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 · Arrange disposition once patient is stabilized skull fractures Pasqua Hospital - arrange STAT transfer to RGH · Paralysis or known unstable spinal fracture Rural Hospitals – arrange STAT transfer to RGH · Major Burns** through RQ Bedline Physician Access Line (306-766- 6050) who will direct the call to the TTL DO NOT delay transport NO If patient presentation changes at any Assess mechanism of injury point upgrade patient to higher activation level and follow TTA guidelines Falls · Adults: greater than 6 meters (20 feet) Trauma Consult · Children: greater than 3 meters (10 feet) or two or three Does not require overhead paging times the height of the child Prehospital High-risk auto crash · Assess patient and determine TTA Level · Intrusion, including roof: greater than 12 inches · Update receiving facility · occupant site or 18 inches any site Yes Transport to a trauma center, which, · Ejection (partial or complete) from automobile depending upon the defined trauma system, · Death in same passenger compartment need not be the highest level trauma center 3 · Vehicle telemetry data consistent with a high risk of Triage Nurse injury · Triage patient following standard process Auto vs. pedestrian/bicyclist Emergency Department Physician · Thrown, run over, or with significant impact (greater · Preform assessment and treatment than 30 kph) · Consult TTL on admission or as needed · Motorcycle crash greater than 30 kph Rural Hospitals – Consult the Emergency Department Physician through RQ Bedline Physician NO Access Line (306-766-6050) as needed Trauma Assessment Assess special considerations Does not require overhead paging Prehospital · Assess patient and determine TTA Level Older Adults · Update receiving facility · Risk of injury/death increases after age 55 years · Transport to a trauma center or hospital · SBP less than 110 may represent shock after age 65 capable of timely and through evaluation and · Low impact mechanisms (e.g. ground level falls) may initial management of potentially serious injury Yes result in severe injury Triage Nurse Anticoagulants and bleeding disorders · Triage and utilize appropriate resources upon 4 · Patients with head injury are at high risk for rapid arrival deterioration Emergency Department Physician Pregnancy greater than 20 weeks · Preform assessment and treatment Healthcare provider judgment · Consult TTL as needed Rural Hospitals – Consult theEmergency NO Department Physician through RQ Bedline Physician Access Line (306-766-6050) as needed Transport / Triage as standard procedure *adapted from the CDC, National Center for Injury Prevention July 6, 2017 and Control, 2011 guidelines for Field Triage of Injured Patients V(12) **Definition of Major Burns

• > 20% TBSA partial and/or full thickness any age • >10% TBSA partial and/or full thickness age < 10 or > 50 • Burns to hands, face, feet, genitalia, joints • Full thickness burns > 5% TBSA any age • Electrical burns • Chemical burns • Inhalation injury • Burns associated with major trauma

Legend TTA – Trauma Team Activation RGH – Regina General Hospital STARS – Shock Trauma Air Rescue Society ALS – Advanced Life Support ACP – Advanced Care Paramedic MIVT – Mechanism, Injury, Vital Signs, Treatment ETA – Estimated Time of Arrival CDC – Center for Disease Control SBP – Systolic Blood Pressure EMS – Emergency Medical Service Kph – Kilometers Per Hour TBSA – Total Body Surface Area