Trauma Triage Protocol
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Arizona Guidelines for Field Triage of Injured Patients (Regional Modifications Are Permissible)
Arizona Guidelines for Field Triage of Injured Patients (Regional modifications are permissible) FIELD TRIAGE DECISION SCHEME Measure vital signs and level of consciousness Glasgow Coma Scale ≤13 Systolic blood pressure (mmHg) <90 mmHg Step One Respiratory rate <10 or >29 breaths per minute (<20 in infant aged < 1 year1), or need for ventilator support YES NO Transport to a Trauma Center2. Steps 1 and 2 attempt to identify the most seriously injured Assess anatomy of injury. patients. These patients should be transported preferentially to the highest level of care within the trauma system. • All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee • Chest wall instability or deformity (e.g., flail chest) • Two or more proximal long-bone fractures • Crushed, de-gloved, mangled, or pulseless extremity Step Two3 • Amputation proximal to wrist or ankle • Pelvic fractures • Open or depressed skull fracture • Paralysis YES NO Transport to a Trauma Center2. Steps 1 and 2 attempt to identify the most seriously injured Assess mechanism of injury patients. These patients should be transported preferentially to the highest level of care within the and evidence of high-energy trauma system. impact. • Falls o Adults: >20 feet (one story is equal to 10 feet) 4 o Children : >10 feet or two or three times the height of the child • High-risk auto crash 5 Intrusion , including roof: >12 inches occupant site; >18 inches any site Step Three3 o o Ejection (partial or complete) from automobile o Death in same passenger compartment o Vehicle telemetry data consistent with high risk of injury 6 • Auto vs. -
Edition 2 Trauma Basics
Welcome to the Trauma Alert Education Newsletter brought to you by Beacon Trauma Services. Edition 2 Trauma Basics Trauma resuscitation is the initial stabilization and early life saving interventions provided to the trauma patient. It doesn’t mean that CPR was performed. When assessing the trauma patient it is important to recognize clues that indicate what is wrong now and what could go wrong later. Investigating the mechanism of injury is one of the most important clues to evaluate. This can be done by listening carefully to the MIST report from EMS and utilizing the 60 second time out for EMS to give report Source: https://tinyurl.com/ycjssbr3 What is wrong with me? EMS MIST 43 year old male M= unrestrained driver, while texting drove off road at 40 mph into a tree, with impact to driver’s door, 20 minute extrication time I= Deformity to left femur, pain to left chest, skin pink and warm S= B/P- 110/72, HR- 128 normal sinus, RR- 28, Spo2- 94% GCS=14 (Eyes= 4 Verbal= 4 Motor= 6) T= rigid cervical collar, IV Normal Saline at controlled rate, splint left femur What are your concerns? (think about the mechanism and the EMS report), what would you prepare prior to the patient arriving? Ten minutes after arrival in the emergency department the patient starts to have shortness of breath with stridorous sound. He is now diaphoretic and pale. B/P- 80/40, HR- 140, RR- 36 labored. Absent breath sounds on the left. What is the patients’ underlying problem?- Answer later in the newsletter Excellence in Trauma Nursing Award Awarded in May for National Trauma Month This year the nominations were very close so we chose one overall winner and two honorable mentions. -
Title: ED Trauma: Trauma Nurse Clinical Resuscitation
Title: ED Trauma: Trauma Nurse Clinical Resuscitation Document Category: Clinical Document Type: Policy Department/Committee Owner: Practice Council Original Date: Approved By (last review): Director of Emergency Services, Approval Date: 07/28/2014 Trauma Medical Director, Medical Director Emergency (Complete history at end of document.) Services POLICY: To provide immediate, effective and efficient patient care to the trauma patient, designated nursing staff will respond to the trauma room when a trauma page is received. TRAUMA CONTROL NURSE: 1) Role: a) The trauma control nurse (TCN) is a registered nurse (RN) with specialized training in the care of the traumatized patient, and who will function as the trauma team’s lead nurse. b) The TCN shall have successfully completed the Trauma Nurse Core Course (TNCC), Advanced Cardiac Life Support (ACLS), Emergency Nurse Pediatric Course (ENPC) or Pediatric Advanced Life Support (PALS), and role orientation with trauma services. c) Full-time employee or regularly scheduled part-time Emergency Department (ED) nurse. d) RN must have 6 months of LMH ED experience. 