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Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, Baptista S, Mesquita C, Alexandrino H. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg 2023; 49:1771-1781. [PMID: 36414695 DOI: 10.1007/s00068-022-02166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
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Affiliation(s)
- André Bento
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Ferreira
- Department of General Surgery, Hospital Central do Funchal, SESARAM, Funchal, Portugal
| | - Carlos Yánez Benitez
- General and Gastrointestinal Surgery, Royo Villanova Hospital, SALUD, Zaragoza, Spain
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Piotr Kozera
- Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Sérgio Baptista
- Department of Anesthesiology, Centro Hospitalar do Médio Tejo, EPE, Tomar, Portugal
| | - Carlos Mesquita
- Head of Clinic (Consultancy in General and Emergency Surgery and Trauma), Private Practice Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
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Taylor J, Gezer R, Ivkov V, Erdogan M, Hejazi S, Green R, Tallon JM, Tuyp B, Thakore J, Engels PT, Ackery A, Beckett A, Vogt K, Parry N, Heyd C, Coates A, Lampron J, MacPhail I. Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CAN J EMERG MED 2023:10.1007/s43678-023-00516-z. [PMID: 37184823 DOI: 10.1007/s43678-023-00516-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Trauma team leaders (TTLs) have traditionally been general surgeons; however, some trauma centres use a mixed model of care where both surgeons and non-surgeons (primarily emergency physicians) perform this role. The objective of this multicentre study was to provide a well-powered study to determine if TTL specialty is associated with mortality among major trauma patients. METHODS Data were collected from provincial trauma registries at six level 1 trauma centres across Canada over a 10-year period. We included adult trauma patients (age ≥ 18 yrs) who triggered the highest-level trauma activation. The primary outcome was the difference in risk-adjusted in-hospital mortality for trauma patients receiving initial care from a surgeon versus a non-surgeon TTL. RESULTS Overall, 12,961 major trauma patients were included in the analysis. Initial treatment was provided by a surgeon TTL in 57.8% (n = 7513) of cases, while 42.2% (n = 5448) of patients were treated by a non-surgeon TTL. Unadjusted mortality occurred in 11.6% of patients in the surgeon TTL group and 12.7% of patients in the non-surgeon TTL group (OR 0.87, 95% CI 0.78-0.98, p = 0.02). Risk-adjusted mortality was not significantly different between patients cared for by surgeon and non-surgeon TTLs (OR 0.92, 95% CI 0.80-1.06, p = 0.23). Furthermore, we did not observe differences in risk-adjusted mortality for any of the subgroups evaluated. CONCLUSIONS After risk adjustment, there was no difference in mortality between trauma patients treated by surgeon or non-surgeon TTLs. Our study supports emergency physicians performing the role of TTL at level 1 trauma centres.
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Affiliation(s)
- John Taylor
- Royal Columbian Hospital Emergency Department, New Westminster, BC, Canada.
| | | | - Vesna Ivkov
- Emergency and Trauma, Fraser Health Authority, Surrey, BC, Canada
| | - Mete Erdogan
- NS Health Trauma Program, Implementation Science, Nova Scotia Health, Halifax, NS, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC, Canada
| | - Robert Green
- Departments of Critical Care, Emergency Medicine, Anesthesia, and Surgery, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
| | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Community Health and Epidemiology, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Jaimini Thakore
- Data, Evaluation and Analytics, Trauma Services BC, Fort Langley, BC, Canada
| | - Paul T Engels
- Trauma, General Surgery and Critical Care, Trauma and Acute Care Surgery, McMaster University, Hamilton, ON, Canada
| | - Alun Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Trauma and Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew Beckett
- University of Toronto, Toronto, ON, Canada
- Canadian Forces Health Services, Ottawa, ON, Canada
| | - Kelly Vogt
- Western University, London, ON, Canada
- Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - Neil Parry
- Trauma Program, Surgery and Critical Care Medicine, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada
| | - Christopher Heyd
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Coates
- Trauma Program Manager, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jacinthe Lampron
- General Surgery, Acute Care and Trauma, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Iain MacPhail
- Fraser Health Trauma Network, UBC, Vancouver, BC, Canada
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Bouderba S, Lecky F, Soltana K, Neveu X, Kumar DS, Bouamra O, Coats TJ, Tardif PA, Belcaid A, Gonthier C, Moore L. Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada. Can J Surg 2023; 66:E32-E41. [PMID: 36653031 PMCID: PMC9854907 DOI: 10.1503/cjs.001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Comparisons across trauma systems are key to identifying opportunities to improve trauma care. We aimed to compare trauma service structures, processes and outcomes between the English National Health Service (NHS) and the province of Quebec, Canada. METHODS We conducted a multicentre cohort study including admissions of patients aged older than 15 years with major trauma to major trauma centres (MTCs) from 2014/15 to 2016/17. We compared structures descriptively, and time to MTC and time in the emergency department (ED) using Wilcoxon tests. We compared mortality, and hospital and intensive care unit (ICU) length of stay (LOS) using multilevel logistic regression with propensity score adjustment, stratified by body region of the worst injury. RESULTS The sample comprised 36 337 patients from the NHS and 6484 patients from Quebec. Structural differences in the NHS included advanced prehospital medical teams (v. "scoop and run" in Quebec), helicopter transport (v. fixed-wing aircraft) and trauma team leaders. The median time to an MTC was shorter in Quebec than in the NHS for direct transports (1 h v. 1.5 h, p < 0.001) but longer for transfers (2.5 h v. 6 h, p < 0.001). Time in the ED was longer in Quebec than in the NHS (6.5 h v. 4.0 h, p < 0.001). The adjusted odds of death were higher in Quebec for head injury (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09-1.51) but lower for thoracoabdominal injuries (OR 0.69, 95% CI 0.52-0.90). The adjusted median hospital LOS was longer for spine, torso and extremity injuries in the NHS than in Quebec, and the median ICU LOS was longer for spine injuries. CONCLUSION We observed significant differences in the structure of trauma care, delays in access and risk-adjusted outcomes between Quebec and the NHS. Future research should assess associations between structures, processes and outcomes to identify opportunities for quality improvement.
