WHAT’S INSIDE


Tackle Trauma presentsStraight Outta Quarantine


What’s happening later this year at STACS 2021


Trauma Policy Highlight -Wheels and Weed

 

PRESIDENT’S LETTER

Dear AzTA Members, Sponsors and Colleagues,

Remaining in unprecedented times in Arizona and a cross the county, we cannot forget that robust trauma systems are more critical now than ever as an indicator of public health. As we move out of the pandemic and into a revival of strengthening public health demands, we are reminded that trauma is a pressing public health epidemic. At AzTA, we know that trauma systems represent comprehensive and complex infrastructures dedicated to providing optimal care for injured patients. Since its founding in2007 as a coalition of all the trauma centers inArizona, we have continued to reexamine our role in supporting and strengthening the trauma system inArizona by bringing together trauma providers rather than regional division. In 2020, AzTA underwent a lifecycle examination to inform the future of the organization and a subsequent restructuring to broaden the involvement of trauma providers at all levels of the trauma system. We aim to utilize leadership and shared expertise to support a broader spectrum of trauma services, from injury prevention efforts and an integrated network of trauma centers to concerted research agendas and policy enhancements.

We strongly feel that the AzTA stands poised to make a difference in the lives of Arizona’s residents. AzTA’s continuous improvement of trauma care is characterized by our redefined pillars of education, research, collaboration, prevention, and advocacy.

We are proud of our organization’s successes over the thirteen years, particularly in providing more opportunities for meaningful engagement of our members and sponsors, introducing strong educational programming formats and topics, and providing professional development and outreach opportunities. In the year ahead, we will continue these initiatives and add programming designed for engaging broader participation of trauma providers, virtual programming, and events held in collaboration with other organizations in Arizona and beyond.

Thank you, members, for your continued participation and enthusiasm in our professional community and sponsors for your incredible support and advice. A robust trauma system requires the efforts of everyone.

Bellal Joseph, MD, FACS
President, Arizona Trauma Association
Michelle Notrica, PharmD, JD, MPH
Executive Director, Arizona Trauma Association

12TH ANNUAL SOUTHWEST TRAUMA AND ACUTE CARE SYMPOSIUM (STACS) – OCTOBER 7-8, 2021

by David Notrica, MD, FACS, FAAP, STACS Conference Chair

While COVID-19 remains an ongoing concern with an uncertain impact on future travel and large in person events, the Arizona Trauma Association (AzTA) leadership has made the decision to have the 13th Annual Southwest Trauma and Acute Care Symposium (STACS) for 2021 as a virtual event over two days.

STACS has always provided incredible national speakers and great opportunities to meet your peers in the trauma and acute care surgery community. Our conference is open to all providers, from paramedics to nurses, registrars to trauma surgeons. We remain excited about the future and the return of STACS in 2022 as a traditional conference, retaining virtual and on-demand options which have been very popular.

In 2021, we will once again have many outstanding speakers delivering concise 20-minute lectures on relevant trauma and critical care topics. The conference will include a somewhat shortened format over the two days, and the on-demand viewing will be available for up to one year after the conference.

Individual and Hospital group rates are available at a significantly lower cost this year due to the abbreviated schedule and generous financial support from our sponsors. Plan to get your CME/CE with us!

 

WHEEL SANDWEED:
POTENTIAL IMPACT OF MARAJUANA LEGALIZATION ON TRAUMA IN ARIZONA

By: Jesse Scott & Michelle Notrica, PharmD, JD, MPH

In the 2020 general election, Arizona became the 13th state to legalize recreational marijuana after 10 years of legal medical use. Proposition 207 (A.R.S. Title 36, Chapter 28.2) legalized the possession and use of marijuana for anyone age 21 years or older. Individuals in Arizona are now permitted to grow no more than six marijuana plants in their residence and can possess up to one ounce of marijuana, with no more than five grams in a concentrated form.

Starting this month, we will see increased recreational sales at retail dispensaries. With the ensuing increase in the use of this substance, those working in the emergency and trauma systems may have several questions. What will be the impact of legalization on trauma? Are there any additional medical implications in caring for trauma patients who may have marijuana in their system?

The impact of legalization on trauma systems:
Traumatic injury related to marijuana usage could potentially increase, but the impact depends on the enforcement of existing laws. In a study by DM Notrica et al., a statistically significant increase in the mortality rate for all ages occurred in states where marijuana was decriminalized (Notrica et al., 2020, 764-765). However, there was no change in mortality rates where statutes penalizing marijuana-influenced driving were strongly enforced. Currently, Proposition 207 prohibits driving while impaired on marijuana, but as research suggests, impaired driving laws are not working as intended. The new law allows the Arizona Legislature, with a three-quarters majority, to enact a law that puts a threshold on the active metabolites allowed in the bloodstream, similar to a blood-alcohol-content limit. The catch is that it can only enact that law “when scientific research on the subject is conclusive and the National Highway Traffic Safety Administration recommends the adoption of such a law.” This question is highly debated and complicated. Metabolites can take days to resolve; making it difficult for law enforcement to demonstrate that the marijuana was actively impairing the driver. Some auto manufacturers are considering high-tech sensors, but this technology is not available commercially yet.

Is there anything the trauma community can do? Notrica et al., found that existing regulations such as maintaining strong impaired driving laws and continuing to utilize traditional law-enforcement tools to assess impairment once a driver is pulled over may be sufficient. Targeting known accident zones with increased enforcement and high fines may also be more effective in preventing accidents from impaired driving. Going forward, the trauma community must advocate for evidence-informed laws that utilize accident data to target high accident zones with increased fines and ongoing enforcement to minimize the impact of marijuana impairment.

Medical Implications: Marijuana in Injured Patients
Medical concerns regarding patients who may have marijuana in their system raise another potential issue for trauma providers. With chronic use, cannabis can interact with the coagulation cascade, disrupting the speed of clot formation, clot strength, and clot formation time. According to a study by Stupinski et al., this ultimately increases the rate of thrombotic events (deep vein thrombosis and pulmonary embolism) in trauma patients. Interestingly though, there was no increase in the rate of stroke or myocardial infarction (Stupinski et al., 2020).

Conclusions:
How is this knowledge useful? By knowing that patients who consume marijuana regularly are at a higher risk of trauma, and have a higher risk of hyper coagulability, patients and communities may be risk-stratified by marijuana usage. In communities with a high proportion of marijuana users, the number of motor vehicle collisions may initially rise until penalties are reinforced. And in areas of high, chronic use, risk stratification of patients can help identify the potential for hyper coagulability.

 

 

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    The Arizona Trauma Association (AzTA) was started by a group of surgeons in 2007 to improve the delivery of health care to injured patients throughout the state of Arizona by supporting collaborative research, education and outreach activities of trauma centers in the state of Arizona.

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