Trauma Alerts

[MedicPrincess]

While working an OT Shift, I was discussing a patient that I called a Trauma Alert on, and when arriving at the hospital the Trauma Surgeon proceded to attempt in the removal of a large piece of my rear end for calling it, to which I replied simply "He meets criteria, with only 1. I did not use Paramedic Preference" and left the Trauma Bay.

The EMT I had with me mentioned where his father works they do not have such a thing as a "Trauma Alert" due to it being a Level 1 Trauma Center. Which got me to thinking about the different criteria in different states.

Does your system call Trauma Alerts? What is the Criteria for calling a TA?

Floridas include (notice the last Judgement of EMT or Paramedic line that trumps all):

Adult Trauma Alert​

Any one of the following:​

• Active airway assistance required
beyond administration of oxygen.
• HR 120 without radial pulses.
• Systolic BP < 90.
• Best Motor Response 4 or total GCS 12.
• 2nd or 3rd degree burns on 15% of body.
• Amputation proximal to wrist or ankle.
• Penetrating injury to head, neck, or torso.
• Two or more long-bone fracture sites
(humerus, radius/ulna, femur, tibia/fibula).
• Paralysis, loss of sensation, or suspected spinal
cord injury.​

Or any two or more of the following:​

• RR 30
• Sustained HR 120 beats/minute
• GCS Best Motor Response = 5
• Major degloving injury or flap avulsion > 5 inches
• Gunshot wound to extremity
• One long-bone fracture
from MVC or fall 10 feet
• Age 55
• Ejected/thrown from any vehicle
(including ATV, motorcycle,
moped, or truck bed).
• Steering wheel deformity​

Or judgment of EMT,
paramedic, or other​

healthcare professional.

Pediatric TA Criteria
Age less than 16
Any 1 of the Following:

• Active airway assistance required beyond O2 Admin
• Any airway adjunct including manual jaw thrust, multiple suctioning, or other to assist ventilation
• AMS
• Paralysis, loss of sensation, or suspected spinal cord injury
• Faint or nonpalpable radial or femoral pulse
• Systolic BP <50
• Open long bong fx, multple fx, or dislocation of sites
• Major degloving or flap avulsions
• 2nd or 3rd degree burns on > or = 10% BSA
• Amputations of proximal to wrist or ankle
• Penetrating injury to head, neck, torso

Or any two or more of the following:

• Suspected amnesia, or LOC
• Systolic BP <90
• Palpable carotid or femoral, but no radial or pedal
• Suspected closed long bone fx
• Patient weighs < or = 11kg, or body length is < or = 33in

Or judgment of EMT,

paramedic, or other​

healthcare professional

 

[Grady_emt]

Our base hospital and only Level 1 trauma center has "Stat Packs" basically a trauma alert. The criteria are as follows:

Anatomic/Physiological Criteria:
Systolic <90
GCS<10
Respirations 10<29
Penetrating injury to Head, Neck, Torso, extremitys proximal to Knee/Elbow
Flail Chest
2 or more proximal long bone fractures
Crush, Mangle, or de-gloving injury
Amputation proximal to wrist/ankle
Pelvic Fx
New/sudden onset paralysis

Mechanical Criteria:
Falls >2x pt height
Prolonged extrication time >20 minutes
Complete or Partial Ejection from vehicle
Death in same passenger compartment
Seperation of motorcycle rider from bike (ejection equivelent)
Pedestrian/cyclist thrown or run over by vehicle

Also, anytime deemed so by the Red Zone Emergency Medicine Attending, and Chief of Trauma Surgery.

 

[KEVD18]

all of the trauma centers i would transport to would handle this the same way:

i call in and say im coming with a trauma.
they say thank you, we'll be ready for you.
that information ****might**** make it to the trauma team prior to my arrival
when i get there, the receiving rn will make their own call. if they agree, the trauma team will be in the same room with me in <2min.

the only people boston hospitals place any value in are the city trucks and med flight. everything thats come out of the radio from a private is taken with a grain of salt somewhere around the size of conneticut. unless you call in a code. that the generally take seriously.

 

[RailFan77]

all of the trauma centers i would transport to would handle this the same way:

i call in and say im coming with a trauma.
they say thank you, we'll be ready for you.
that information ****might**** make it to the trauma team prior to my arrival
when i get there, the receiving rn will make their own call. if they agree, the trauma team will be in the same room with me in <2min.

WOW...Your trauma center says thank you? One in particular that I used to go into up here would hardly ever answer the radio and one time when I called them w/ a trauma, they asked me why I am bothering them on the radio. That one ended with the nurse telling me (in a not so nice way) that they get ambulances from all over the county and they just come in...why do we have to be the *** holes who take her away from another pt to answer the radio.

 

[Sasha]

We have trauma alerts, they go to ORMC. But you can bet 90% of the calls there the nurses whine that they didn't need to be trauma alerted.

 

[reaper]

MP,

That is the one nice thing in FL. State wide protocols for trauma alerts and stroke alerts. Where I am now, they have neither.

We call the hospital and tell them what we are coming in with. They may decide to have a trauma team there, or the pt may have to wait awhile.

In FL, I always tried to match a criteria on a trauma alert. I saved Paramedic preference as a last resort. They start not being happy with you, if all your alerts are off preference only!

