TRAUMA REPORT Year in Review 2021

In Memory of William H. Marx, DO, FACS

The 2021 trauma program annual report is dedicated to Dr. William H. Marx. We lost our dear Dr. Marx unexpectedly, and far too soon on February 9, 2022. Over the course of his career, Dr. Marx, “Bill”, has positively impacted care of the injured patient at every level. He has many notable achievements, beginning with a distinguished career in the United States Army, serving as a Lieutenant Colonel on active duty from 1978-1989 and then reserve duty from 1989-2011. He was a dynamic member of the ACS (American College of Surgeons) serving in numerous capacities, most recently as the Chair of the VRC (Verification Review Committee). Bill was also integral in the development and implementation of the NYS Trauma System, serving as the Chair of the Survey Subcommittee from 19992006 and then as the Chair of the State Trauma Advisory Committee from 2006-2022. He was instrumental in the state’s decision to implement the ACS standards for trauma center verification, forever ensuring the optimal care of the injured patient in NYS. Here at Upstate, he was serving as Professor of Surgery, Trauma Medical Director, Division Chief, and Medical Director to the OR. It was easy to forget what a “big deal” he was as he never projected anything but kindness and caring about his team, seeking to find ways to develop, uplift, and support others in their own careers. If you ask any of us who worked with him, we would probably say we took him for granted. His absence is loud and is felt throughout the trauma world. Our hearts are heavy for our own loss and for his beloved family. Despite this, we also have hope and gratitude. His work will have a lasting influence that will never be forgotten and has set the course for an amazing future for the care of trauma patients that will only get brighter because of Dr. Marx.

TREATING TRAUMA

Despite being in the second year of a global pandemic we continued our mission to deliver high quality, specialized care to the injured. Our clinical and administrative teams have been increasingly busy with a steady rise in volume of patients meeting trauma registry inclusion criteria of over 400 patients in the last 5 years.

In 2021, over 3,500 patients were entered into our trauma registry. This includes patients that were admitted, transferred, and treated and released from the ED, and any death in the ED that was not admitted. Of those patients, there were 2,534 were admitted for inpatient care in the hospital. Our trauma catchment area covers a large geographic area including 14 counties, resulting in 1,520 patients being transferred in from referral hospitals.

Over the past year we were able to offer professional educational opportunities in trauma care to physicians and nurses, both internally here at Upstate and across the region. Through our Stop the Bleed Program we taught bystanders basic hemorrhage control techniques so even the community members can help save lives.

In our performance improvement program we added an additional team member and refreshed our processes including the implementation of a new rounding tool in order to better identify opportunities for improvement even while a patient is currently admitted. We also made great strides in our data collection, implementing a new work flow in the registry, and creating a new trauma data dictionary to ensure high quality accurate data collection, critical to driving research, performance improvement, and injury prevention.

Members of our team participate in local, regional, statewide and national level, leadership. William Marx, DO, served as the VRC (Verification Review Committee) Chair over the last 3 years. Jolene Kittle, PhD, RN, has served as a Director at Large on the Board of Directors for the Society of Trauma Nurses as well as the Chair/Immediate Past Chair for Annual Meeting Planning Committee of the Trauma Center Association of America. Jerry Morrison, RN, Trauma Outreach and Education Coordinator, has served as President Elect for the NYS Chapter of the American Trauma Society and is beginning his term as President in January of 2022.

We are also very excited to have added new members to our team including Shelby Brabant, MS, RN, Performance Improvement Coordinator, Otencia Hanley, MSHI, BA, Trauma Registrar, Christine Abood, Administrative Assistant, and Melaina King, BSN, RN, Injury Prevention Coordinator.

Upstate’s Adult Level I Trauma Program is designated by the New York State Department of Health as the only Level I trauma center in the

TRAUMA

comprised of any individual who comes in contact with our trauma patients or provides support for those who do including trauma surgeons, emergency medicine physicians, orthopedic and neurosurgeons, trauma nurses from a variety of specialties, hospital care technicians, radiology technicians, blood bank team, and so many others who are critical to delivering the highest quality care to the most injured. Behind the scenes, is a team overseeing the operations of the program, ensuring the standards for verification are met and include a trauma medical director, program manager, performance improvement coordinators, outreach and injury prevention coordinator, and trauma registrars (data abstractors).

