Procedure Title: Trauma Activation System – Princess Alexandra Hospital
Purpose:
This document outlines the Princess Alexandra Hospital Emergency Department (ED) and Trauma Service Trauma Activation System in response to potentially time-critical trauma notifications
Outcome of the Procedure:
The provision of multi-disciplinary staff and resources to a potentially time critical trauma patient in the ED.
Authorised to Undertake the Procedure:
Activation will occur according to activation criteria at the discretion of the Senior Emergency Medical Staff on duty. Trauma Alert activation may also be made by the Triage Nurse/ED Clinical Nurse Consultant/Nursing Resuscitation Team Leader on request of the Senior Emergency Medical Staff on duty or according to activation guidelines with verbal communication to Senior Emergency Medical Staff.
Associated Procedure:
This procedure should be read and implemented in conjunction with the PAH Time Critical Care Red Blanket Protocol which is an extension of the Trauma Activation System to facilitate rapid transfer of the haemodynamically unstable / presumed actively bleeding patient from the ED to the OT for immediate surgical intervention
Procedure:
This guideline outlines the Princess Alexandra Hospital two-tiered Trauma Activation System:
1. Trauma Alert
· An alert process primarily involving ED staff and the trauma service.
2. Trauma Response
· A response process requiring a hospital-wide response for time critical patient(s).
Notification and Activation
· All incoming Trauma related calls are forwarded to the ED Consultant on duty (or Registrar overnight) via the Senior Emergency DECT phone – 7215 (external – 3176 7215).
· Trauma Alert or Trauma Respond activation will be made from the ED by notifying “switch” (through 666 or direct phone call) and dispatched via Switch.
· As outlined above, activation will occur according to activation criteria at the discretion of the Senior Medical Staff on duty. Trauma Alert activation may also be made by the Triage Nurse/ED Clinical Nurse Consultant/Nursing Resuscitation Team Leader on request of Senior Medical Staff on duty or according to activation guidelines with verbal communication to Senior Medical Staff.
· Activation will be based on pre-hospital clinical information available – special circumstances, abnormal physiology, nature of injuries, treatment given, and the perceived need for Multidisciplinary Team attendance or possible Operative/Invasive Radiological Intervention, according to activation guidelines.
· Activation Guidelines are guidelines only – senior clinical judgement is utilised based on individual circumstances – if in doubt activate.
· Where emergent transfer to Operating Theatres (OT) appears probable based on available information/direct patient assessment, trauma respond activation will occur and direct and immediate contact with the Trauma Surgeon, Anaesthetic Registrar and other relevant Specialty Consultant/s (and Registrar/s) will be made by the Senior Emergency Trauma Team Leader. If those contacted are unable to attend a surrogate attendee must be provided. A Red Blanket activation may be made after discussion between the ED Team Leader and the Trauma Surgeon as per the Time Critical Care Red Blanket Protocol
· Trauma Alert/Respond can be up or downgraded ONLY by Senior ED Medical Staff on duty.
· ‘TRAUMA STANDDOWN’ will be activated to notify Theatre if surgery is not imminently required after the initial assessment of the patient after a Trauma Respond. This is important to remember, as the Operating Theatres is often put on hold until further notice from ED. This is done via contacting switch and requesting a trauma stand-down.
Team Composition and Staff Response Appendix 1
Trauma Alert
· Staff notified consists of:
- ED Senior Medical Staff on duty
- ED Resuscitation Staff – medical and nursing
- Trauma Service Clinical Nurse Consultant, case managers
- ED Radiographer
- General Surgical Registrar.
· During hours, the Trauma Clinical Nurse Consultant is required to attend and will assist with data collection, documentation and bed management.
· The Surgical Registrar will attend depending on competing priorities. If the Surgical Registrar is unable to attend, he/she should follow-up with the ED consultant to ensure that his/her services are not required.
Trauma Respond
· The following Staff are notified and required to respond in the following manner:
ATTEND / CALL (7215 / external – 3176 7215) / NOTIFICATION ONLY· ED Senior Medical Staff on duty and Emergency Physician on-call after hours
· General Surgical Registrar and Surgical Education and Training (SET) 1 / Principle House Officer (overnight)
· Trauma Fellow during working hours
· Trauma Service CNC during working hours / · Trauma surgeon – Acute Surgical Unit Consultant during hours and General Surgeon on-call after hours
· Anaesthetics Registrar / Consultant
· Theatre Floor Coordinator
· Orthopaedic Registrar
· ICU Senior Registrar / · Director of Trauma unless is the Trauma Surgeon on-call
· Blood Bank
· CT Radiographer
· ED Radiographer
The Senior Emergency Trauma Team Leader may change the composition of the Trauma Respond at their discretion and may call or ask switch to call other relevant specialties as required.
Where staff are required to attend but are unable to do so, they will arrange for a surrogate to attend.
TRAUMA ACTIVATION CRITERIA Appendix 2
Trauma Alert Actions/Response
· Activated by Senior Medical Staff, or delegate after communication with Senior Medical Staff.
