Timeliness of Management of Trauma Related Hemorrhage and Trauma Related Coagulopathy

项目总结 受伤是46岁以下人群最常见的死亡原因，受伤后出血是 可预防死亡的最常见原因。出血的治疗需要及时的程序来阻止 出血以及防止血液变稀的药物和输血。专攻医疗服务的医院 治疗损伤的方案、药物、设备和临床工作人员全天24小时可用 一周。在专门医院接受治疗的伤者更有可能存活。然而，数量太多了。 每年受伤的人都不能在专门的医院接受治疗，所以轻伤在 不是专门治疗伤病的医院。重伤者被送往非专科医院 专科医院距离太远或急救医务人员救治伤员 低估一个人受伤的严重程度。不是专门治疗伤害的医院不参与 在正在进行的损伤临床试验、区域数据登记或国家质量改进计划中，以及作为 结果那里发生了什么导致人失血过多致死的事情不得而知。这项申请是长期的 目的提高创伤后出血救治的及时性。具体目标将是：1) 了解在有和没有专门治疗伤病的医院中，伤后出血是如何处理的； 2)找出患者得不到及时治疗的原因；3)确定如何提高治疗的及时性 治疗。中心假设是出血的治疗在没有专科的医院里没有标准化。 在治疗伤员方面有困难，并导致延迟将伤者转移到专科医院。识别 可更改的医疗保健系统、医院和患者因素可以为系统流程的设计提供信息 先在非专科中心快速暂时止住伤者的出血，然后加速 通过吸引来自不同医院的关键利益相关者，将其转移到专科医院。这将是 确保受伤后流血的人在正确的时间在正确的地点得到护理。归根结底， 在正确的时间进行正确的治疗将使最初被送往非专门治疗创伤的医院的人 与那些被送往专科医院的人有同样的生存机会。作为职业发展奖，建议的 培训计划将包括数据科学、系统工程和设计方面的培训。需要学习的方法 并将采用机器学习、故障模式、影响和危害性分析以及以用户为中心的设计。 该项目与健康相关的是了解目前受伤后出血的实践管理，在 以提高出血救治的及时性，增进受伤患者的健康。

PROJECT SUMMARY Injury is the most common cause of death in people younger than 46 years of age, and bleeding after injury is the most common cause of preventable death. Treatment of bleeding requires timely procedures to stop the bleeding as well as medications and blood transfusions to prevent blood thinning. Hospitals that specialize in treating injury have protocols, medications, devices and clinical staff available 24 hours a day and seven days a week. Injured people treated at specialized hospitals are more likely to live. However, there are far too many injured people every year than can be treated at specialized hospitals so minor injuries are cared for at hospitals not specialized in treating injuries. Severely injured people are taken to hospitals not specialized in treating injuries when specialized hospitals are too far away, or the emergency medical personnel underestimate how seriously injured someone is. Hospitals not specialized in treating injuries do not participate in ongoing injury clinical trials, regional data registries nor national quality improvement programs, and as a result what happens there that leads to people bleeding to death is unknown. This application's long-term objective is to improve the timeliness of treatment of bleeding after injury. The Specific Aims will be to: 1) understand how bleeding after injury is managed in hospitals that do and do not specialize in treating injuries; 2) identify the reasons patients do not get timely treatment; and3) determine how to improve the timeliness of treatment. The central hypothesis is that treatment of bleeding is not standardized in hospitals not specialized in treating injuries and leads to a delay in transferring injured people to specialized hospitals. Identifying modifiable healthcare system, hospital, and patient factors can inform the design of a systematic process to quickly temporarily stabalize bleeding of injured people initially at non-specialized centers then expedite transfer to specialized hospitals by engaging key stakeholders from across the spectrum of hospitals. This will ensure that people who are bleeding after injury are cared for at the right place at the right time. Ultimately, the right treatment at the right time will give people initially taken to hospitals not specialized in treating injuries the same chance at life as those taken to specialized hospitals. As a Career Development Award, the proposed training plan will include training in data science, systems engineering and design. The methods to be learned and employed will be machine learning, failure mode, effects and criticality analysis and user-centered design. The health relatedness of the project is to understand current practice management of bleeding after injury, in order to improve the timeliness of bleeding treatments to enhance the health of injured inviduals.