This report was primarily prepared by: William Marx, DO, FACS Trauma Medical Director through 2022 Jolene Kittle, PhD, RN, ACCNS-AG, NE-BC, TCRN, CCRN-K, CFRN, CEN Trauma Program Manager through 2022

OUTREACH & EDUCATION

As a Level I Trauma Center, it is our responsibility to be a resource to the medical community to promote the highest-level of care to trauma patients.

Interacting with hospitals and EMS agencies in our trauma region allows us to better understand the care that they provide and the resources they possess.

Upstate Trauma Center is a verified Level I program, ready and waiting 24/7 to treat the region’s most critically injured patients. As the only Level I in the region, Upstate services a 14-county area that is home to 1.7 million people and includes 28 referral hospitals.

Syracuse

14 counties in the central New York Trauma service area

Broome Cayuga Chenango Cortland Herkimer Jefferson Lewis

Madison Oneida Onondaga Oswego St. Lawrence Tioga Tompkins

Trauma research identifies current best practices for the care of trauma patients which is shared through formal educational programs.

National certification programs are conducted for EMS providers, nurses, advanced practice providers and physicians both at Upstate and throughout our trauma region.

The pandemic created challenges to traditional methods of visiting outside hospitals and conducting educational programs.

Virtual visits replaced those conducted on-site at outside agencies.

Virtual classrooms and on-line learning modules replaced traditional lectures while in-person sessions were still necessary for skills training and testing.

Top 10 Transferring Hospitals

Educational Offerings

Courses Available through Number of Upstate Trauma Program classes offered

ATCN (Advanced Trauma Care for Nurses) 3

ATLS - Upstate (Advanced Trauma Life Support) 6

ATLS - Fort Drum (Advanced Trauma Life Support) 2

ATOM (Advanced Trauma Operative Management) 3

RTTDC (Rural Trauma Team Development Course) 1

Stop the Bleed 3

TCAR (Trauma Care After Resuscitation) 8

TNCC (Trauma Nurse Core Course) 8

Trauma Resuscitation - Remote 1 Trauma Resuscitation - Upstate 5

• Trauma is a leading cause of death and disability for all age groups and is the number one cause of death for persons under the age of 44 (source: www.cdc.gov/injury/wisqars/fatal.html)

• Trauma is preventable!

• Our injury prevention efforts focus on the most common causes of injury in our trauma region. Upstate currently works with many community partners to address these preventable injuries as well as offer several programs to reduce falls, motor vehicle crashes, and violence.

Please visit the injury prevention section on Upstate Trauma’s webpage for more resources.

We see many types of injuries at Upstate, and injuries from falls are at the top of the list. They outnumber motor vehicle crashes, violent assaults and motorcycle crashes combined. If we break this down further, we see that our older populations are affected the most by falls. Falls can be costly both financially and in quality and duration of life to individuals. They threaten older adults’ safety and independence. Falling is NOT a normal part of aging though, and we are working hard to keep our older adults safe and fall-free.

Upstate Trauma works with various community agencies and partners to ensure fall prevention programs and strategies reach our

Did you know? Over

individuals

INJURY PREVENTION 40,000

die from falls each year

(CDC WISQARS data 2019).

communities. The evidence-based injury prevention programs utilized in 2021 were A Matter of Balance (AMOB) and Tai Chi for Arthritis and Falls Prevention. Upstate Trauma partners with Upstate Healthlink who provide a lot of this programming and even host several virtual seminars on fall prevention topics.

Patients who present to the hospital with falls, or who are screened to be at-risk for falls, also receive specialized care by a robust team of professionals including geriatricians, pharmacists, social workers, PT/OT, and nurses. Best practice guidelines and follow-up care help our patients to gain back their quality of life.

Trauma Admissions by Injury Type

Bicycle crash

ATV crash

Firearm injury

Assault Stabbing

Motorcycle

crash

Motor vehicle crash Falls

2020 2021

2021 Top Trauma Admissions by Type

Falls 45%

Motor vehicle crashes 17%

Gunshot/stabbing 9%

Assault 4%

Motorcycle crashes 5%

ATV crash 3%

Other 17%

Falls by Age Group

Ages 15 - 19 2%

Ages 20 - 29 4%

Ages 30 - 39 7% Ages 40 - 49 5%

Ages 50 - 59 12%

Ages 60 - 69 18%

Ages 70 - 79 22% Ages 80 + 30%

Violent crime has become an urgent public health problem across the country. Unfortunately, Syracuse violence committed daily is 2.16 times higher than the national average (FBI uniform crime reporting data 2020). Onondaga County’s violent crime rate has been consistently high in recent years, with the 5th highest rate of violent crime with firearms in the state (FBI uniform crime reporting data 2020). 25 community members were killed by gun violence in Syracuse just this year (Syracuse City Police department). In 2021, Upstate Trauma center treated 824 assaulted patients, 287 patients who were stabbed, and 178 patients who were victims of firearm violence.

