Thread by @ResusOne

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How does a city's trauma system come together to both prepare for the expected surge of the #COVIDー19 #pandemic & manage the ongoing #epidemic of #gunviolence & other trauma?

Through a great collaborative effort, we published the #Philadelphia experience in @JTraumAcuteSurg

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The full paper is published ahead of print here: journals.lww.com/jtrauma/Citati…

It represents the importance of #teamwork in ensuring a robust, rapid, coordinated effort to manage an evolving threat

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Our publication timing coincides with a brutal #July4th weekend where #Philadelphia saw over 30 people shot including several children

But how did the #pandemic and #socialdistancing mandate affect trauma volume in our centers?

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We found that, despite our overall #trauma volume being lower than usual, the number and proportion of #penetrating trauma actually increased in the first several weeks of the #pandemic.

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This trend was also seen in other cities including #Chicago, #Houston, #SanAntonio, and #Dallas

#gunviolence

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Causes are likely multifactorial including:
-increased unstructured time
-increase in #gun sales
-higher unemployment/financial strain

But we have seen this #epidemic for a long time - as with many things, #COVID19 just brought it into sharper focus.

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Through #geospatial mapping, we were able to find a significant relationship of shooting events occurring with a higher incidence in those #Philadelphia neighborhoods most affected by #COVID19 infection.

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An association b/w #race and both #COVID19 incidence and severity has been documented.

The #geospatial relationship identified in our study suggests the social determinants of health contributing to high viral concentration likely also correlate with endemic violence.

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Many of the highest-density ZIP codes represent #Philadelphia neighborhoods that have suffered from poor socioeconomic conditions, & these feed into two of the adult and one pediatric #trauma centers that most accounted for the increased proportion of penetrating trauma

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Combined w/ the surge of #COVID19 patients requiring #criticalcare, this worsening of the #trauma #epidemic posed a significant threat to our city's ability to maintain trauma readiness, especially during the early dynamic phase of the #pandemic

How did we approach this?

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We individually adapted national guidance from @ACSTrauma (facs.org/media/press-re…) but also felt it critical to work together across our trauma system.

So we set up a citywide weekly teleconference of trauma directors/managers-forming a regional medical operations center

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This allowed - in addition to local preparations - the ability to share current #COVID19 & trauma patient census data, facility-level surge activities, #PPE postures, and clinical lessons learned from managing #pandemic patients, especially in its early dynamic phase

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Some more specific benefits of our collaboration included augmenting adult center capacity through use of pediatric centers, modifications to trauma airway management & ventilator use, coordinating #PPE protocols across centers, and sharing of care #guidelines

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The early #pandemic phase was dynamic, w/ rapidly evolving guidance and challenges.

Coordination to both face this threat & ensure ongoing readiness for other emergencies (including #trauma) is critical-siloed adoption could have delayed care & led to patient or staff harm.

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We hope that by sharing our experience we may help
other centers & regions prepare for future simultaneous surges in both critically ill & injured patients.

I want to thank my co-authors & the wider team at all our #Philadelphia centers that made this response possible