Trauma Logistics: The things to know Emergency Department Physician
The University East Bank Campus is verified by the American College of Surgeons as a Level II Trauma Center. We serve the metro and referring areas as a definitive care trauma center for our patients.
Any injured patient is a trauma patient. Any patient being admitted to the hospital or transferred to another facility due to a traumatic injury is a trauma patient. Some of these patients may have trauma team activation. The mechanism could be anywhere from a fall to a motor vehicle accident. This includes isolated injures with seemingly low impact trauma (i.e. ground level falls). Many of these patients have severe injuries.
Trauma Team Activation (TTA) is an organized multidisciplinary approach to the care that we provide to trauma patients. Your role in the trauma team is crucial to the outcome of our patients.
The University has two-tiered trauma team activation. Level Red/Full TraumaThe University Team Activation has two -andtiered Level trauma White/Partial team activation Trauma Team Activation Level Red/Full TraumaLevel Team Red/Full Activation Trauma and Level Team White/Partial Activation Criteria Trauma Team Activation Level Red/Full Trauma Team Activation Criteria
Trauma Team Activation Level Red/Full: EMS Judgment Decision of ED attending/Charge RN/Trauma MD, APP, or RN to upgrade only BP <90 systolic in adults (2 consecutive prehospital SBP < 90) Confirmed age specific hypotension in pediatrics AGE mmHG 6 years + 90 2-5 years 80 12-24 months 75 0-12 months 70 Respiratory distress, airway compromise, intubated Flail chest/major chest trauma Unstable trauma transfers (respiratory distress, intubated with on-going respiratory issues or receiving blood) Penetrating wounds to head, neck, chest, abdomen and/or genitalia GCS 3-8 related to trauma Unstable pelvis C-spine injury with neuro deficit Traumatic paralysis to include limbs Tourniquet in place Burns should be diverted enroute to a burn center Trauma Logistics: The things to know Emergency Department Physician
Level White/Partial Trauma Team Activation Criteria:
Trauma Team Activation Level White/Partial: EMS Judgment Decision of ED attending/Charge RN/Trauma MD, APP or RN to upgrade only Amputations at finger/toe or below GCS 9-12 related to trauma Penetrating wounds to proximal extremity with potential neurovascular compromise Femur fracture related to trauma with mechanism greater than a ground level fall Two or more long bone fractures in two different extremities Focal neurological deficits/symptoms Fall from > 15 feet for adults Fall greater than 2x their height for pediatrics Drowning Severe Hypothermia <34°Celsius or <93.2°Farenheight 30 minute or longer extraction times at scene Intrusion of 18 inches or greater Ejection from vehicle Person stuck by motor vehicle
EMS TIME OUT: 1. Time out is announced and everyone in the room stops what they are doing and listens to the EMS report 2. EMS will give a brief 60 second or less report to the trauma team 3. Once report is given the patient is moved to the hospital gurney
Trauma Logistics: The things to know Emergency Department Physician
ED MD Roles during Trauma Team Activation (TTA): Respond to all TTA’s Initiates trauma activation system in collaboration with the emergency room charge nurse or trauma resource nurse Participates in huddle prior to patients arrival/or at the time of pts arrival indicating their role in the TTA and acknowledging all the nurses participating in the TTA. Participate in EMS Time Out Wear role sticker Don protective gear for TTA Reds (gown, gloves, mask,…) Assumes role of the medical leader until the trauma surgeon/trauma APP/trauma resident arrives in the department o A formal handoff needs to occur with the trauma provider assuming the lead role. Performs primary and secondary survey of the patient while maintaining cervical spine immobilization Disposition is collaborative decision with the trauma provider