We are combating this major public health issue at Upstate with VEPOP. VEPOP helps victims of street violence through collaboration with community agencies and a follow-up process. VEPOP identifies victims of

violent crime and capitalizes on the “teachable moment” to reduce the rate of recidivism of violent trauma. These referrals and follow-ups with patients ensure continuity of care to promote alternatives to violent lifestyles and create opportunities for patients to achieve their goals.

Our very own Renee Gregg, LMSW, is an integral role in this program. She is a dedicated, 100% VEPOP social worker. She has been in this role since 2019 and has touched over a thousand lives since starting. “I really care about my VEPOP people,” she says, as she puts together personalized Christmas care packages for those in the program. There is a skateboard, toothbrushes, towels, deodorant, backpacks, and remotecontrolled cars amongst the items. “I provide individuals with lifestyle alternatives, helping them to overcome complex trauma and systematic barriers in order to change their lives.” And

Renee Gregg LMSW

this is no small undertaking. Renee has an impressive list of resources and networks she utilizes to aid victims of violence. Not only does Renee connect people to these resources, but she creates strong relationships with the patients and their families. This may mean Renee will even drive to someone’s home just to help make sure they catch their ride for a medical appointment.

Once a patient presents with intentional violent trauma to Upstate (whether admitted or discharged from the emergency department), a Violence Trauma Assessment is performed by Renee. This may mean she is coming in at all hours of the day or night to reach these patients. Based on this assessment, Renee formulates a plan to help. Renee follows these patients throughout their hospitalization and continues to follow-up with them after discharge. She helps victims set and achieve goals with referrals made to community

partners that provide many valuable resources. These range from:

• Safe & secure housing

• Mental health care

• Primary care

• Mentorships

• School & educational opportunities

• Obtaining employment

• Support with substance use disorders

• Food, clothing

• Disability assistance

• Legal help

• Child care

• Various other services

These individuals will remain in the program for as long as it takes for them to feel independently safe and secure. In 2021, Renee introduced over 600 patients to the VEPOP program. “Its a lot of people and I’m doing my best to help them all.”

Pictured (L to R): Mackenzie LePage RN, Lisa Johnston RN, Kaitlyn Reber RN, Renee Gregg LMSW, Mary Rose Rodda LMSW, and Julie Wiszniewski RN pose for #EndGunViolence Day in the Surgical/Trauma ICU

In 2021, Upstate Trauma center treated

patients who were assaulted patients who were stabbed patients who were victims of firearm violence.

BEHIND THE SCENES SPOTLIGHT ON THE REGISTRY

Behind the scenes at a level 1 trauma center, is a comprehensive database, with a data abstraction team comprised of 6 registrars. With the second highest trauma volume in New York State, our team of registrars collected data on over 3,500 trauma patients aged 15 and up in 2021. Each case contains over 200 data points starting from the pre-hospital care through the patient’s discharge. Extensive time and effort is spent each year employing strategies to ensure the highest quality data collection. We have data points required by the National Trauma Data Standard, New York State, as

well as internal data fields. This year the team embarked on a 3month project to develop and maintain an internal data dictionary tying the 3 together to ensure that the data points are collected accurately and consistently. These data are used to determine what our outreach and educational needs are in our region, drive our injury prevention strategies, are used for research, and submitted to the Trauma Quality Improvement Program (TQIP). TQIP is a quality benchmarking program, using our data, comparing us to other level 1 trauma centers throughout the United States,

showing us our strengths in performance as well as identifying any opportunities for improvement. The trauma database and our team of abstractors is our secret weapon to continuously strive to improve our care through understanding our program, the care we deliver, and the population we serve.

3,500

Registrars collected data on over trauma patients.

Welcome to Our Newest Team Members

Otencia was born and raised on the tropical twin island federation of St Kitts and Nevis in the Caribbean. She moved to Upstate NY in 2016 after living in NYC for 12 years to join the Upstate University Hospital team. In 2021 she joined the Trauma Registry Team. Otencia has a warm personality and is highly motivated to learn the registry. She is a great addition to our team.