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Affiliation(s)
- Samy Bouderba
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Fiona Lecky
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Kahina Soltana
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Xavier Neveu
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Dhushy Surendra Kumar
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Omar Bouamra
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Timothy J Coats
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Pier-Alexandre Tardif
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Amina Belcaid
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Catherine Gonthier
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
| | - Lynne Moore
- From the Department of Social and Preventive Medicine, Université Laval, Québec, Que. (Bouderba, Soltana, Tardif, Moore); the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de recherche du CHU de Quebec - Université Laval, Hôpital de l'Enfant-Jésus, Québec, Que. (Bouderba, Soltana, Neveu, Tardif, Moore); the Department of Emergency Medicine, University of Sheffield, Sheffield, UK (Lecky); the Trauma Audit and Research Network, Salford, UK (Kumar); the Department of Biology, Medicine and Health, Trauma Audit and Research Network, Manchester, UK (Bouamra); the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (Coats); and the Institut national d'excellence en santé et en services sociaux, Québec, Que. (Belcaid, Gonthier)
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Pandian V, Ghazi TU, He MQ, Isak E, Saleem A, Semler LR, Capellari EC, Brenner MJ. Multidisciplinary Difficult Airway Team Characteristics, Airway Securement Success, and Clinical Outcomes: A Systematic Review. Ann Otol Rhinol Laryngol 2022:34894221123124. [DOI: 10.1177/00034894221123124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate whether implementation of a multidisciplinary airway team was associated with improvement in (1) rate of successful airway securement at first attempt; (2) time to secure airway; and (3) overall complication rate in patients with a difficult airway, as compared with usual care. Data Sources: Ovid Medline, Embase, Scopus, Cochrane Central, and CINAHL databases. Review Methods: Systematic review of literature on inpatient multidisciplinary team management of difficult airways, including all studies performed in inpatient settings, excluding studies of ventilator weaning, flight/military medicine, EXIT procedures, and simulation or educational studies. DistillerSR was used for article screening and risk of a bias assessment to evaluate article quality. Data was extracted on study design, airway team composition, patient characteristics, and clinical outcomes including airway securement, complications, and mortality. Results: From 5323 studies screened, 19 studies met inclusion criteria with 4675 patients. Study designs included 12 quality improvement projects, 6 cohort studies, and 1 randomized controlled trial. Four studies evaluated effect of multidisciplinary difficult airway teams on airway securement; all reported higher first attempt success rate with team approach. Three studies reported time to secure the difficult airways, all reporting swifter airway securement with team approach. The most common difficult airway complications were hypoxia, esophageal intubation, hemodynamic instability, and aspiration. Team composition varied, including otolaryngologists, anesthesiologists, intensivists, nurses, and respiratory care practitioners. Conclusion: Multidisciplinary difficult airway teams are associated with improved clinical outcomes compared to unstructured emergency airway management; however, studies have significant heterogeneity in team composition, algorithms for airway securement, and outcomes reported. Further evidence is necessary to define the clinical efficacy, cost-effectiveness, and best practices relating to implementing difficult airway teams in inpatient settings.
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Affiliation(s)
- Vinciya Pandian
- Immersive Learning and Digital Innovations, Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Talha U. Ghazi
- Michigan State University College of Human Medicine, West Bloomfield, MI, USA
| | - Marielle Qiaoshu He
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- US Navy Medical Corps, Washington, DC, USA
| | - Ergest Isak
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Abdulmalik Saleem
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Lindsay R. Semler
- INTEGRIS Health, Oklahoma City, OK, USA
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Michael J. Brenner
- Department of Otolaryngology–Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
- Global Tracheostomy Collaborative, Raleigh, NC, USA
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