CHHS13/333

Canberra Hospital and Health ServicesClinical Procedure Trauma Team ActivationContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Procedure................................................................................................................................. 3

Data collection.......................................................................................................................... 4

Implementation........................................................................................................................ 4

Related Policies, Procedures, Guidelines and Legislation.........................................................5

References................................................................................................................................ 5

Definition of Terms...................................................................................................................5

Search Terms............................................................................................................................ 5

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS13/333

Purpose

This Clinical procedure aims to identify those patients presenting to Canberra Hospital and Health Services (CHHS) with suspected or confirmed life-threatening injuries who require immediate, expert assessment, resuscitation and treatment.

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Alerts

Alerts1. The medical or nursing team leader may upgrade from a trauma alert to a trauma code

at any time, based on physiology or if additional personnel are urgently required

2. In order to identify patients who require tertiary survey, the EDIS “Trauma Alert” box should be ticked for those patients with the following mechanism: Motor Vehicle Accident (MVA) >60km/hr Pedestrian/cyclist hit by car >30km/hr Ejection from vehicle Fatality in vehicle Extraction time >20mins Fall >3 metres

3. Obstetric: >24 weeks gestation call “Obstetric Trauma Alert or Code” - this will alert the Obstetric Registrar to attend. Delivery suite should also be requested to attend to perform CTG monitoring. Any indication of delivery in ED – NICU team must be called

4. Take particular care & if in doubt, err on the side of calling a trauma alert for patients:a) over 70 years of ageb) who are anticoagulated or have a history of bleeding disorder

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Scope

The trauma team is the central element of trauma care and management and refers to a multidisciplinary group of health care professionals who aim to provide the multi-trauma patient with immediate, expert assessment, resuscitation and treatment. Trauma team activation occurs from the Emergency Department (ED) and should be initiated by the triage nurse prior to, or on, patient arrival. There may occasionally be instances where the trauma team is called to the Intensive Care Unit (ICU) or Operating Theatres (OT), however this is very rare. The Trauma Team Activation Clinical Procedure includes all patient age demographics.

Trauma Code Team Members

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CHHS13/333

Members of the trauma team are allocated by the Trauma Team Leader: Trauma Team Leader (ED Registrar/Consultant) / Nursing Team Leader Airway Doctor (ED, ICU or Anaesthetics Registrar/Consultant) / Airway Nurse Circulation Doctor (ED or ICU Registrar/Consultant) / Circulation Nurse Procedure Doctor (ED or Surgical Registrar/Consultant) / Procedure Nurse Radiographer Wardsperson (blood bank runner)

Note – The above response should occur for trauma codes in almost all cases, however, ED team response may be varied at the discretion of the Senior ED Doctor & Nurse according to resources required for other seriously ill/injured patients in ED at the time.

Subspecialists who may be allocated to the teamWhile not necessarily involved as a part of the trauma team, these members act as consultants in care, and facilitate the progression to definitive care. Neurosurgical Registrar Cardiothoracic Registrar Plastics Registrar Orthopaedic Registrar Radiologist

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Section 1 – General Information

A Trauma Code or Trauma Alert must be activated for either:a) notification received of imminent patient arrivals meeting the below criteria, orb) actual arrival of injured patients with the below criteria

Dial 8 and state Trauma Code/Alert. Ensure the EDIS box for Trauma Code or Alert is checked (please see notes for additional information).

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Section 2 – Criteria for Trauma Code

Required response: ED, Trauma, ICU, Anaesthetics, Radiographer, Wardsman

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Triage category 1Injuries: Airway – intubated, compromised, or evidence of airway burns All penetrating injuries to the head/neck/chest/abdomen/pelvis/groin/back Fracture of 2 or more long bones Crush injury or amputation of a limb Burns >20% BSA Spinal cord injury with any neurological deficit

Vital Signs: Heart rate <50 or >120 Systolic BP <90 (child below 5yo <70) Respiratory rate <10 or >29 (child below 5yo >40) Glasgow Coma Score 13 or less

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Section 3 – Criteria for Trauma Alert 1

Criteria for TRAUMA ALERT 1

Required response: ED, Trauma only

Triage category 2Mechanism Criteria: Any form of traumatic mechanism that does not meet trauma code criteria (for example:

Motor vehicle/motorcycle/cyclist/pedestrian accident or Fall > 3 metres ) with established or potential serious injuries i.e. stable isolated fractured femur Trauma alerts should only be called after patient arrival and assessment by triage nurse. AND

Meets triage category 2 criteria in line with National guidelines

Other Criteria: Pregnancy >24 week or unsure of dates 2

Transfers from other hospitals should be discussed with the admitting officer, triage nurse and the transport team as to the patient’s injuries, physiological stability and therapeutic requirements before deciding on trauma alert versus code versus Cat 3.

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Evaluation

The Trauma Coordinator will review all moderate – severe trauma patients presenting to the hospital on a daily basis. This will be monitored and collected daily and all data collected will be stored in the Trauma Registry. KPI reports will be generated monthly and presented to the ACT Trauma Committee for appropriate action.

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Implementation

This Clinical Procedure will be discussed at Multidisciplinary meetings and in existing program of education including in-services. It will be sent to staff via email and will be available via the ACT health Intranet in Policy/Clinical Guidance.

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Related Policies, Procedures, Guidelines and Legislation

Policies Trauma team roles and responsibilities Major trauma admission policy Consent and Treatment

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Work Health and Safety Act 2011

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References

P Jenkins, J Rogers, A Kehoe, JE Smith (2015) An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre, Emergency Medicine Journal, 32(5):364-367

P. A. Cameron, B. J. Gabbe, K. Smith, B. Mitra (2014) Triaging the right patient to the right place in the shortest time, British Journal of Anaesthesia, 113(2):226-233

D. Tiel Groenestege-Kreb, O. van Maarseveen, L. Leenen, S. J. Howell (2014) Trauma Team, British Journal of Anaesthesia, 113(2):258-265

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Search Terms

Trauma, Trauma team, Activation, Trauma team Activation

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

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CHHS13/333

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval

This document supersedes the following: Document Number Document Name

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register