What "paramedic discretion" reason have you trauma activated for?

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ParamedicStudent

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So obviously, all counties have different trauma activation criteria, although many are similar. So, just wondering, what have you activated for that wasn't listed? Or personally will/should.

I know some counties don't have restrained rollovers as a criteria, but due to mechanism, I'd probably would.
Any traumas with a positive LOC, just because there's a possible concussion/internal head injury.
Any traumas with an elderly pt and/or use of blood thinners.

I'd like to hear your answers
 
All of those criteria you mentioned are trauma activations. I’ve never activated the trauma service for a patient that didn’t meet the defined trauma criteria.

In short, if a patient doesn’t meet the trauma criteria, they don’t get an activation. The trauma service will quickly become pissed if you activate for incidents that don’t meet the criteria and you’ll be the medic that cried wolf one too many times.
 
If it does not meet trauma criteria but it may potentially be then i would just call report and let the ER decide how they want to respond. If you don’t activate and it ends up being more critical than initially thought it isn’t a big deal for the ER to upgrade their status (assuming it’s a Level 1 ER).
 
To get to our level I, we have at least a 40 minute transport. If things change, I’ll call back and advise them... but they have pretty clear cut criteria for an activation. The big thing that trips up a lot of the older guys is mechanism. We don’t activate the trauma service solely on mechanism. The CDC trauma decision tool is a pretty good resource. Of course, each facility will have its own activation criteria.

Actually, I have a bigger issue with a trauma activation being called by the hospital for stuff that is NOT a trauma. That happens more than an inappropriate field activation.
 
Sadly we activate trauma alerts as well as the hospital based on mechanism.

I cover 2 race tracks in my area with one of the tracks frequently having motorcycles. These riders will go down at 70-130 mph and have very minor injuries but because of the speed we are forced to transport to the trauma center. About 2 months ago I had a rider go down at ~95mph and his only injury was a full thickness laceration on his ring finger. During my call in to the hospital they wanted me to fly this patient because of the mechanism.

For me, the only time I will call a trauma alert is based off of our guidelines and criteria. The hospital can and has decided to make alerts on patients that did not need it.
 
We don't call alerts or activations, we call base and the attending or resident calls it.
 
Our county’s trauma criteria is essentially a cute, and paste of the CDC’s criteria. Anything that isn’t physiological or anatomical (Step 1, or 2) would be consults.

On the helicopter we have little say on where we go, but I’ll still consult for Step 3’s, and 4’s (mechanism and EMS provider judgement, respectively). More often than not the MICN’s at our trauma center activate them as what they call 912’s, which is a slightly less urgent rendition of critical trauma criteria; same amount of staff with half the urgency.

My guess is that they assume that since it’s coming in via air, the potential for major injuries is higher. There have been those instances when our report has basically bypassed even activating.

On the ground, I can easily bypass calling to consult if the patient was in a rollover, but wants transport for superficial injuries. If it’s on the fence, I call and let the trauma center decide what they want to do with it.
 
ParamedicStudent said:
So obviously, all counties have different trauma activation criteria, although many are similar. So, just wondering, what have you activated for that wasn't listed? Or personally will/should.

I know some counties don't have restrained rollovers as a criteria, but due to mechanism, I'd probably would.
Any traumas with a positive LOC, just because there's a possible concussion/internal head injury.
Any traumas with an elderly pt and/or use of blood thinners.

I'd like to hear your answers
Click to expand...
Mechanism isn't a good predictor of anything. Calling trauma alerts for every restrained rollover patient doesn't make sense without significantly more information. I am more likely to ask the hospital not activate a team, i.e. does the 65 year old on thinners who fell and now has a small contusion on a orbital with no other complaints need a team? Not really, but that was the vogue thing for a while. He'll get his CT one way or another.
 
ParamedicStudent said:
So obviously, all counties have different trauma activation criteria, although many are similar. So, just wondering, what have you activated for that wasn't listed? Or personally will/should.

I know some counties don't have restrained rollovers as a criteria, but due to mechanism, I'd probably would.
Any traumas with a positive LOC, just because there's a possible concussion/internal head injury.
Any traumas with an elderly pt and/or use of blood thinners.

