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Introduction
Welcome to the trauma and emergency healthcare system in Southwest Texas and thank you for your interest in learning more about the trauma program in Southwest Texas. You will find this manual beneficial as you embark upon this role and we encourage you to retain a copy of this text as it may serve as reference material later in your career.

Trauma Care History in Texas
Trauma care has evolved into a specialty of many local and regional hospitals over recent decades. Trauma centers have established high quality, comprehensive medical services to patients. The public relies on trauma centers to provide emergency services in settings ranging from high density urban areas to distant rural critical access facilities. Regardless of where your program is located, it provides critical services in a timely manner to patients who often need lifesaving measures. As a Trauma Program Manager or Coordinator (TPM/C), it is your primary responsibility to ensure patients are receiving the best care possible. This is often accomplished by compilation and analysis of data, policy review, and continuous performance improvement patient safety initiatives. The following chapters will provide an overview of many aspects of trauma care and acts as a guide to help you succeed in your new role as a TPM/C.

These guidelines outlines the process of the completing the tertiary survey on trauma inpatients and who, how and when this should be completed.

Definitions

Tertiary Survey refers to the comprehensive general physical re-examination and review of all investigations, including diagnostic imaging and blood results, within 24 hrs and again when the patient is conscious and cooperative (Hajibandeh et al, 2015)

Missed injury detection are those that are not identified by primary or secondary surveys but are detected by tertiary survey (Hajibandeh et al, 2015).

Overview/Background

Missed injuries are considered an important issue in trauma patients and can lead to significant mortality and morbidity. The reported incidence of missed injuries is variable ranging from 1% to 40%. Risk factors for missed injuries include:

Altered level of consciousness such as:

• Central nervous system injury
• Intoxication and sedation
• A distracting injury
• Poly trauma patients
• Patients needing emergency surgery

The tertiary survey is widely used in the reassessment of trauma patients, reducing any missed injuries that may be overlooked at the initial time of presentation. The best available evidence demonstrates support in favour of tertiary survey in terms of missed injury reduction, and supports its use in management of trauma patients (Hajibandeh et al, 2015).

No abstract available.

Objectives:
The core learning objectives of this module are to provide a basic understanding of the following:

• The Need for Trauma QI Programmes
• The Elements of Trauma QI Programmes
• Effective Trauma QI Programmes
• Summary and Conclusion

Objectives:
The core learning objectives of this module are to provide a basic understanding of the following:

• Review of the Benefits of Trauma QI
• Experience of Trauma QI in Low- and Middle-Income Countries
• Experience of QI in Other Fields in Low- and Middle-Income Countries
• Status of Trauma QI Globally
• Summary and Conclusion

Objectives:
The core learning objectives of this module are to provide a basic understanding of the following:

• The Role M&M Conferences Have in Improving Trauma Systems
• How M&M Conferences Can Be Utilized and Improved in all Circumstances, Including Low- and Middle-Income Countries
• Identifying, Recording and Responding to Poor Outcomes
• Summary and Conclusion

Objectives:
The core learning objectives of this module are to provide a basic understanding of the following:

• Basic Principles of Preventable Death Panel Reviews
• Constituting the Panel
• How to Prepare and Present Data to Panel Members
• Specifics of the Case Review Process
• Summary and Conclusion