Shelby has been a Registered Nurse for over 6 years. She was enrolled in the Dual Degree Partnership in Nursing Program at Le Moyne College which allowed her to simultaneously earn her 2-year nursing degree, along with her BSN. She began her career in inpatient Medical/Surgical nursing with a focus in ventilator-dependent patients. She transitioned to Upstate in 2016 and began practicing as a floor nurse in Surgical Specialties. In 2018, she was promoted to Clinical Training Specialist in the outpatient surgical care setting. While practicing full-time, Shelby earned her MSN in Nursing Administration from SUNY Empire State College. Following completion of her MSN, she accepted a position as Performance Improvement Coordinator for Upstate’s Adult Trauma Program.

Christine - started working at Upstate in June of 2021 with the Trauma Service Department as an Administrative Assistant. Prior to that Chris worked at St. Joseph’s Hospital for 21 years as a Administrative Assistant for the Hospitalist group. She is originally from New Jersey, and move to Syracuse 30 years ago to raise her three children.

Melaina has practiced at the bedside for 10 years with experience working in a Neuro ICU, Medical ICU, Surgical ICU and Trauma ICU. She has been an RN educator for several years as well as a rapid response /code nurse. Melaina has a B.A. in Psychology from SUNY Geneseo and a BS in Nursing from University of Rochester. She is a certified critical care RN as well as a certified trauma RN. Melaina is a Stop the Bleed instructor, Trauma Survivors’ Network Coordinator, TCRN Item Writer and an active member of the Society of Trauma Nurses and American Trauma Society.

Otencia Hanley, MSHI, Trauma Registrar

Shelby Brabant, MSN, RN, PI Coordinator

Christine Abood Administrative Assistant

Melaina King, Injury Prevention Coordinator

CONTINUUM OF CARE HIGHLIGHT EMERGENCY SERVICES

Emergency services nursing at Upstate maintains the highest standards of trauma care through formalized training classes and continuous quality improvement projects. They are always at the ready, in collaboration with emergency medicine and trauma services, to receive and provide quality care to any patient needing them.

- Michelle Zoanetti, MSN, MBA, RN, NEA-BC Associate Director of Nursing for Emergency Services

The collaboration between Emergency Medicine and Trauma Surgery facilitates rapid identification and stabilization of injuries. From the moment they arrive in the emergency department, and throughout their entire hospital stay, our multidisciplinary approach to trauma patients provides the highest level of care for the acutely injured.

-

Matthew Camara MD, Assistant Professor of Emergency Medicine

The emergency department at Upstate Medical University is a vital part of the Level 1 trauma center. The Adult Emergency Department at Upstate Medical University Hospital, Downtown Campus, provides 2 dedicated trauma bays where clinicians perform a fast, intense, full-body exam and initiate treatment for injuries. Emergency Services is an integral part of the trauma team that is instrumental in triage of trauma patients and comanaging patient care.

8,089

injured patients were treated in 2021. 2,356

Of those patients, were admitted to the hospital for further care.

Where do admitted injured patients go after the Emergency Department?

ICU 22% Operating room 16% Acute care unit 62%

As the region's only Level-One Trauma Center, Upstate Medical University is a fast-paced facility with modern technology and up-todate interventions utilized in caring for the injured. Serving 14 counties, Upstate Medical University supports a population transported by ground or air from the central New York region.

General surgeons, orthopedic physicians, neurosurgeons, anesthesiologists, radiologists, and

board-certified critical care physicians are on call 24/7.

Nursing staff with certifications in Advanced Cardiac Life Support (ACLS), Trauma Nursing Core Course (TNCC), Advanced Trauma Care for Nurses (ATCN), and Trauma Care After Resuscitation (TCAR) provide excellent care for trauma patients.

CONTINUUM OF CARE HIGHLIGHT TRAUMA CLINIC

When a patient is discharged from hospital care, follow up is often necessary to ensure proper healing and optimize recovery. Trauma clinic, an outpatient surgical office, located within Upstate Hospital’s Surgical Subspecialties downtown campus, provides outpatient support for those impacted by trauma. The clinic is open five days/week, with the trauma team evaluating patients on Thursday afternoons. However, with flexible nursing and surgical staff, the clinic can frequently accommodate different scheduling needs. Additionally, as the COVID-19 pandemic evolved, trauma clinic was able to offer telemedicine options for many of their patients. Telemedicine visits are currently still being used and allow the office to better adapt to scheduling needs for long term care facilities, rehabilitation centers, and patients who reside outside of Syracuse.

