TRAUMA TRIAGE: CONCEPTS in PREHOSPITALTRAUMA CARE Robert E

Total Page:16

File Type:pdf, Size:1020Kb

TRAUMA TRIAGE: CONCEPTS in PREHOSPITALTRAUMA CARE Robert E TRAUMA TRIAGE: CONCEPTS IN PREHOSPITALTRAUMA CARE Robert E. O'Connor, MD, MPH, FACEP ABSTRACT is immense, with 1.6 million emergency department visits for assault in 2002. While there were more than This report examines the efficacy of current trauma triage 42,000 automotive deaths in the United States in 2002, roles to determine the exigency of field care and transport there were more than 17,000 homicides, with a death of severely injured patients from a variety of medical pop- ulations. Key words: emergency medical services; trauma; rate of 6.1 per 100,000. The vast majority of homicides, triage. nearly 12,000, are caused by firearms, with a death rate PREHOSPITALEMERGENCYCARE2006;10:307-310 of 6.1 per 100,000.6The health care burden of caring for the injured is vast and requires that the regional health INTRODUCTION care system share this burden with minimal overtriage and undertriage. A regional trauma plan is an inclu- Effectivefield triage of trauma victims requires iden- sive model tha t integra tes the resources of hospitaIs and tification of patients at risk of dying and their rapid communities throughout the region in providing care transport to hospitaIs capable of treating severe injuries. to the severely injured trauma patient. ldentification of these patients at the scene can be diffi- When the trauma triage rule works well, emergency cultbecause prehospital personnel must rapidly apply medical technicians (EMTs) and paramedics get to the structured triage decision making. Precise application scene and apply judgment with explicit triage criteria oíprehospital trauma triage criteria is critical for ensur- to determine quickly which hospital to transport pa- ing that the maximum number of patients with severe tients to and which life-saving interventions to admin- injuries is transported to trauma centers. The tradeoff ister at the scene and during transport. Most prehospital in the prehospital management of trauma balances a trauma triage criteria adopt a combination of physio- perceived need to "stay and play" tempered by the re- logic, anatomic, and mechanism of injury components, ality of having to "load and go." While the prehospital but this approach still fails to identify a number of pa- trauma triage instrument may be helpful in determin- tients with severe injuries and often burdens trauma ing the exigency of field care and initiation of trans- centers with patients with minor injuries.7,8 port, the real utility lies in identifying patients war- ranting transport to the regional trauma center, even ifnon-trauma centers are bypassed on the way.l-13 On- Physiologic Criteria line medical direction may be used to enhance triage decisions.4 Various types of diagnostic and monitoring techniques The annual automotive crash distribution in the are available in the prehospital environment, but it is United States is shown in Table 1. Less than one half of unclear how increasing complexity of diagnostic equip- all tow-away crashes involve personal injury. Of those ment improves the ability to predict the need for a life- injured, fewer than 9% have serious injury and fewer saving intervention. One recent study suggested that a than 3% have time-critical injury. Rapid identification weak radial pulse may be used to triage trauma patients of patients with serious injury, especially if time crit- in field conditions with limited instrumentation.9 An- ical, is the goal of any prehospital triage scheme. To other study showed that when an abnormal radial pulse appropriately conserve resources, such a scheme must character (weak or absent) and abnormal Glasgow have sufficient specificity and not result in excessive Coma Scale (GCS) verbal and motor components were overtriage.5 present, the probability of needing a life-saving inter- While automotive trauma accounts for the larger pro- vention was >88%. These data show that simple and portion of patients likely to benefit from treatment at a rapidly acquired manual measurements could be used trauma center, interpersonal violence places substantial to effectively triage non-head-injured trauma patients demands on trauma systems. The scope of the problem and may provide a more rapid and accurate assessment than more sophisticated techniques.lO If blood pressure (BP) is to be used as a triage in- strument, a manual BP should be obtained. Automated From the Department of Emergency Medicine, Christiana Care BP determinations are consistent1y higher than manual Health System, Newark, DE. BP, particularly in hypotensive patients. Some recom- mend that automated BP devices should not be used for Address correspondence to: Robert E. O'Connor, MO, MPH, FACEP, Christiana Care Health System, 4755 Ogletown-Stanton Road, PO