2) Trauma Control Duties: a) Inspects and stocks trauma room at beginning of each shift and after each trauma patient is discharged from the ED. b) Attempts to maintain trauma room temperature at 80-82 degrees Fahrenheit. c) Communicates with pre-hospital personnel to obtain patient information and prior field treatment and response. d) Makes determination that a patient meets Type I or Type II criteria and immediately notifies LMH’s Call System to initiate the Trauma Activation System. e) Assists physician with orders as directed. f) Acts as liaison with patient’s family/law enforcement/emergency medical services (EMS)/flight crews. -
Needs Assessment for New Trauma Center Development in the Commonwealth of Pennsylvania 2014
WHITE PAPER ON NEEDS ASSESSMENT FOR NEW TRAUMA CENTER DEVELOPMENT IN THE COMMONWEALTH OF PENNSYLVANIA 2014 Purpose Currently new trauma center development in Pennsylvania—with limited exception—is driven by competitive financial and hospital/healthcare system imperatives. The Pennsylvania Trauma Systems Foundation strongly recommends that going forward, new trauma center applications be based on a needs assessment process so as to optimize distribution of trauma centers in the trauma system and thereby provide optimal trauma care for the citizens of the Commonwealth of Pennsylvania. A guide for such a needs assessment is provided in this paper. Introduction Trauma systems have developed based on the sole precept that optimal recovery from traumatic injury is best achieved through the organization of prehospital and hospital preparedness and capability into a codified continuum of care. A codified continuum of care that is designated/accredited on a regular basis by qualified organizations such as the Pennsylvania Trauma Systems Foundation (PTSF). It is undisputed that trauma centers in states such as Pennsylvania have significantly improved the public health for citizens of the Commonwealth. Trauma is the fifth leading cause of death in Pennsylvania. A Pa. Department of Health study demonstrated a 30% reduced chance of death for severely injured patients treated in an accredited trauma center. In 2012, 95.6% of the 40,479 trauma qualifying patients treated at a trauma center survived. Currently, there are a total of 32 trauma centers in PA as noted below. 1 Figure 1 Source: http://www.rural.palegislature.us/demographics_rural_urban_counties.html As is readily appreciated, the majority of trauma centers are in the most populated counties (Philadelphia and Allegheny) with large areas of the state seemingly having little or no ready access to organized trauma care. -
Neurologic Deterioration Secondary to Unrecognized Spinal Instability Following Trauma–A Multicenter Study
SPINE Volume 31, Number 4, pp 451–458 ©2006, Lippincott Williams & Wilkins, Inc. Neurologic Deterioration Secondary to Unrecognized Spinal Instability Following Trauma–A Multicenter Study Allan D. Levi, MD, PhD,* R. John Hurlbert, MD, PhD,† Paul Anderson, MD,‡ Michael Fehlings, MD, PhD,§ Raj Rampersaud, MD,§ Eric M. Massicotte, MD,§ John C. France, MD, Jean Charles Le Huec, MD, PhD,¶ Rune Hedlund, MD,** and Paul Arnold, MD†† Study Design. A retrospective study was undertaken their neurologic injury. The most common reason for the that evaluated the medical records and imaging studies of missed injury was insufficient imaging studies (58.3%), a subset of patients with spinal injury from large level I while only 33.3% were a result of misread radiographs or trauma centers. 