II. Indications

  1. Trauma Evaluation at Trauma Level III Emergency Department

III. Protocol: Trauma Evaluation

  1. Approach
    1. Medical provider immediately at bedside to perform Primary Survey and Secondary Survey
    2. Full TTA or Partial TTA determined based on evaluation (if not already defined by EMS report)
  2. Criteria
    1. Emergency Department Provider, charge nurse or EMS judgement
      1. Life or limb saving intervention required
    2. Serious injury Mechanism
      1. Death in same passenger compartment
      2. Extrication >20 minutes
      3. Unrestrained (without seatbelt) at freeway speed
      4. Automobile versus pedestrian or Bicycle accident (esp. >5 mph)
      5. Motorcycle, dirt bike, ATV or Snowmobile accident at >20 MPH with rider separation from the vehicle
    3. Fall from height
      1. Age >55 with either serious comorbid condition or on Anticoagulation therapy (e.g. Warfarin)
      2. Age 5 years or less
    4. Other indications
      1. Emergency air medical transport initiated by EMS
      2. Penetrating limb injury

IV. Protocol: Full Trauma Team Activation (Full TTA)

  1. Approach
    1. Full Trauma code called
    2. Response by 2 medical providers and 2 RNs, surgeon, anesthesia, pharmacy and ER technician
      1. Also responding: Respiratory therapy, radiology, phlebotomy, security
    3. Goal to transfer to Level I or Level II Trauma facility within 30 minutes
  2. Criteria
    1. Emergency Department Provider judgement
      1. Life or limb saving intervention required
    2. Airway compromise (including intubation in the field)
    3. Penetrating or crush wounds to the head, neck, chest, Abdomen or genitalia
    4. Glasgow Coma Scale (GCS) <8 attributed to Trauma
    5. Traumatic paralysis or absent pulse in any extremity
    6. Unstable Pelvic Fracture or bilateral Femur Fractures
    7. Trauma in Pregnancy >24 weeks AND Vaginal Bleeding or contractions attributed to Trauma
    8. Decreased perfusion or signs shock (based on at least 2 consecutive BPs or Heart Rates)
      1. Age <1 year
        1. Systolic Blood Pressure<70 mmHg
        2. Heart Rate (HR) >180/min or <80/min
      2. Age 1-2 years
        1. Systolic Blood Pressure<75 mmHg
        2. Heart Rate (HR) >180/min or <70/min
      3. Age 2-5 years
        1. Systolic Blood Pressure<80 mmHg
        2. Heart Rate (HR) >180/min or <60/min
      4. Age >6 years
        1. Systolic Blood Pressure<90 mmHg
        2. Heart Rate (HR) >160/min or <60/min
      5. Adults
        1. Systolic Blood Pressure<90 mmHg
        2. Heart Rate (HR) >120/min

V. Protocol: Partial Trauma Team Activation (Partial TTA)

  1. Approach
    1. Partial TTA called within Emergency Department
    2. Immediate response by a medical provider, 2 RNs, ER technician, radiology, phlebotomy
    3. Goal to transfer to Level I or Level II Trauma facility within 120 minutes
      1. Alternatively, may admit to presenting hospital with surgical Consultation
  2. Criteria
    1. Emergency Department Provider judgement
    2. Glasgow Coma Scale (GCS) <14 attributed to Trauma
    3. Focal neurologic deficit attributed to Trauma
    4. Asphyxiation attributed to Trauma (e.g. Drowning, hanging)
    5. Severe Hypothermia related to Trauma (core Temperature <34 C or <94 F)
    6. Ejection from vehicle
    7. Burn Injury >20% body surface area
    8. Severe orthopedic injury
      1. Open long bone Fracture
      2. Two or more long bone Fractures in different extremities
    9. Falls
      1. Age under 18 years old
        1. Fall from height >2x greater than the patient's own height
      2. Age 18 years old or older
        1. Fall from height 15 feet or more

VI. References

  1. (2016) CALS Manual, 14th ed, 1:83-5
  2. Fairview Health Services, Trauma Guidelines

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