EPIC: Montana's New TBI Standard of care

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Monday, Aug 28, 2023

“She’s okay.. Her coordination after falling down the stairs when she was 3 years old has been a constant struggle..” 

“His personality is so different now.  It is like I don’t even know him.  Ever since he was hit by that car on his road bike…”

You can hear the echoes of hundreds of voices of TBI patients & their loved ones around Montana.. 

Each year, there are over 300 Montanans that die from TBI.  It is the culprit of 2.2 million emergency department visits and 52,000 deaths around the country.  

And unfortunately, Montanas TBI rate is higher in comparison to the rest of the nation.  It could be our rough and tumble lifestyles.  Or it could be that we live on the last great frontier with long distances to definitive care.  

The State of Arizona conducted a research study and treatment plan aimed to dramatically improve the care of traumatic brain injury patients and significantly decrease mortality.  

What they found was startling…

What is EPIC?

EPIC is an evidence-based treatment protocol & quality improvement initiative for improving outcomes and decreasing mortality in patients with TBI.  

It involved a collaboration of EMS agencies and hospitals around the state of Arizona whose common goal was simple: Stop the 3 H-bombs of TBI.  

They underwent a training course that took roughly 2 hours to be able to provide care within the parameters of the study.   

Started in 2007, it spanned until it's publish date in 2019.  

EPIC included 21,852 patients.  It linked prehospital and hospital data before and after the study.  The conclusion was: 

  • A lower rate of intubation despite greater injury severity.
  • A much higher rate of BVM-only airway management.
  • A greater likelihood of having an SpO2 of 100%. 
  • A greater reversal of hypoxia by the time of trauma center arrival.
  • A greater likelihood of receiving a fluid bolus in hypotensive and near-hypotensive patients.
  • A greater volume of fluid boluses in hypotensive and near-hypotensive patients.
  • A lower rate of hyperventilation/hypocapnia in intubated patients.

Nobody could have predicted the stats.  By implementing the EPIC treatment protocol they saw a: 

  • DOUBLING of adjusted odds of survival in severe TBI patients
  • TRIPLING of adjusted odds of survival in intubated severe TBI patients.  
  • A FIVEFOLD increase in adjusted rates of survival with severe TBI in pediatric patients
  • And over a SEVEN FOLD increase in adjusted rates of survival in pediatric patients managed by positive pressure ventilation. 

Montana's Turn

After being introduced to the study and seeing its incredible effects on survival and neurological outcomes, Montana has decided to partner with the EPIC project to improve the lives of hundreds of TBI patients.  

Montana EMSTS created the course curriculum that takes approximately  2 hours and is based on the original study. It  provides it at no cost for agencies and facilities throughout the state.  

SIMMT’s educators, along with a cadre of other EPIC-MT Trainers scattered throughout the state, are able to provide the training to ensure that your agency or facility is prepared with the most up-to-date standards of care.  

Reach out for more information and to get scheduled for training in your area.