Box field or hospital triage decisions. Manual BP determi- 6001, Newark, DE 19718. e-mail: <[email protected]>. nations should be used until systolic BP is consistent1y doi: 10.1080 /10903120600723947 >110 mm Hg.n 307 308 PREHOSPITALEMERGENCYCARE jULY / SEPTEMBER2006 VOLUME 10/ NUMBER 3 TABLE1. Annual Automotive Crash Distribution in the (side vs. front vs. rear), rollover, restraint use, and bag United States29 deployment. In the future, information from car sen- Motor vehicle crashes 11.4 million sors to public safety answering point, crash location, Vehicle towed 3.0 million and even voice communication with occupant may be Treated and released from hospital 1.2 million used to predict injury severity. Vehides equipped with Treated at the scene 300,000 "smart" sensors will be able to relay information to Hospitalized 230,000 Vehicles involved in fatalities 47,000 EMTs on change in velocity, vector of impact, and res- cue strategies before they arrive at the crash site. Safety measures could indude instructions on extrication and Another predictor of serious trauma is a respiratory disabling of airbags to reduce the chance of inadvertent rate >25 breaths/min. Respiratory rate may be a useful deployment.17 triage tool for trauma care providers where the scene is Substantial undertriage of serious trauma patients to chaotic and evacuations 10ng.12 trauma centers appears to be occurring, especially in The prehospital GCS score is a reliable physiologic older persons and in persons with brain injuries. Ef- parameter for predicting hospital admission after a mo- forts to understand why undertriage is occurring so fre- tor vehide crash. When obvious indicators (hypoxemia, quently are hampered by fragmentation of the systems multiple long bone fractures, focal neurologic deficits) of care, inadequate data management systems, and lack for trauma team activation are lacking, the prehospi- of trauma care performance reporting by non-trauma tal GCS score may be used to reduce overtriage and center hospitals.18 undertriage rates.n Undertriage of older trauma victims has been a persistent and serious problem. Because of physio- logic changes and preexisting disease, blunt trauma in Mechanism Cri teria older persons is often covert. Prehospital trauma triage guidelines developed for use with a general adult pop- Investigators from the Royal Melbourne Hospital con- ulation may not be sensitive enough to detect covert ducted a study to assess whether prehospital triage injuries in elder1y trauma patients. In one study, under- guidelines, based on mechanistic criteria alone, accu- triage was 8% for young and middle-aged men, 12% rately identified victims of motor vehide crashes with for young and middle-aged women, 18% for older men, major injury. Multivariate logistic regression indicated and 15% for older women. Overtriage was also present that prolonged extrication time, passenger compart- in alI age groups, indicating that many motor vehide ment intrusion, high speed, and ejection from vehide crash victims who were admitted to trauma centers were statistically associated with major injury. Vehide could have been admitted to non-trauma center hos- rollover and fatality in the same vehide were not statis- pitaIs. Low sensitivity and specificity of trauma triage tically associated with major injury. These data suggest guidelines result in undertriage and overtriage. Some that existing guidelines for the prehospital triage of mo- argue that prehospital triage guidelines should indude tor vehide crash victims, based on mechanistic criteria age as a decision point to avoid placing older persons alone, may need revision.14 at risk for undertriage.19 Paramedic judgment has been identified as an alter- Conversely, overtriage of younger trauma patients native method for the triage of trauma patients but is appears to be prevalent. Helicopter transport of pedi- as of yet unverified.15 Although there is little evidence atric trauma patients in an urban emergency medical to strictly support the rule, scene time should generally services (EMS) system was assessed to identify the ap- be limited to ten minutes unless factors such as delayed propriateness of using this modality for the young. The extrication supervene. majority of pediatric trauma patients transported by he- Are some criteria more sensitive than others? In one licopter were found to have sustained minor injuries.20 study, mechanism of injury was the only reason for Trauma triage scores, severity of illness measures, trauma center transport in 29 of 112 patients. Neither and mortality prediction models quantify severity of intubation nor emergent surgery was required in any injury and stratify patients according to a specified out- of these patients, and alI survived. Only two had an In- come. Triage scoring
Recommended publications
  • 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.