 

[tydek07]

Our Trauma Alert Guideline

Sorry, Didn't work like I wanted it to... will try posting it later

 

[FF894]

So, do you call in a report with other patients or just trauma cases? It seems that if they system is set up a certain way, it should be followed or altered to meet everyones' true needs. If they (nurses) think they are getting called too often, why not make a regional decision to only call if patient meets 2 of the criteria or whatever would make sense.

Sounds like not everyone is on the same page and you are stuck in the middle because you are just trying to do the right thing.

Just in my experience, I only call in a report to the trauma center if there is hemodynamic comprimise or something that requires immediate intervention on arrival. Otherwise I let triage nurse make decision. There are also hospitals that take a report on every patient even if its a nothing call.

 

[Ridryder911]

My state has trauma triage and by-pass guidelines. All states were to have some form of Trauma Guidelines and triage for level of Trauma Center alerts.

I should know I spent over two years of my (full time job) life researching, discussion (& cussing), and writing them.

They are similar to the American Academy of Surgeons (ACS) guidelines. I will post them when I can find the file supplement.

R/r 911

 

[KEVD18]

most of the hospitals in my area only require entry notification for priority 1 calls(immediate life threats), or any call where a special team is needed. they want to be apprised of codes, suspected mi/cva's, trauma alerts, violent psych's, etc. anything where they need to alert special people. other than that, they do not want to hear word one from you until you get there. call boston medical center with an entry notification for a chief complain of sick dont feel good x 3days and its very possible you'll get slapped when you walk in.

conversely, other hospital in the area(norwood comes to mind) get righteously pissed if you dont call in everything. i ran a call that ended up going to them for ankle pain s/p athletic activity. pt was actually found still playing basketball when we showed up. i d/x'd it as drug seeking behavior and didnt bother to call it in. i got my buttox handed to me. after that, i never missed a call. once, just to prove a point, called them from the parking lot. i was literally on the phone with the triage nurse as i walked in. she asked me what my eta was and i said turn around. wasnt my fault, i was coming in from the snf across the street and up a block.

 

[alphatrauma]

It is ultimately the facility's call

In my area, regardless of what an EMT/Medic might think or call in over the radio, it is the ER Attending Physician's call whether or not to initiate a (Alpha or Bravo) "Trauma Alert". Due to the huge amount of resources that are pulled for such a situation, I have worked with many docs who liked to "eyeball" patients first, before opening the floodgates. Once the patient arrived, they could either upgrade or downgrade as appropriate.

I personally wouldn't want to be the guy on the ambulance that pointed for the fence... and only wound up hitting a single.

 

[WuLabsWuTecH]

most of the hospitals in my area only require entry notification for priority 1 calls(immediate life threats), or any call where a special team is needed. they want to be apprised of codes, suspected mi/cva's, trauma alerts, violent psych's, etc. anything where they need to alert special people. other than that, they do not want to hear word one from you until you get there. call boston medical center with an entry notification for a chief complain of sick dont feel good x 3days and its very possible you'll get slapped when you walk in.

conversely, other hospital in the area(norwood comes to mind) get righteously pissed if you dont call in everything. i ran a call that ended up going to them for ankle pain s/p athletic activity. pt was actually found still playing basketball when we showed up. i d/x'd it as drug seeking behavior and didnt bother to call it in. i got my buttox handed to me. after that, i never missed a call. once, just to prove a point, called them from the parking lot. i was literally on the phone with the triage nurse as i walked in. she asked me what my eta was and i said turn around. wasnt my fault, i was coming in from the snf across the street and up a block.

One of the hospitals is notorious for not picking up, but always wanting a full report. My medic partner once walked in, with the line still ringing, and when asked why he didn;t call in, he replied if they wanted to pick up the phone they could talk to him over the phone that was rining, but personally he felt it silly to talk through a phone when the other person is standing in front of him!

 

[medicdan]

call boston medical center with an entry notification for a chief complain of sick dont feel good x 3days and its very possible you'll get slapped when you walk in.

A few weeks ago I heard a call come in for something BS then saw the crew come in, then heard the ensuing tongue lashing.

conversely, other hospital in the area(norwood comes to mind) get righteously pissed if you dont call in everything. i ran a call that ended up going to them for ankle pain s/p athletic activity. pt was actually found still playing basketball when we showed up. i d/x'd it as drug seeking behavior and didnt bother to call it in. i got my buttox handed to me. after that, i never missed a call. once, just to prove a point, called them from the parking lot. i was literally on the phone with the triage nurse as i walked in. she asked me what my eta was and i said turn around. wasnt my fault, i was coming in from the snf across the street and up a block.

The rule is, as I understand it, is that hospitals in Boston city dont want entry notes, everyone else does. The exception is the Faulkner, they want BLS entry notes.

Boston CMED will actually comment on your hospital/note choice. If, for example, you request a faraway ER for an arrest they will suggest a closer one or they will ask why you want a BLS entry note to Mass General.

I saw a memo two weeks ago, the Brigham now wants an entry note for ALL bariatric patients that come in to the ER--so they can prepare their team and equipment.

 

[KEVD18]

all the big hospitals want is pri 1 notes, or any call that requires a team.

faulkner changes their mind 12 times a year on whether or not they want p2 bls notes. when i was on the road, i got so sick of dealing with them. of course, the faulkner did make a wonderful receiving hospital for all the drunks and hobos that ended up going.