8.3% poor quality radiographs. The incidence of missed Objective. To characterize patients with spinal injuries injuries resulting in neurologic injury in patients with who had neurologic deterioration due to unrecognized spine fractures or strains was 0.21%, and the incidence as instability. a percentage of all trauma patients evaluated was 0.025%. Summary of Background Data. Controversy exists re- Conclusions. This multicenter study establishes that garding the most appropriate imaging studies required to missed spinal injuries resulting in a neurologic deficit “clear” the spine in patients suspected of having a spinal continue to occur in major trauma centers despite the column injury. Although most bony and/or ligamentous presence of experienced personnel and sophisticated im- spine injuries are detected early, an occasional patient aging techniques. Older age, high impact accidents, and has an occult injury, which is not detected, and a poten- patients with insufficient imaging are at highest risk. -
Mass/Multiple Casualty Triage
9.1 MASS/MULTIPLE CASUALTY TRIAGE PURPOSE · The goal of the mass/multiple Casualty Triage protocol is to prepare for a unified, coordinated, and immediate EMS mutual aid response by prehospital and hospital agencies to effectively expedite the emergency management of the victims of any type of Mass Casualty Incident (MCI). · Successful management of any MCI depends upon the effective cooperation, organization, and planning among health care professionals, hospital administrators and out-of-hospital EMS agencies, state and local government representatives, and individuals and/or organizations associated with disaster-related support agencies. · Adoption of Model Uniform Core Criteria (MUCC). DEFINITIONS Multiple Casualty Situations · The number of patients and the severity of the injuries do not exceed the ability of the provider to render care. Patients with life-threatening injuries are treated first. Mass Casualty Incidents · The number of patients and the severity of the injuries exceed the capability of the provider, and patients sustaining major injuries who have the greatest chance of survival with the least expenditure of time, equipment, supplies, and personnel are managed first. H a z GENERAL CONSIDERATIONS m Initial assessment to include the following: a t · Location of incident. & · Type of incident. M · Any hazards. C · Approximate number of victims. I · Type of assistance required. 9 . 1 COMMUNICATION · Within the scope of a Mass Casualty Incident, the EMS provider may, within the limits of their scope of practice, perform necessary ALS procedures, that under normal circumstances would require a direct physician’s order. · These procedures shall be the minimum necessary to prevent the loss of life or the critical deterioration of a patient’s condition. -
Guidelines for Trauma Team Activation (TTA)
Guidelines for Trauma Team Activation (TTA) ONE of the following criteria must be present with associated traumatic mechanism L e v e Measure Vital Signs and level of consciousness l Trauma Team Activation ALL TTA 1 & 2's MUST BE TRANSPORTED TO RGH Rural Travel time greater than 1 hour, failed airway · Glasgow Coma Scale less than 13 or immediate life threat divert to local facility and · Systolic Blood Pressure less than 90mmHg arrange STAT transport to RGH Trauma Center · Respiratory Rate less than 10 or greater then 29 breaths Prehospital per minute (less than 20 in infant), or advanced airway · Assess patient and determine TTA Level 1 support required · Early activation to receiving facility with: TTA Level, MIVT Report, ETA · STARS Activation or ALS (ACP) intercept NO · Update facility as needed Yes · Transport to Trauma Center Assess anatomy of injury Triage Nurse · Alert TTL Physician with TTA level, MIVT Report, ETA · TTL has a 20min response time · All penetrating injuries to head, neck, torso, and · Alert switchboard to overhead page: extremities proximal to elbow or knee Trauma Level ‘#’ ETA · Chest wall instability or deformity (e.g. flail chest) Trauma Team Lead · Two or more proximal long-bone fractures · Update ER on incoming Rural Trauma patients · Crushed, degloved, mangled, pulseless or amputation · Assume lead role and MRP status of an extremity proximal to wrist or ankle · Prepare resuscitation team · Pelvic fractures (high impact) · Assess, Treat and Stabilize patient 2 · Major facial or head trauma including depressed/open -
MASS CASUALTY TRAUMA TRIAGE PARADIGMS and PITFALLS July 2019