    [Show full text]
  • Blunt and Blast Head Trauma: Different Entities
    International Tinnitus Journal, Vol. 15, No. 2, 115–118 (2009) Blunt and Blast Head Trauma: Different Entities Michael E. Hoffer,1 Chadwick Donaldson,1 Kim R. Gottshall1, Carey Balaban,2 and Ben J. Balough1 1 Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, and 2 Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Abstract: Mild traumatic brain injury (mTBI) caused by blast-related and blunt head trauma is frequently encountered in clinical practice. Understanding the nuances between these two distinct types of injury leads to a more focused approach by clinicians to develop better treat- ment strategies for patients. In this study, we evaluated two separate cohorts of mTBI patients to ascertain whether any difference exists in vestibular-ocular reflex (VOR) testing (n ϭ 55 en- rolled patients: 34 blunt, 21 blast) and vestibular-spinal reflex (VSR) testing (n ϭ 72 enrolled patients: 33 blunt, 39 blast). The VOR group displayed a preponderance of patients with blunt mTBI, demonstrating normal to high-frequency phase lag on rotational chair testing, whereas patients experiencing mTBI from blast-related causes revealed a trend toward low-frequency phase lag on evaluation. The VSR cohort showed that patients with posttraumatic migraine- associated dizziness tended to test higher on posturography. However, an indepth look at the total patient population in this second cohort reveals that a higher percentage of blast-exposed patients exhibited a significantly increased latency on motor control testing as compared to pa- tients with blunt head injury ( p Ͻ .02). These experiments identify a distinct difference be- tween blunt-injury and blast-injury mTBI patients and provide evidence that treatment strategies should be individualized on the basis of each mechanism of injury.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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
    [Show full text]
  • 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.
    [Show full text]
  • Isolated Severe Blunt Traumatic Brain Injury: Effect of Obesity on Outcomes
    CLINICAL ARTICLE J Neurosurg 134:1667–1674, 2021 Isolated severe blunt traumatic brain injury: effect of obesity on outcomes Jennifer T. Cone, MD, MHS,1 Elizabeth R. Benjamin, MD, PhD,2 Daniel B. Alfson, MD,2 and Demetrios Demetriades, MD, PhD2 1Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago, Illinois; and 2Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California OBJECTIVE Obesity has been widely reported to confer significant morbidity and mortality in both medical and surgical patients. However, contemporary data indicate that obesity may confer protection after both critical illness and certain types of major surgery. The authors hypothesized that this “obesity paradox” may apply to patients with isolated severe blunt traumatic brain injuries (TBIs). METHODS The Trauma Quality Improvement Program (TQIP) database was queried for patients with isolated severe blunt TBI (head Abbreviated Injury Scale [AIS] score 3–5, all other body areas AIS < 3). Patient data were divided based on WHO classification levels for BMI: underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class 1 (30.0–34.9 kg/m2), obesity class 2 (35.0–39.9 kg/m2), and obesity class 3 (≥ 40.0 kg/ m2). The role of BMI in patient outcomes was assessed using regression models. RESULTS In total, 103,280 patients were identified with isolated severe blunt TBI. Data were excluded for patients aged < 20 or > 89 years or with BMI < 10 or > 55 kg/m2 and for patients who were transferred from another treatment center or who showed no signs of life upon presentation, leaving data from 38,446 patients for analysis.
    [Show full text]
  • 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.
