Calling Trauma Team Alerts

[abckidsmom]

When you have a trauma patient, and you call report and saying "I'm calling in a trauma, we're 15 minutes out with blah blah blah," does your local trauma center ever *not* alert the patient?

Is there proven benefit for patients in having the trauma team waiting for them when they arrive?

What are your local criteria? Links?

I recently took a 22 yo male who was pulled out of a house fire unconscious after falling down the stairs inside. He had an altered mental status with neck pain and severe headache after he started to wake up some. No singed facial hair, no burns, no soot in his airway. Initial sats were 100%, HR 132, BP 150/98.

After a few minutes on high flow O2, he woke up some, remained anxious, confused, oriented to person and place, and complaining of headache, still satting 100%, HR down to 92, BP 138/70.

He was complaining of neck pain, no visible trauma, no neuro deficits.

Would this guy have met the criteria for a TTA at your local trauma center?

 

[Clare]

Criteria for the resus team at Auckland City Hospital are

1. Must be an RT call from Ambulance, and
2. Must have an immediately or potentially life threatening problem, and
3. Any of the following patterns of injury
- Penetrating injury to the head, neck or torso
- Flail chest
- Lacerations with significant arterial bleeding
- Burns > 20% BSA
- Complex pelvic injury
- Two or more proximal long bone fractures (humerus, tibia, femur)
- Traumatic amputation proximal to knee or elbow
- Major crush injury
- Paraplegia or quadriplegia
- Fall > 3 metres
- Cyclist or motorcyclist versus car
- Pedestrian versus car or train, or
4. Any of the following vital signs
- RR < 10 or > 29
- BP < 90 mmHg
- GCS < 13

The key here is that you have to have instability with your pattern of injury or problem; so somebody who has fallen but has no abnormal vital signs or major injuries does not meet the criteria; nor does somebody with a very low blood pressure but who is stable.

We don't really have a "trauma team" we have a resus team who are like ED Registrar, a couple of nurses, maybe an anaesthetist if they are called down, surgical registrar as required etc.

 

[DesertMedic66]

If we call for a trauma alert then our local center will be ready and waiting. Depending on how the medic gives the call in the hospital can call a trauma alert without us knowing.

 

[JPINFV]

When you have a trauma patient, and you call report and saying "I'm calling in a trauma, we're 15 minutes out with blah blah blah," does your local trauma center ever *not* alert the patient?

Is there proven benefit for patients in having the trauma team waiting for them when they arrive?

Granted, this is a level 2 with a gen surg and EM residencies, so man power is a little different than a trauma center without residencies (i.e. plenty of people are always around to help and surgeons are always in house)

Do we always alert/activate using the loosest definition of trauma? No. The call you gave would probably be an "alert" at my hospital (residents respond, no OR on hold) in contrast to an activation (residents and attendings respond, OR goes on hold). Unfortunately, I don't know the exact criteria for the difference between nothing, alert, and activation.

 

[Brandon O]

Local hospitals vary from "specific criteria, no activation at judgment of EMS unless criteria are met or it's the helicopter calling" to "activate at the level specified by EMS or it's your butt."

One of the big ones recently took away the ability for the triage nurse to make the call due to over-activation.

 

[Bullets]

When you have a trauma patient, and you call report and saying "I'm calling in a trauma, we're 15 minutes out with blah blah blah," does your local trauma center ever *not* alert the patient?

Is there proven benefit for patients in having the trauma team waiting for them when they arrive?

What are your local criteria? Links?

Im confused, why would the trauma center alert the patient? We have the patient, and if they are going to Trauma then usually they are unconscious or unable to comprehend what we are saying. Otherwise the patient already knows they are going to Trauma so no need for the hospital to say "Hey, youre in Trauma"

We follow the standard NJ Trauma triage guidelines sprinkled with a little common sense.