I'd like to hear your answers
Click to expand...

I'm now a doc (just an FYI), and I trained at a busy trauma center. Rollover alone would not be a trauma, a positive LOC + trauma was not enough to be a trauma, and again, elderly or blood thinner + trauma did not necessarily mean trauma activation. However, some of those would be trauma alerts at other places.

My advice: stick to protocol. If the patient doesn't meet the protocol and you are concerned, pick up a phone and call to briefly discuss it. I never have a problem with meeting EMS in the hallway to quickly evaluate a patient and then deciding to call an alert. If you start deviating, docs will stop listening to you. Unfortunately, where I trained, EMS wasn't the best, so unless it sounded bad (penetrating trauma to trunk or head, or vital signs unstable), we often did not activate trauma until we saw the patient. (EMS also called enough garbage STEMI alerts that we stopped calling the alerts until we saw the ECG.)
 
Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011

Guidelines for Field Triage of Injured Patients (With flowcharts)

I do vaguely recall one patient who was brought to the trauma center, where EMS wanted a trauma alert. construction accident, patient had bilaterally tib fib fractures from an I beam falling on him (I think, it was several years ago). Doc came over and said the situation didn't warrant a trauma alert. Looked bad, and he was hurting, but it didn't meet the criteria.

I can recall numerous trauma alerts for mechanism, or questionable reasons. Sometimes mechanism warrants a ride to the trauma center, but not a trauma team activation. I have seen EMS make things a trauma alert just because they can (to this day I swear they made the situation sound worse than it really was, and the ER didn't see why this was a trauma alert); but I have also heard from the Trauma team attending that they would rather over alert the team than under alert.
 
Fun thing working tracks and races: call the hospital to get permission for a refusal on someone that rolled their vehicle at 300+; good way to freak out the charge nurses.
I work PT at the service that covers the Salt Flats in Western Utah. common type of accident there.
 
johnrsemt said:
call the hospital to get permission for a refusal on someone that rolled their vehicle at 300+; good way to freak out the charge nurses.
Click to expand...
you have to get a nurses permission to let a patient refuse?

I can see consulting an MD (since you work under their license) for a high risk refusal, but a nurse might have the same or less education as you (esp if they are a diploma nurse or ASN)
 
I had a stabbing and I use that word loosely a few years ago around the holidays. Family started arguing and son stabbed dad with tip of a steak knife. Dad was rather obese therefore making the wound fairly superficial. Technicality it was a trauma and we all hemmed and hawed about it on scene but ended up making base contact to CYA. Told the MICN the wound and I think I used the words laceration was 1/2 in tops wide by maybe 1/4 inch deep and next thing I know I’ve got the King of calling Trauma doctor Kwang on the radio freaking out saying there could be serious injuries so we needed to bring him an hour away to our nearest trauma center. I explained the minor lac to the doctor and got cut off saying he would be calling a trauma and would see us in an hour. We got down there and they had a full trauma activation ready for us. Talk about biggest waste of resources. I got called in to QA a week later & told them to pull the tapes and sure enough you can hear me clear as day saying minor laceration and description.
 
Funny, I only spent roughly a year in Redlands, yet this ARMC doc is forever burnt into my memory. A notorious doc who’s name is echoed beyond ICEMA.

I somehow doubt his ego minds this much...
 
A lot of placea use the CDC Trauma Triage criteria, which is the Step 1-4 criteria that many of us are familiar with.

I can think of only 2 or 3 people that I've activated a Step 4 for paramedic discression. One was pregnant and the other was becoming less alert, but not altered. It's pretty hard to find someone who DOESNT fall into a Step 3 or 2 criteria, yet still needs to go to a trauma center.
 
So, paralysis is a criteria...what about paresthesia? I activated a trauma alert based on progressive paresthesia - could have been "legitimate" by mechanism (which is a bit of BS), though.
 
We cannot activate but I have certainly talked them out of activation. There for a while separation from an ATV, motorcycle, or bicycle at greater than 5mph was a 912. That one became pretty easy to talk them out of activation.
 
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