· Triaged as Cat 1 or Cat 2 to a Trauma/Resuscitation Bay depending on clinical presentation
Trauma Respond Actions/Response
· Activated by Senior Medical Staff.
· Triaged as Cat 1 to Trauma/Resuscitation Bay
· High level of suspicion for the need for Multidisciplinary Team attendance or possible Operative/Invasive Radiological Intervention, based on senior clinical interpretation of available information.
Triage
· Trauma Alert – triage as Cat 1 or Cat 2 to a Trauma/Resuscitation Bay depending on clinical presentation.
· Trauma Respond – triaged as Cat 1 to Trauma/Resuscitation Bay.
Documentation
· Trauma Forms must be completed for all Trauma Alerts and Responds.
· The nursing resuscitation team leader will commence documentation and data collection with assistance from the Trauma Clinical Nurse Consultant.
· It is the responsibility of the Senior Medical Staff member involved to ensure the Trauma Form is completed.
Evaluation Method:
As part of the Trauma Review Process, there will be regular audit of trauma activations as well as missed activations.
HYPERLINK TO: Trauma Procedures
Appendix 1
TRAUMA ALERT
Internal Trauma Team Response
Likely need for Time-Critical Surgical &/ Radiological Intervention
Call 666
“TRAUMA ALERTETA x minutes”
1. ED Senior Medical Staff on duty if not already aware
2. Trauma CNC (will attend during hours)
3. General Surgical Registrar
or
Surgical SET 1 / PHO (A/Hrs)
4. ED radiographer
Notify ED Consultant after hours as required
Notify other specialties as required
TRAUMA RESPOND
SERIOUSLY &/or MULTIPLY INJURED PATIENT
Need for Multidisciplinary Trauma Team Response
Anticipated need for Time-Critical Surgical &/ Radiological Intervention
Call 666
“TRAUMA RESPOND”ETA x minutes
7215”
1. During Hours - Acute Surgical Unit Consultant
After Hours – General Surgeon on-call
2. General Surgical Registrar
AND
Surgical SET1/PHO (A/Hrs)
3. Orthopaedic Registrar
4. Anaesthetic Registrar
5. Blood Bank
6. Theatre Floor Coordinator
7. ICU Senior Registrar
8. Director of Trauma – 24 hours
9. Trauma Fellow 24 hours (to attend during hours)
10. Trauma Unit CNC
11. CT and ED Radiographer
12. ED Social Worker (Daytime Monday to Friday)
Notify ED Consultant on-call if after hours
Notify other relevant Specialties immediately
Notify Trauma Surgeon & Anaesthetic Registrar directly & urgently if Theatre imminent
Activate Red Blanket Protocol in consultation with Trauma Surgeon if meets Red Blanket criteria
“TRAUMA
STANDDOWN”
If OT not imminent
Appendix 2
TRAUMA ALERT – ACTIVATION GUIDELINE
Mechanism / · MVA > 60km/hr· MBA / cyclist > 30km/hr
· Pedestrian impact > 30 km/hr
· Fall > 3 m
· Vehicle rollover
· Fatality in same vehicle
· Ejection from vehicle
· Extrication > 30 mins
· Explosion
· Torso crush / pinning / entrapment
· Stabbing to neck or torso
· Near drowning
· Attempted hanging
Specific Injuries
(This is not exhaustive)
(Torso = thorax, abdomen or pelvis) / · GCS 10 - 14
· Significant facial trauma
· Traumatic limb amputation proximal to carpus / tarsus
· Limb injury with vascular compromise / degloving injury to proximal limb
· Blunt chest trauma inc flail chest
· Suspected spinal injury
· Compound long bone #
· 2 or more long bone #
· Suspected # pelvis
· Major crush injuries (torso or proximal limb)
· Burns > 20% or suspected airway burns
Advanced Treatment Pre-hospital / · Intubation
· Assisted ventilation
· Chest decompression
Other Criteria / · Interhospital transfer of patients with major trauma < 48 hrs from time of injury
· Pregnancy
· Significant co-morbidities
· Bleeding diathesis / anticoagulation
· Age > 65 years
· 2 or more patients
ED SENIOR MEDICAL STAFF DISCRETION
TRAUMA RESPOND ACTIVATION GUIDELINE
* This is a guideline only. The decision on activation is ultimately a senior ED medical decision based on the available information at the time.
Vital Signs / · Anticipated difficult airway*· Evidence of shock likely to need Interventional Radiology or surgical intervention
Investigations / · FAST (focussed abdominal sonography in trauma) positive and shocked
Specific Injuries
(This list is not exhaustive)
(Torso = thorax, abdomen or pelvis) / · Suspected penetrating injuries to the torso, with evidence of shock
· Severe burns
ED SENIOR MEDICAL STAFF DISCRETION
· * May require involvement of anaesthetics only, rather than a “Trauma Respond”, at the discretion of the Senior Medical Trauma Team Leader.
· The Senior Emergency Trauma Team Leader may change the composition of the Trauma Respond team at their discretion and may call or ask switch to call other relevant specialties as required.
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