The trauma clinic is staffed with registered nurses and administrative personnel who assist patients and providers in the office with dressing changes, small procedures, and telemedicine visits. The discharge process from inpatient care can be overwhelming for patients, especially after a traumatic event. In addition to in-person assistance, the trauma clinic nursing staff is available

via telephone to answer dischargerelated questions, provide care advice, initiate prescription refills, and coordinate appointments and follow up imaging. The staff commonly act as care coordinators by ensuring individual patient needs are met post discharge, ranging from establishing home nursing care, arranging transport, and assisting with physical/occupational therapy needs. In doing so, the clinic can provide reassurance to trauma patients during a stressful time, while bridging the gap between hospital care and resumption of home life.

The clinic is easily accessible for both patients and providers, as parking validation is available, and the clinic is housed within the downtown campus. This makes evaluating patients more efficient for resident physicians, who often oversee the care of trauma clinic patients with attending physician guidance, and advanced practice providers (NP, PA). The physician and advanced practice staff are easily accessible for the clinic nurses when advanced decision making, or care planning is required. Through a multidisciplinary approach, clinic serves as a steadfast resource for advice and comfort during an often-challenging time in a trauma patient’s life.

Elizabeth La Sagna, Cynthia Fifield, Maryann Alessendrello, and Mary Remollata

The trauma clinic evaluated 243 patients in 2021.

(left to right)

CONTINUUM OF CARE FOR THE CRITICALLY INJURED TRAUMA PATIENT.

Emergency Services and the Trauma Clinic are two key components of the continuum of care for trauma patients. This continuum of care is detailed further on the following pages.

In the United States, there are five levels of trauma designation. The highly coordinated services at Upstate University Hospital have earned the facility a Level 1 trauma center designation.

According the the American Trauma Society, a Level 1 trauma center has these resources:

• 24-hour coverage by general surgeons and prompt availability of a wide range of specialties.

• Serves as a referral resource for communities in nearby regions.

• Provides leadership in prevention and public education and provides continuing education of the trauma team members.

• Incorporates comprehensive quality assessment.

• Offers teaching and research effort to help direct innovations.

In addition, the center must meet minimum requirement for annual volume of severely injured patients.The chart on the following page shows the entire continuum of care for trauma patients — from education to prevent trauma, to the scene of the injury, to the moment they arrive, through all procedures and treatment, and past their discharge to rehabilitation and maintenance. This multidisciplinary approach requires the seamless professionalism of many persons, within Upstate's walls and beyond.

It is our hope that in each issue of this annual report, that we will spotlight services in this continuum of care. This year we are pleased to highlight Upstate's areas of Emergency Services and Trauma Clinic.

CONTINUUM OF CARE

Prevention

The goal of our outreach efforts is to have fewer visits to our emergency services programs.

EMS

The majority of our patients are transported by EMS services.

ER

Upstate has highly specialized trauma rooms and uniquely trained trauma staff in our ER, see pages 12-13.

Diagnostics/Imaging

Upstate has top-of-the-line specialty imaging equipment available 24/7/365 for our injured patients.

OR/IR

Upstate has comprehensive coverage of specialized, highly-skilled surgeons and interventional radiologists who perform critical patient procedures.

Acute

TRAUMA VIRTUAL TOURS

This year we added a virtual tour of our resuscitation rooms and an overview of our resuscitation process to our website.

The tour is unique as the technology used allows you to have a 360 degree view of the pictures and videos that were utilized.

Being linked to our website allows anyone to have immediate access to education about our Trauma team and how it responds to an emergency.

Learning Modules include the following:

• Radio Room

• Donning PPE

• Trauma Positions

• Trauma Room MIST Hand-Off

• Primary Assessment

• Secondary Assessment

• Disposition

To view, visit: www.upstate.edu/trauma

QuickLink: Upstate Trauma Resuscitation Overview

Radio Room

Incoming EMS calls are received on the radio or on a telephone line. Calls are answered by an ER physician. ER physician or Nurse activates the trauma code.

We dedicate this training program to Dr. William Marx and Dr. Jessica Summers. Dr. Summers passed away unexpectedly in the summer of 2021. She had most recently been serving as the Burn Medical Director and a Trauma Surgeon. Dr. Summers was a talented and dedicated surgeon with a passion for teaching and mentoring.

Their legacy will live on through this project.