Referred Trauma Patients (One Call Process): Referring facilities call the patient access center and the first question they get asked is “Is this an injured patient?” If the answer is “Yes” the call is directed to the ED. The ED answers the call and accepts the patient. After accepting the patient the ED MD notifies trauma of the patient coming in. If the patient is going to be a TTA Red the ED MD needs to call the staff trauma surgeon and let them know the patient is coming and estimated arrival time. Staff trauma surgeons are required to respond within 15 minutes of patient’s arrival for all TTA Reds. ***The more notification that can be given to the staff trauma surgeon the better*** Trauma will then admit the patient. All injured patients are accepted at the University with the exception of the following: o We do NOT accept: o Extremities with vascular compromise o Severed limbs being considered for reimplantation; mangled extremities o Complex pelvic/acetabular fractures o Burns
Trauma Logistics: The things to know Emergency Department Physician
Things to consider on all trauma patients: Order Aspen Collars for patients prior to them leaving the ED Alert trauma of any patient being admitted to the hospital for their injury i.e. fall, hip fracture, rib fractures, head bleed,… Notify trauma staff and APP/resident about patient coming to the hospital All patients admitted to the hospital for an injury need to be admitted to the EAST Bank since that is the designated trauma facility
Things to know about Trauma: The trauma surgeons are general surgeons with specialized trauma training Trauma Job Code Pager 0755 is the Trauma Advanced Practice Provider or Trauma Moonlighter o Call for trauma admissions/consults/questions Trauma Job Code Pager 0259 is for trauma staff o Call if expecting a TTA Red pt o Call if questions There is a back-up trauma staff if you are unable to get a hold of the primary trauma staff for some reason.
Hours of Coverage: All can be reached at Job code pager 0755 7a-5p Trauma Advanced Practice Provider o Responsible for Riverside ICU & Trauma 5p-6p Junior resident o Responsible for SICU and Trauma 6p-7a Moonlighter o Responsible for CVICU, Trauma and TTA’s/trauma consults for admission at Amplatz Job code pager for staff trauma surgeon is 0259 Trauma Resource Nurse has variable hours M-F pager 9306
Trauma Logistics: The things to know Emergency Department Physician
Please see attached protocols/policies that pertain to Emergency Department: o Admission of injured patient policy . http://intranet.fairview.org/Policies/S_076775#
o Mandatory consult policy . http://intranet.fairview.org/Policies/S_076265#
o Assessment of pregnant patients with traumatic injuries . http://intranet.fairview.org/Policies/S_096353#
o Emergent O Negative blood release for trauma team activations . http://intranet.fairview.org/Policies/S_081268#
o Trauma Transport STAT . http://intranet.fairview.org/Policies/S_081274#
o C-spine clearance protocol . http://intranet1.fairview.org/docs/DOC-48269
o Backboard clearance protocol . http://intranet1.fairview.org/docs/DOC-48270
Trauma Logistics: The things to know Emergency Department Physician
Communication Process: TTA Red with Operating Room Objective: To clarify the process that should occur when a Trauma Team Level Red is activated. Specifically, address what communication should occur with the operating room during a TTA Red.
1. ED Staff/RN/Trauma RN: Will communicate with the OR once they are notified of a patient coming from an outside facility where they are going to be a TTA Red and there is a high likelihood they will go to the OR. 2. ED Staff/RN: Page TTA Red when they anticipate that the patient is about 10 minutes out. OR Charge RN receives this page. (Note: this is difficult to determine due to lack of communication from EMS, therefore there may be times when the TTA Red is paged out with a longer wait time for the patient due to an unknown ETA.) 3. OR Charge RN: Calls the ED to find out if there is likelihood they will go to the OR. 4. Trauma Team: Assesses and stabilizes patient 5. Trauma Surgeon: Will call the OR to notify them that the patient will or will not be going to the OR. (Note: this call could be delayed due to stabilization of the patient, the OR charge nurse should feel empowered to call the ED for updates and question if there is going to be a need for an OR room.) 6. OR Charge RN: Will call the trauma team and notify them of when a room is ready (if the trauma team hasn’t been notified that a room was ready when the Trauma Surgeon called) 7. Code Anesthesia Resident: Will respond to TTA Red’s and communicate back to the CRNA and Attending anesthesiologist regarding the case