Tag Archives: RTTDC

Creating A Virtual RTTDC Course

The Rural Trauma Team Development Course (RTTDC) was introduced by the American College of Surgeons (ACS) to improve the care of trauma patients in rural communities. It is a staple of education for Level III and IV trauma centers in rural areas. Like everything else, most courses were shut down by the COVID-19 pandemic.

Conemaugh Memorial Medical Center in Johnstown, Pennsylvania, polled its local referral hospitals and discovered that the majority felt a significant need for continuing, in-person education that was not being met. This need, coupled with the observation of an increased number of opportunities for improvement in patients transferred to them, led them to consider adapting the RTTDC to a virtual format so the course could continue.

Since RTTDC is a product of the ACS, it is no simple matter to change it in any way. The trauma program worked with the ACS to get permission to make changes to the course.  Speakers with specialization in their topic recorded all of the lectures. They contained embedded questions to be answered using the polling feature of the Zoom software used.

The most challenging adaptation was simulation development for the hands-on portions of the course. These were painstakingly recorded on video in a simulation laboratory and incorporated into the lecture material.

Preregistration was brisk, and 41 participants signed up for the course. The format consisted of a lecture with live discussion and participant questions, followed by a simulation video moderated by the course director. All questions were answered before moving on to the next module.

Several positive changes were noted in the months following the course:

  • Many facilities purchased additional equipment, such as traction splints, pelvic binders, and blood warmers.
  • Some hospitals began acquiring tranexamic acid and prothrombin concentrate.
  • One facility modified its radiographic imaging policy.
  • All hospitals tightened their performance improvement processes and began to identify more opportunities for improvement.

Of course, some downsides were also identified:

  • Production of the course was very intensive and administratively challenging.
  • There was the possibility of teleconferencing hardware/software failure.
  • It was difficult for the presenters to “read the audience” because of the Zoom headshot.
  • Truly interactive discussions were difficult to achieve.

Bottom line: This is a creative example of a rural trauma center identifying regional needs and developing an innovative solution despite the pandemic. Despite the amount of work needed to pull it off, the results were very positive. Although the course should ideally be produced in person, this may not be feasible in some very remote areas. 

Hopefully, the ACS will be able to recognize this work and the need for this format. It should create a virtual version to help spread the word to all rural trauma centers.

Reference: Virtual Rural Trauma Team Development Course: Trying To Zoom In On A Solution. J Trauma Nursing 20(3):186-190, 2023.

Rural Trauma Team Development Course Impact On Trauma Transfers

The Rural Trauma Team Development Course (RTTDC) is yet another quality program developed by the American College of Surgeons (ACS). It is designed for all trauma professionals in rural areas including doctors, nurses, advanced practice providers, prehospital providers, and administrative support. The course is presented over the course of one day and covers a number of topics including:

  • Organizing a rural trauma team
  • Preparing rural hospitals to manage trauma patients
  • Identifying local resources and limitations
  • Resuscitation of trauma patients
  • Initiating early transfer
  • Developing a performance improvement process
  • Building relationships between rural hospitals and regional or state trauma systems

The trauma group at Vanderbilt compared a group of six non-trauma hospital in rural Tennessee who had participated in the RTTDC with six other rural hospitals matched for size, volume, and distance from the Level I center.

Here are the factoids:

  • A total of 130 RTTDC patients were compared with 123 from hospitals that had not participated
  • Overall demographics and number of imaging studies were the same
  • The call to transfer occurred 41 minutes sooner in the RTTDC hospitals
  • Length of stay in the referring ED was 61 minutes shorter in the RTTDC hospitals
  • Number of images obtained pre-transfer and mortality were unchanged

Bottom line: The numbers were small and the review was retrospective, but the results are nonetheless impressive. Granted, there was no decrease in mortality, but this is a relatively crude indicator, especially when small numbers are involved. But time to phone call and time spent in the referring ED were significantly shorter. Does anyone think that longer times to transfer are somehow good for patients?

Rural hospitals should consider attending RTTDC in order to improve the care of patients from their communities.

Reference: Rural trauma team development course de-creases time to transfer for trauma patients. J Trauma 81(4):632-637, 2016.