I. Introduction of Traumatoloy Department

Trauma is the fourth leading cause of death and the most important cause of preventable death in Taiwan. As in the other countries, trauma remains the “neglected disease “ in the majority hospitals in Taiwan , but not in Far-Eastern Memorial Hospital. Because of the authorities in our hospital regarded traumatology as one of the core competences of our hospital, we set up the first one trauma team in Taipei county in 2002. The trauma team is a functional team for taking care of severely injuries patients. It consists of surgeons, emergency physicians, interventional radiologists, intensive care specialists, and anesthesia specialists which provides team approach for the trauma patients with multiple organs involvement. The trauma team is on duty 7 days a day and 24 hours a week. We took care of trauma victims who sustained serious torso trauma, with unstable hemodynamics, and with multi-organs involvement. Due to the increasing numbers of major trauma patients treated in our hospital, we established the first one organized traumatology division in Taipei County in July 2006 . This division consists of four attending physicians and one nursing specialist who dedicate to the care of multiple trauma patients. The chief of this division is also responsible for the coordination of trauma team in the surgical department of Far-Eastern Memorial Hospital. All the staffs in out team are dedicated to the care of torso trauma, resuscitation, and combined injuries of the trauma victims.

The advancement of clinical practice dependents on a good training system. Our fellowship program will give the clinical fellows the opportunities to achieve the basic and advanced knowledge and techniques in the care of trauma patients. The programs include the treatment of thoracoabdominal injuries, external skeletal fixation techniques, intensive care training program, and the acute care surgery program for abdominal emergency. Due to the advancement of nonoperative management for torso trauma patients, trauma surgeons have to increase the exposure to the acute care surgery for abdominal emergency. We also dedicate to apply for minimal invasive approach for acute care surgery.

We always use the mostly updated guidelines as the treatment standard when we care for multiple trauma patients. Our service includes the clinical studies in traumatology and acute care surgery. One of our expertise is the prevention and treatment of abdominal compartment, including the abdominal wall reconstruction technique. The other one of our clinical interest is the minimal invasive approach for the abdominal stabbing injury patients. Our team provides not only the mostly cooperative, but also the mostly comprehensive team approach modality in Taipei County .From October 2002 till now, we have been taking care of more than 600 major trauma patients with a mortality rate of 10%. More than 50% of them whose injury severity score (ISS) is greater than 16 and most of them need multidisplinary treatment modalities.

The other important factors of a good trauma care system other than team work are a good communication between team members. The nursing specialist in our team acts as an active coordinator for all the major trauma patients in our hospital. We have dedicated to the trauma registry system in Taiwan from the very beginning and hoped this work will contribute to the trauma research in Taiwan. We look forward to make “trauma” no more a “neglected disease” in Taiwan in the future.

 The Division of Traumatology of Surgical Department in Far-Eastern Memorial Hospital

The traumtology division of the surgical department in Far-Eastern Memorial hospital was established in July 2006 as the first one organized traumatology division in Taipei County. This division consists of four attending physicians and one nursing specialist who dedicate to the care of multiple trauma patients. The chief of this division is also responsible for the trauma team in the surgical department of Far-Eastern Memorial Hospital. The trauma team is a functional team for taking care of severely injuries patients. It consists of surgeons, emergency physicians, interventional radiologists, intensive care specialists, and anesthesia specialists which provides team approach for the trauma patients with multiple organs involvement. The trauma team is on duty 7 days a day and 24 hours a week. The staffs in traumatology division are dedicated to the care of torso trauma, resuscitation, and combined injuries of the trauma victims.

The advancement of clinical practice dependents on a good training system. Our fellowship program will give the clinical fellows the opportunities to achieve the basic and advanced knowledge and techniques in the care of trauma patients. The programs include the treatment of thoracoabdominal injuries, external skeletal fixation techniques, intensive care training program, and the acute care surgery program for abdominal emergency. Due to the advancement of nonoperative management for torso trauma patients, trauma surgeons have to increase the exposure to the acute care surgery for abdominal emergency. We also dedicate to apply for minimal invasive approach for acute care surgery.

We always use the mostly updated guidelines as the treatment standard when we care for multiple trauma patients. Our service includes the clinical studies in traumatology and acute care surgery. One of our expertise is the prevention and treatment of abdominal compartment, including the abdominal wall reconstruction technique. The other one of our clinical interest is the minimal invasive approach for the abdominal stabbing injury patients. Our team provides not only the mostly cooperative, but also the mostly comprehensive team approach modality in Taipei County.   

II. Introduction of Attending Physicians:

1.    Dr. Heng-Fu Lin

Chief

Master of Institute of Emergency and critical care, National Yang Min University

Bachelor of National Taiwan University

Specialities

1.     Care of multiple trauma patients

2.     Laparoscopic management for abdominal trauma 

2.     Dr . Jwo-Luen Pao

Bachelor of National Taiwan University

Specialities

1. Orthopedic trauma

2. Minimally invasive surgery for spine 

3.     Dr. Wen-Jui Chang

Bachelor of National Yan-Ming University

Specialities

 Neurotrauma 

4.     Dr. Hui-Fu Huang

Bachelor of National Taiwan University 

Specialities

Reconstructive surgery for multiple trauma patients 

 One of our expertise is the prevention and treatment of abdominal compartment, including the abdominal wall reconstruction technique. The other one of our clinical interest is the minimal invasive approach for the abdominal stabbing injury patients. Our team provides not only the mostly cooperative, but also the mostly comprehensive team approach modality in Taipei County.

III. The clinical guide of trauma care:

1. Surgical Indication For Acute Traumatic Intracranial Hemorrhage:

1.     EDH:

a.      any symptomatic EDH.

b.     Acute asymptomatic EDH > 1cm in its thickness measurement

c.     Threshold for surgery in pediatrics should be very low due to less room for clot

2.     SDH:

a.      symptomatic SDH that are greater than about 1 cm at its thickness measurement ( 5mm in pediatrics )

3.     Contusion ICH

a.      mass effect with midline shift than 5mm.

All patient should have ICP monitor postoperatively to monitor ICP.

Surgical Indication for ICP Monitor Other Than Mentioned above

1.     patients with severe head injury ( GCS < =8 )

a.      with abnormal brain CT

b.     with normal brain CT and two of the followings

1) age > 40 Y/O

2) SBP < 90mmHg

3) decerebrate or decorticate posturing on motor exam              

2. multiple systemic injury with altered consciousness level

Surgical Indication for Spinal Injury

1. In patients with complete spinal cord injury

c.     the goal is spinal stabilization

d.     performing within 4-5 days after medically stabilized

2. In patients with incomplete spinal cord injury

e.      the goal is decompression and spinal stabilization as soon as possible