of Anaesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr-Debré, 30029 Nîmes, France
^h Trauma Intensive and Critical Care Unit, Department of Anaesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, 75000 Montpellier, France
ⁱ Department of Anaesthesiology and Intensive Care, Henri Mondor Hospital and University Paris-Est, Assistance publique–Hôpitaux de Paris, 94010 Créteil, France
^j Department of anaesthesia and intensive care, Lyon Sud hospital, 69495 Pierre-Bénite cedex, France
^k Intensive care and Anaesthesiology department, Percy Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
^l Department of Anaesthesiology and Critical Care, Paris Saclay university AP–HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
^m Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, University Toulouse 3, Paul Sabatier, UMR 1214, Inserm/UPS, ToNIC: Toulouse NeuroImaging Center, 75000 Toulouse, France
ⁿ Medical imaging, CHU Henri-Mondor, Assistance publique–Hôpitaux de Paris (AP–HP), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
^o Department of anaesthesia and intensive care, Assistance publique–Hôpitaux de Marseille, hôpital Nord, 13000 Marseille, France
^p Department of anaesthesia and intensive care, Annecy Genevois hospital, 74374 Epagny–Annecy, France
^q Department of anaesthesia and intensive care, Dijon university hospital, BP 77908, 21709 Dijon, France
^r Department of anaesthesia and intensive care, Beaujon hospital, Assistance publique–Hôpitaux de Paris, 92110 Clichy, France
^s Hôpitaux-Paris-Nord-Val-De-Seine, université Paris–Diderot, 75018 Paris, France
^t Adult intensive care & continuing care unit, Perioperative medicine, Clermont-Ferrand university hospital, 75000 Clermont-Ferrand, France
^u Anaesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, 75015 Paris, France
^v Paris Descartes University, Sorbonne Paris Cité, 75000 Paris, France
^w Strasbourg university hospital, Hautepierre hospital, Department of anaesthesia and surgical intensive care–Strasbourg university, faculté de médecine, Fédération de médecine translationnelle de strasbourg (FMTS), Strasbourg, France
^x Sorbonne University, UMR Inserm 1166, IHU ICAN, Assistance publique–Hôpitaux de Paris, Emergency department, hôpital Pitié-Salpêtrière, 75013 Paris, France
^y CEnSIM, Centre d’enseignement par simulation, centre hospitalier Metropole Savoie, 73000 Chambéry, France
^z LaRAC–laboratoire de recherche sur les apprentissages en contexte, University Grenoble Alpes, 38000 Grenoble, France
^aa Emergency medicine department, Hospices civils de Lyon, Lyon university, HESPER EA 7425, centre hospitalier Herriot, 69003 Lyon, France
^ab Department of general, visceral and endocrinous surgery, hôpital de la Pitié-Salpêtrière, Sorbonne university, UMR CNRS-Inserm U678, Assistance publique des Hôpitaux de Paris (AP–HP), 75013 Paris, France
^ac Intensive Care & Anaesthesia Department–Desgenettes Teaching Military Hospital, 69003 Lyon, France

^⁎Corresponding author. Pôle d’anesthésie-réanimation, hôpital Albert-Michallon, BP 217, 38043 Grenoble, France.Pôle d’anesthésie-réanimation, hôpital Albert-MichallonBP 217Grenoble38043France

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Abstract

In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years.

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Keywords : Trauma, Trauma system, Guidelines, Strategy, Organisation

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Vol 38 - N° 2

P. 121-130 - avril 2019 Retour au numéro

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