Adult Major Trauma (Including Traumatic Cardiac Arrest)

Pediatric Major Trauma (Including Traumatic Cardiac Arrest) New CDC Trauma Triage Algorithm

• The CDC Trauma Triage Algorithm is designed as a triage tool to help decide patient destination and the clinical care protocols are designed to provide treatment options. Time is ticking…..

• The Golden Hour‐ – Best survivability from incident to surgery is one hour.

• Platinum 10 minutes‐ – Scene time should be limited to 10 minutes.

Adult Trauma

ACS-COT Level I OR Level II Trauma Center Clinically, either level trauma center is acceptable for transport For patients falling into either box 1 or box 2

Transport patients w/ Box 1 or 2 Criteria to: “High Level TC –level I / level II”

University Hospital Stony Brook, Southside Hospital or Good Samaritan Hospital Level I Adult Trauma Centers University Hospital Stony Brook (ACS‐COT Adult Level I)

Nassau University Medical Center Transferring to Nassau County Trauma Centers

• According to State EMS, you are not expected to, but may, cross regional boundaries to reach the most appropriate hospital per regional hospital destination policies. Transport time <= 30 minutes

NYSDOH Regional Trauma Center ‐NUMC Nassau County Trauma Centers • Level I Adult TC ‐ Northwell Manhasset, and Winthrop University Hospital. • Level II Adult TC ‐ South Nassau Hospital. • Level I Pediatric TC ‐ Cohen Children’s Medical Center. • NYSDOH Pediatric Regional Trauma Center‐Winthrop University Level II Adult Trauma Centers Good Samaritan Hospital

Southside Hospital Pediatric Trauma

ACS-COT Level I OR Level II Trauma Center Clinically, either level trauma center is acceptable for transport For patients falling into either box 1 or box 2

Pediatric Patients w/ Box 1 or 2 Criteria to: “High Level TC –level I / level II” Transport Pediatric patients less than or equal to fourteen (< = 14) years of age to a Pediatric Trauma Center. University Hospital Stony Brook (Level I) or Good Samaritan Hospital Level II.) Pediatric Major Trauma

• A reminder regarding pediatric patients: while it is most preferable that pediatric patients, defined by the ACS‐COT as less than or equal to fourteen (< = 14) years of age, be transported to a Pediatric Trauma Center (University Hospital Stony Brook and Good Samaritan Hospital), transport to an adult trauma center, as opposed to a non‐trauma center, is acceptable when conditions prevent timely ambulance transport or use of medevac helicopter. Pediatric Trauma Centers University Hospital Stony Brook

Level I Pediatric Trauma Center Good Samaritan Hospital

Level II Pediatric Trauma Center ACS-COT Level I ,II ,III or (NYSDOH defined Area Trauma Center.) Transport to Level I,II,III or (NYSDOH defined Area Trauma Center) is acceptable for patients who fall into these boxes Level III Trauma Centers

NYSDOH defined Area Trauma Center (ACS‐COT) Adult Level III Non‐Trauma Centers • Eastern Long Island Hospital • St. Catherine of Siena Hospital • John T. Mather Memorial Hospital • St. Charles Hospital • St. Joseph Hospital Right Destination:

– Utilize CDC Field Triage Tool: • “Trauma Center Level Criteria and Selection”

– Transport patients w/ Box 1 or 2 Criteria to: • “High Level TC –level I / level II”

– Transport patients w/ Box 3 or 4 Criteria to: • “Any level TC –level I, II, III or NYSDOH defined Area Trauma Center.”

– Transport to pediatric trauma center: • Patients less than or = to 14 years old – University Hospital at Stony Brook – Good Samaritan Hospital

– Specialty care centers: • SBUH‐ Burns and Re‐implantation centers

– Consider Medivac utilization for Box 1 and 2 patients: • When High Level TC is more than 30 min. by ground transport time Ground Transport Time

• If the ground transport time from scene to trauma center will take more than 30 minutes, utilize medevac or contact medical control for a destination decision. Medevac

€ If the medevac is unavailable, you must transport by ground to the closest trauma center, regardless of level.

*Transport to the closest ED if the patient: ~ has an unmanageable airway ~is in cardiac arrest ~or medical control so directs… So when do I go to a Level III or Area Trauma Center only?

„For all patients: the ambulance ground time to a high level ( I or II) trauma center exceeds 30 minutes (Medical Control MUST be notified) „For pediatric patients: the ambulance ground time to a trauma center ( I or II) with pediatric commitment exceeds 30 minutes. (Medical Control MUST be notified) „Medevac is unavailable. (Medical Control MUST be notified) „Patient meets CDC Trauma Triage Center criteria for mechanism or special circumstances (steps 3 or 4) „Medical Control so directs • If a patient meets CDC Trauma Triage Guidelines for transport to a Level I or Level II Trauma Center or, in the case of pediatric trauma, to a pediatric trauma center, and the patient (for whatever reason) is transported to a non‐trauma center hospital, or a non‐pediatric trauma center …

Continued… …a post call signal 34 to Medical Control is required as soon as feasible after the call to ensure that the trauma system is made aware of the patients presence and the secondary transfer, if indicated, can be expedited. Trauma Pre‐Notification

• TRAUMA PRE‐NOTIFICATION is not the traditional hospital radio presentation • It is a pre‐notification that a patient meeting CDC Box 1 or 2 criteria is enroute • Level I and II Trauma Centers • trauma surgeon to be present upon patient arrival • Level III and NYSDOH defined Area Trauma Centers. • 30 minute response for Trauma Surgeon • Starting the process 15 minutes prior to arrival at TC should enhance response times in the County Trauma Center Pre‐Notification • ______Hospital, this is __(EMS Agency)_ giving a TRAUMA PRE‐NOTIFICATION. • Patient is a _____ year old male/female.

• ETA is _____minutes. (Pre‐notification at least 15 minutes out is ideal)

• Patient meets CDC Box 1 or 2 criteria: (Report all that apply)

□ GCS < 13 □ Amputation proximal to wrist or elbow □ Systolic BP < 90 mmHg □ Pelvic fracture □ Respiratory Rate < 10, or >29 or needing ventilatory support □ Open or depressed skull fractures (< 20 in infant)

□ Penetrating injury to head, neck, torso or extremity proximal □ Paralysis to elbow or knee

□ Chest wall instability or deformity □ Other: (does not met CDC criteria, but EMS provider feels that Trauma Pre‐Notification is warranted, □ Two or more proximal long bone fractures i.e. patient with tourniquet in place and stable VS, CPR □ Crushed, degloved, mangled or pulseless extremity in progress) BEDSIDE REPORT FORMAT “MVIT”

Mechanism Brief description of MOI (age, gender if not done in trauma notification) Vitals Lowest BP and Highest HR Current GCS, pupils Injury Suspected or confirmed significant injuries Treatment / ETT, IV’s, chest decompression, tourniquets, pelvic binder, Timing splints, CPR, etc. Response to treatment Duration of event or injury Other Known allergies, PMH, medications (especially anticoagulants or antiplatelet agents), special circumstances Questions Any questions? Solicited and answered by EMS provider FAQ’s

• Does it matter if I have an ALS crew? – No, these guidelines are for both ALS and BLS providers.

• Should I request the medevac if I can drive to the Level I or II Trauma Center in under 30 minutes? – The patient should be taken to the closest Level I or II Trauma Center in the least amount of time from the scene.

• What is the definition of an uncontrolled airway? – It is a patient that, after exhausting all options, you cannot get air into their lungs.