1 Mass Casualty Trauma Triage - Paradigms and Pitfalls EXECUTIVE SUMMARY Emergency medical services (EMS) providers arrive on the scene of a mass casualty incident (MCI) and implement triage, moving green patients to a single area and grouping red and yellow patients using triage tape or tags. Patients are then transported to local hospitals according to their priority group. Tagged patients arrive at the hospital and are assessed and treated according to their priority. Though this triage process may not exactly describe your agency’s system, this traditional approach to MCIs is the model that has been used to train American EMS As a nation, we’ve got a lot providers for decades. Unfortunately—especially in of trailers with backboards mass violence incidents involving patients with time- and colored tape out there critical injuries and ongoing threats to responders and patients—this model may not be feasible and may result and that’s not what the focus in mis-triage and avoidable, outcome-altering delays of mass casualty response is in care. Further, many hospitals have not trained or about anymore. exercised triage or re-triage of exceedingly large numbers of patients, nor practiced a formalized secondary triage Dr. Edward Racht process that prioritizes patients for operative intervention American Medical Response or transfer to other facilities. The focus of this paper is to alert EMS medical directors and EMS systems planners and hospital emergency planners to key differences between “conventional” MCIs and mass violence events when: • the scene is dynamic, • the number of patients far exceeds usual resources; and • usual triage and treatment paradigms may fail. -
The Trauma Center Providing Lifesaving Care for Critically Injured Patients
A community newsletter from Antelope Valley Hospital July/August 2017 The Trauma Center Providing Lifesaving Care for Critically Injured Patients Rapid Response Mental Health Services Team Ready to Expansion on Horizon Provide Early Intervention 24/7 In this issue Growing Excellence 2 CEO Message 3 Mental Health Services Right in Your Expansion on Horizon Own Backyard 4 Rapid Response Team Ready to Provide Early Intervention 24/7 5 Hyperbaric Oxygen erapy he previous issue of HealthConnect featured an article describing the Aids in Wound Healing upcoming reopening of our outpatient surgery center through a part - nership between AV Hospital and a local surgery center. In this issue AVH Trauma Center Provides T 6 we’re announcing the expansion of our mental health services. Combined, Lifesaving Care for Critically these two initiatives signify a renewal as well as a change for both our hospital Injured Patients and the overall healthcare in our community. 9 Amazing Person e renewal, of course, is our continued commitment to ensuring that local From Tragedy Comes Sense families don’t need to travel outside the Antelope Valley to receive exceptional of Community for AVH care. at has never been truer than it is today. AV Hospital is a state-of-the-art Employee and Family medical center offering services, technologies and staffing far beyond what would normally be found in a traditional local community hospital. is includes our Hospital Highlights 10 incredible trauma center, which is also featured in this issue. What’s more is Annual Summer Blood Drive that our 450-member medical staff includes primary care physicians, internists 12 and specialists who have been trained at some of the best medical schools and programs in the world. -
Fat Embolism Syndrome – a Qualitative Review of Its Incidence, Presentation, Pathogenesis and Management