    [Show full text]
  • 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
    [Show full text]
  • Traumatic Brain Injury (TBI)
    Traumatic Brain Injury (TBI) Carol A. Waldmann, MD raumatic brain injury (TBI), caused either by blunt force or acceleration/ deceleration forces, is common in the general population. Homeless persons Tare at particularly high risk of head trauma and adverse outcomes to TBI. Even mild traumatic brain injury can lead to persistent symptoms including cognitive, physical, and behavioral problems. It is important to understand brain injury in the homeless population so that appropriate referrals to specialists and supportive services can be made. Understanding the symptoms and syndromes caused by brain injury sheds light on some of the difficult behavior observed in some homeless persons. This understanding can help clinicians facilitate and guide the care of these individuals. Prevalence and Distribution recover fully, but up to 15% of patients diagnosed TBI and Mood Every year in the USA, approximately 1.5 with MTBI by a physician experience persistent Swings. million people sustain traumatic brain injury disabling problems. Up to 75% of brain injuries This man suffered (TBI), 230,000 people are hospitalized due to TBI are classified as MTBI. These injuries cost the US a gunshot wound and survive, over 50,000 people die from TBI, and almost $17 billion per year. The groups most at risk to the head and many subsequent more than 1 million people are treated in emergency for TBI are those aged 15-24 years and those aged traumatic brain rooms for TBI. In persons under the age of 45 years, 65 years and older. Men are twice as likely to sustain injuries while TBI is the leading cause of death.
    [Show full text]
  • Anytown Trauma Center Trauma Protocols
    ANYTOWN TRAUMA CENTER TRAUMA PROTOCOLS TITLE: TRAUMA TEAM ACTIVATION PROTOCOL PURPOSE: The purpose of the protocol is to establish guidelines for trauma team activation and define the members of the responding trauma team to facilitate the resuscitation and management of critical or seriously injured patients who require rapid, organized resuscitation, evaluation and stabilization to promote optimal outcomes. It also serves to provide triage guidelines for adult and pediatric patients. PROCESS: 1. TRAUMA TEAM ACTIVATION PROTCOL A. The criteria for activation of the trauma team is clearly defined and posted at the Emergency Department triage desk, by the EMS communication station and in the resuscitation rooms. B. The trauma team may be activated prior to arrival based on the EMS communication and their assessment. C. The trauma surgeon, emergency medicine physician, emergency department charge nurse/ house supervisor, emergency department nurses and the Trauma Program Manager may activate the trauma team. D. The person calling the trauma activation will initiate the trauma page to group page the trauma team and will specify the MOI, BP, HR, ETA and level of activation required and age if available. E. If the trauma team members are present in the emergency department and alert is still communicated to ensure everyone is notified. F. Trauma team member notification and arrival times will be documented on the trauma flow sheet (paper or electronic). G. Trauma team members will sign-in when they arrive. H. Trauma team members will be activated for all patients who meet the following criteria: 1. Level 1 trauma activation (major): life threatening injuries and/or unstable vital signs, limb-threating or disability threatening injury 2.
    [Show full text]
  • A Uniform Triage Scale in Emergency Medicine Information Paper
    A Uniform Triage Scale in Emergency Medicine Information Paper Triage: sorting, sifting (Webster’s New Collegiate Dictionary) from the French verb trier- “to sort.” Triage has long been considered a simple frontline sorting mechanism in hospital-based emergency departments (EDs). However, evolution in the practice of emergency medicine during the past two decades necessitates a change in how this entry point process is performed and utilized. Many triage systems are in use in the US, but there is no uniform triage scale that would facilitate the development of operational standards in EDs. A nationally standardized triage scale would provide an analytic basis for determining whether the health care system provides safe access to emergency care based on design, resources, and utilization. The performance of EDs could be compared based on case mix and acuity, and expected standards for facilities could be defined. Planners and policy makers would have the tools and the data needed to make rational improvements in the health care delivery system. This paper on triage will acquaint the reader with the history of triage, and provide an overview of the Australian and Canadian systems which are already in use on a national level. The reliability of triage is addressed, and the Canadian and Australian scales are compared. Future implications for a national triage scale are described, along with the goals and benefits of triage development. While there is some controversy about potential liability issues, the many advantages of a national triage scale appear to outweigh any potential disadvantages. History of triage The first medical application of triage occurred on the French battlefield where sorting the victims determined who would be left behind.
    [Show full text]