STEP 1: PHYSIOLOGY
Glasgow Coma Scale +/-12 or AVPU = P or U
Systolic BP < 90
Pulse < 60/min or > 130/min
Respiration < 10/min or > 29/min

Any of these are YES the to Trauma we go, if no proceed to step two

Step 2:Anatomy
Penetrating Injuries (ex., Gunshot Wounds,
Stab Wounds) to Head, Neck, Torso, Extremities
(above the elbow and knee)
Flail Chest
Fractures - More Than One Fracture Involving
Humerus and/or Femur
Pelvic Fractures
Paralysis or Evidence of a Spinal Cord Injury
Amputation Above Wrist or Ankle
Burns When Combined with Other Major Injuries
High Voltage Electrical Injury


And of these are yes, Trauma!, if no proceed to step 3

Step 3:MOI

Ejection from Motor Vehicle
Extrication > 20 min with an injury
Falls > 20 feet
Unrestrained Passenger in Vehicle Roll Over
Pedestrian, Motorcyclist or Pedalcyclist Thrown or Run Over

Any of these are no, the go to the local hospital


Now, i dont truly adhere to step 3 as much as 1 & 2

And if its a pediatric its also different

Step 1: Physiology
AVPU = responsive to voice, pain, or unresponsive
Evidence of poor perfusion (skin pallor, cool extremities, weak distal pulses, cyanosis/mottling, etc.)
Heart rate:
child < 5 yr old: < 80/min or > 180/min
child > 6 yr old: < 60/min or > 160/min
Respiratory rate > 60, or respiratory distress, or apnea
Capillary refill > 2 seconds (evaluated on warm body part)

Any are Yes, trauma, no, proceed to step 2


STEP II: ANATOMY (any one present)
Penetrating injuries (ex. gunshot/stab wounds) to the head, neck, torso or extremities (above the elbow and knee)
Flail chest
Difficulty or inability to maintain a patent airway
Fractures - more than one involving the humerus and/or femur
Pelvic fractures
Paralysis or evidence of spinal cord injury
Amputation above the wrist or ankle
Burns when combined with other major injuries
Seat belt mark on the torso

ANy yes, Trauma, no, step 3

STEP III : MECHANISM OF INJURY (any one present)
Ejection from motor vehicle
Falls > 3x patient's height
Extrication time > 20 mins with an injury
High voltage electrical injury
Unrestrained passenger in vehicle roll over
Pedestrian, motorcyclist or pedalcyclist thrown or run over
Front seat passenger with deployment of air bag (same side)

You get the idea

 

[VFlutter]

Im confused, why would the trauma center alert the patient? We have the patient, and if they are going to Trauma then usually they are unconscious or unable to comprehend what we are saying. Otherwise the patient already knows they are going to Trauma so no need for the hospital to say "Hey, youre in Trauma"

We follow the standard NJ Trauma triage guidelines sprinkled with a little common sense.


STEP 1: PHYSIOLOGY
Glasgow Coma Scale +/-12 or AVPU = P or U
Systolic BP < 90
Pulse < 60/min or > 130/min
Respiration < 10/min or > 29/min

I believe she meant when EMS calls for a trauma alert and the hospital does not activate based on their discretion, "not alerting". Not literaly alerting or telling the patient something.

For instance you call report and request a trauma alert for a patient who meets some of the criteria above but based off your report the hospital decides not to activate for whatever reason.

Trauma alerts can be very be beneficial in some situations but most notably in those who require immediate surgical intervention or diagnostic imaging. It is pretty crappy when your TBI patient is 3rd in line for a stat CT.

 

[JPINFV]

Im confused, why would the trauma center alert the patient? We have the patient, and if they are going to Trauma then usually they are unconscious or unable to comprehend what we are saying. Otherwise the patient already knows they are going to Trauma so no need for the hospital to say "Hey, youre in Trauma"

Just because EMS calls and says they have a patient who suffered a traumatic injury doesn't necessarily mean that the hospital is going to alert the troops, so to say. Additionally, there may be more than one type of internal alert for the surgical teams.

 

[Brandon O]

At many facilities, the highest level of trauma activation can have tremendous impact. It's no joke to say that people from the blood bank to the chaplain can get notified.

 

[KellyBracket]

For some reason, the chaplains at our hospital are usually johnny on the spot. Certainly have a better response time than anesthesia!

 

[Bullets]

I believe she meant when EMS calls for a trauma alert and the hospital does not activate based on their discretion, "not alerting". Not literaly alerting or telling the patient something.

For instance you call report and request a trauma alert for a patient who meets some of the criteria above but based off your report the hospital decides not to activate for whatever reason.

Trauma alerts can be very be beneficial in some situations but most notably in those who require immediate surgical intervention or diagnostic imaging. It is pretty crappy when your TBI patient is 3rd in line for a stat CT.

