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Summary: Multidisciplinary simulation has been used to successfully teach crisis resource management in operating room and emergency department settings. This article describes a “Mega-Sim” approach using an in-situ simulation that moves among multiple hospital departments to enhance multidisciplinary training and assess institutional response to a rare but high-risk event: trauma in a pregnant patient. It appears that a Mega-Sim can be used to identify systems issues, increase medical knowledge and improve perceptions of teamwork and communication within and among hospital departments., Competing Interests: None declared.

Introduction: Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer., Patients and Methods: We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243). Completion rates of paramedic form and ATLS primary survey variables were extracted. Nominal and interval descriptives were calculated. Documentation rates were considered deficient at <80% and severely deficient <60%. Odds ratios were calculated for primary facility data based on ISS ≥30 vs ISS <30, with 2-sided p-values for confidence intervals RESULTS: Two hundred forty-three patients met inclusion criteria with a mean ISS of 26. Most injured patients were male (79%), the predominant mechanism was blunt (93%) and the average age at injury was 51 years old. Two hundred eighteen patients arrived by Emergency Health Services, and 140 (64%) of EHS pre-hospital forms were transferred with the patient chart. Pre-hospital airway, physiologic data, and GCS completion rates were severely deficient (43-49%). Primary facility data was adequately completed for airway management, systolic blood pressure, and heart rate in (80-83%). Completion rates were deficient for respiratory rate, GCS and temperature (60-77%). An ISS score ≥30 was significantly associated with a lower completion rate for GCS., Discussion and Conclusion: Overall, documentation for inter-hospital transfer of major trauma patients in BC has significant deficiencies. Physiologic and basic ATLS variables are often omitted in transferred charts. The potential for adverse events is high but performance improvement is achievable. We recommend education, training and a standardized trauma transfer protocol to improve system-wide information transfer., (Copyright © 2016. Published by Elsevier Ltd.)

Summary: General surgeons provide life-saving trauma care to a large portion of Canadians. Although trauma care has evolved significantly over the last few decades and now requires fewer operations, when a life-saving operation is required the expectation of competence to perform this operation has not been reduced. A recent study from the United States found decreased resident case-log volumes of trauma operations. Such findings raise the alarm of declining exposure of residents to trauma operations and beg the question of whether graduating residents are competent to care for trauma patients. Examination of the Canadian setting reveals a dearth of published information about the actual exposure of Canadian general surgery residents to trauma care. With the forthcoming evolution of general surgery education into competency-based medical education, we sound a call to action to ensure that all graduating general surgeons are able to provide the care that both the Royal College of Physicians and Surgeons of Canada and the Canadian public demand. [ABSTRACT FROM AUTHOR]