2-RA_OA1 3/24/21 6:00 PM Page 1 Malaysian Orthopaedic Journal 2021 Vol 15 No 1 Timon C, et al doi: https://doi.org/10.5704/MOJ.2103.001 REVIEW ARTICLE Fat Embolism Syndrome – A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management Timon C, MCh, Keady C, MSc, Murphy CG, FRCS Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Date of submission: 12th November 2020 Date of acceptance: 05th March 2021 ABSTRACT DEFINITION AND INTRODUCTION Fat Embolism Syndrome (FES) is a poorly defined clinical Fat embolism 1 occurs when fat enters the circulation, this fat phenomenon which has been attributed to fat emboli entering can embolise and may or may not produce clinical the circulation. It is common, and its clinical presentation manifestations. may be either subtle or dramatic and life threatening. This is a review of the history, causes, pathophysiology, FES is a poorly defined clinical phenomenon which has been presentation, diagnosis and management of FES. FES mostly attributed to fat emboli entering the circulation. It classically occurs secondary to orthopaedic trauma; it is less frequently presents with respiratory, neurological and dermatological associated with other traumatic and atraumatic conditions. features. It typically occurs after long-bone fractures and There is no single test for diagnosing FES. Diagnosis of FES total hip arthroplasty, less frequently it is caused by burns is often missed due to its subclinical presentation and/or and soft tissue injuries 2. -
History of EMS and Trauma
Ronald M. Stewart, MD Austin Trauma and Critical Care Conference June 3, 2016 No Disclosures Thank You to: . Robert Winchell, MD . Peter Fischer, MD . Susan Steinemann, MD . Dave Ciesla, MD Current status Brief history of Trauma Centers and Systems Trauma center care as a business-History The problems with “proliferation” Does trauma center level & volume matter? Current COT approach Summary “One may long, as I do, for a gentler flame, a respite, a pause for musing. But perhaps there is no other peace for the artist than what he finds in the heat of combat…Instead, let us seek the respite where it is-in the very thick of battle. For in my opinion…, it is there.” Albert Camus Robert K. Greenleaf; Larry C. Spears. Servant Leadership: A Journey into the Nature of Legitimate Power and Greatness 25th Anniversary Edition 415 ACS Verified Trauma Centers . Roughly and equal number of other TC Intense controversy in many regions . Number and type of trauma center Relevant . Cost . Stability of system . Outcomes and volume? 1913 The American College of Surgeons 1916 Earnest Codman: “A Study of Hospital Efficiency” 1917 ACS: The Hospital Standardization Program becomes the Joint Commission in 1952 1965 SSA—Medicare/Medicaid conditions of participation 6 National Academy of Sciences: Accidental Death and Disability: The neglected disease of modern society: . EMS . Emergency medicine . Trauma Surgeons . Trauma centers and systems Public Hospitals – de facto trauma centers 7 Structure Processes Outcomes (Structure, process, outcome, access, safety, costs and patient experience) 8 Set relevant high standards Build and insure the right infrastructure, leadership and processes aimed at improving quality and reducing mortality. -
UHS Adult Major Trauma Guidelines 2014
Adult Major Trauma Guidelines University Hospital Southampton NHS Foundation Trust Version 1.1 Dr Andy Eynon Director of Major Trauma, Consultant in Neurosciences Intensive Care Dr Simon Hughes Deputy Director of Major Trauma, Consultant Anaesthetist Dr Elizabeth Shewry Locum Consultant Anaesthetist in Major Trauma Version 1 Dr Andy Eynon Dr Simon Hughes Dr Elizabeth ShewryVersion 1 1 UHS Adult Major Trauma Guidelines 2014 NOTE: These guidelines are regularly updated. Check the intranet for the latest version. DO NOT PRINT HARD COPIES Please note these Major Trauma Guidelines are for UHS Adult Major Trauma Patients. The Wessex Children’s Major Trauma Guidelines may be found at http://staffnet/TrustDocsMedia/DocsForAllStaff/Clinical/Childr ensMajorTraumaGuideline/Wessexchildrensmajortraumaguid eline.doc NOTE: If you are concerned about a patient under the age of 16 please contact SORT (02380 775502) who will give valuable clinical advice and assistance by phone to the Trauma Unit and coordinate any transfer required. http://www.sort.nhs.uk/home.aspx Please note current versions of individual University Hospital South- ampton Major Trauma guidelines can be found by following the link below. http://staffnet/TrustDocuments/Departmentanddivision- specificdocuments/Major-trauma-centre/Major-trauma-centre.aspx Version 1 Dr Andy Eynon Dr Simon Hughes Dr Elizabeth Shewry 2 UHS Adult Major Trauma Guidelines 2014 Contents Please ‘control + click’ on each ‘Section’ below to link to individual sections. Section_1: Preparation for Major Trauma Admissions