Just because EMS calls and says they have a patient who suffered a traumatic injury doesn't necessarily mean that the hospital is going to alert the troops, so to say. Additionally, there may be more than one type of internal alert for the surgical teams.

Oh, guess thats something that happens elsewhere. Around here its an "ON-OFF" kind of thing. If we call and activate, they will be there waiting, scrubbed in. 95% of the time we have ALS, but i have activated it at the BLS level prior to ALS arrival. Now if you activate the trauma team and it ends up not really being a trauma, then you will probably get crap from the team but they never dont activate if we call. Ive had instances at the Level II where the team isnt assembled before we get there, but they never say no if we call it

 

[JPINFV]

At many facilities, the highest level of trauma activation can have tremendous impact. It's no joke to say that people from the blood bank to the chaplain can get notified.

...and sometimes it's needed. I offered to run down to the blood bank on a trauma and wait while they thawed out a massive transfusion protocol set. I ended up having enough time to wander over to the cafeteria for a snack and a soda (both are on the same level) and still get back with several minutes before they were ready with the first batch.

 

[abckidsmom]

These people did the total opposite of a trauma team alert, we stood in the hallway for a few minutes waiting for a bed, and then they put him in an unmonitored hall bed.

I was a bit livid.

In the other trauma centers I've worked with, this would have been a burn patient, even if he didn't have actual burns on his skin, because of the smoke inhalation and altered mental status following that. A burn trauma team alert looks different from a standard one, but it still means that there's a bed and a monitor waiting for the patient when he arrives.

I put his GCS at 13 when we arrived at the hospital. He didn't have it together enough to move off of our stretcher on his own. They assumed he was fine, without even looking at him. I would have liked to see them draw a gas immediately upon arrival and keep him on the monitor untili his mental status cleared.

 

[VFlutter]

On a side note trauma alerts are extremely expensive for a patient. I was charged $4500 just for the trauma activation alone.

 

[abckidsmom]

On a side note trauma alerts are extremely expensive for a patient. I was charged $4500 just for the trauma activation alone.

This is a very good point.

 

[rwik123]

We never activate the team as EMS. The comm center which we give our report too either by radio or phone call makes that evaluation. We had a case review where a critical patient sat in general treatment for a while before his pneumo was discovered and the team was activated. After that it seems like they are pretty liberal with team activation.

 

[medicsb]

These people did the total opposite of a trauma team alert, we stood in the hallway for a few minutes waiting for a bed, and then they put him in an unmonitored hall bed.

I was a bit livid.

In the other trauma centers I've worked with, this would have been a burn patient, even if he didn't have actual burns on his skin, because of the smoke inhalation and altered mental status following that. A burn trauma team alert looks different from a standard one, but it still means that there's a bed and a monitor waiting for the patient when he arrives.

I put his GCS at 13 when we arrived at the hospital. He didn't have it together enough to move off of our stretcher on his own. They assumed he was fine, without even looking at him. I would have liked to see them draw a gas immediately upon arrival and keep him on the monitor untili his mental status cleared.

He fell down stairs and complained of neck pain, why would you have him move himself? Did they "clear" his c-spine? (He'd need imaging per NEXUS or Canadian c-spine rule.)

Sounds like he may have been a GCS14. The motor portion judges being able to do simple commands like squeeze your fingers when asked, take a deep breath, etc. Not get up and walk.

 

[abckidsmom]

He fell down stairs and complained of neck pain, why would you have him move himself? Did they "clear" his c-spine? (He'd need imaging per NEXUS or Canadian c-spine rule.)

Sounds like he may have been a GCS14. The motor portion judges being able to do simple commands like squeeze your fingers when asked, take a deep breath, etc. Not get up and walk.

*I* didn't want him to move anything. There was no discussing the topic with the ED staff. I had him lying still on the stretcher, I didn't get the whole story until it would have been ridiculous to immobilize him. I didn't even think to just blindly immobilize him at the scene.

For GCS, he never opened his eyes. He was very lethargic, with mumbling words that mostly made sense, but only oriented x 2. He followed simple commands.

 

[Veneficus]

For some reason, the chaplains at our hospital are usually johnny on the spot. Certainly have a better response time than anesthesia!

Sometimes you just have to finish the chapter ok? h34r:

edit: the chaplain already read the bible, he knows how it ends

 

[JPINFV]

Sometimes you just have to finish the chapter ok? h34r:

You never interfere with
Airway
Book
Chair.