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T RAUMATIC BRAIN INJURY (TBI) is the leading cause of death and disability in Americans aged 1 to 44. Most often resulting from falls at home, work or play, TBI accounts for 52,000 deaths each year. It also accounts for at least 5.3 million people (2 percent of the US population) currently living with disabilities. The above statistics are from the Brain Trauma Foundation (BTF). Peter B. Letarte, MD, FACS, is a longtime member of the BTF advisory board and helped write two of its national TBI Guidelines. Board- certified in Neurosurgery and certified in Neurocritical Care, Dr. Letarte has been diagnosing, treating and teaching about TBI for the past 30 years — with the United States Navy, the National Highway Transportation and Safety Administration (NHTSA), the Veterans Administration, and Loyola University. Earlier this year, he joined Akron General Health System. "Getting the best outcome you can in TBI really revolves around the pre-hospital care, the neuro and trauma surgery and intensive care around that, and then rehab," Dr. Letarte says. "It all has to be done seam- lessly and well. And it has to be done by people who deal with the brain every day." Farid Muakkassa, MD, Medical Director of Trauma Services at Akron General, agrees. With 22 years of experience as a trauma surgeon, he's the veteran on the team he leads. "It's the team that makes the differ- ence, and that team at Akron General includes board-certified trauma surgeons who are also board certified in intensive care, neurosurgeons, intensivists and neurointensivists, anesthesiologists, radi- ologists, interventional radiologists, rehab physicians, therapists, and specially trained nurses," says Dr. Muakkassa. As an American College of Surgeons (ACS) verified Level I Trauma Center, Akron General has the resources to take care of all injuries regardless of severity. According to Dr. Muakkassa, the trauma team's capabilities to diagnose and treat head trauma — from the time of injury all the way to rehabilitation — go well beyond the ACS requirements. Pre-hospital Management Obtaining medical treatment within 60 minutes — aka "the golden hour" — often makes the difference for critically ill or injured patients in terms of mortality and morbidity. Emergency ground and air transport services speed delivery of patients to Akron General from 26 Ohio counties, mostly in the northeast quadrant of the state. The healthcare providers on board are all specially trained. "We have been involved for many years in educating paramedics and EMTs about trauma life support," says Dr. Muakkassa, pointing out that his teaching curriculum follows the BTF's Guidelines for pre- hospital care of patients with TBI. "I've done a lot of teaching on pre- hospital best practices for dealing with and protecting the injured brain. That's what my work with Nav y corpsmen involved," says Dr. Letarte. Protecting the injured brain — and preventing it from injury — was also the focus of his research with NHTSA and the University of Pittsburgh, where he did his fellowship training in Neurotrauma. According to BTF, following the guide- lines for pre-hospital management of TBI results in correct identification of TBI, optimal treatment in the ambulance or air transport, and direct transfer to a TBI trauma center. BTF has published in-hospital TBI guidelines, too. Their application report- edly reduces ICU length of stay, decreases death and disability by 30 to 50 percent, and increases neurological outcome upon discharge by 30 to 50 percent. "The 'basics' is trauma life support," Dr. Muakkassa explains. "BTF guidelines, which we follow at Akron General, go beyond these." Akron General neurosurgeon Peter B. Letarte, MD, is a longtime member of the Brain Trauma Foundation advisory board. PHOTOS © SMITHBERGER PHOTOGRAPHY, NORTH CANTON, OHIO with TBI by Robert Janek Caring for Patients 1 2 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ M AY/J U N E 2 0 1 5