Sponsor Hospital Council of Greater Bridgeport

6.18 Trauma Alert Guidelines

updated 7/11/2017

Notify CMED of a TRAUMA ALERT under ANY of the following conditions. Regardless of your CMED patch priority, the receiving hospital will determine its level of alert based upon your assessment and information from the field. This process may often require the staff member to ask specific questions to EMS personnel during the radio patch.

Please place the trauma alert as soon as possible, ideally while still on the scene

Physiologic Criteria

• SBP <90 mmHg in an adult or SBP<(70+2 X Age) in a child**
• GCS of 13 or less that resulted from a traumatic mechanism that is not the patient’s baseline
• Respiratory distress or airway compromise (intubate if RR <10 or >29)

Anatomic Criteria

• Penetrating injuries to the head, neck, torso, abdomen, and pelvis, excluding the hands or feet
• Chest wall instability including flail chest
• Evidence of spinal cord injury with motor deficits (i.e. paralysis, paraplegia, quadriplegia, lateralizing signs) or sensory deficits (i.e. parasthesias, or sensory changes)
• Burns 2nd or 3rd degree with >5% TBSA or ANY airway involvement
• Limb amputation excluding digits.
• Multiple or open long bone fractures
• Injuries to more than one organ system
• Crushed, degloved, pulseless or mangled extremity
• Open or depressed skull fracture
• Pelvic fracture

Mechanism Criteria

• Unrestrained occupant in rollover
• Hanging or Drowning Event
• Death of same-vehicle occupant
• Partial or complete ejection from vehicle
• Significant vehicle deformity with = 12 inches of intrusion into passenger compartment, steering wheel deformity, dash deformity, or = 18 inches of intrusion to any part of the vehicle
• Prolonged extrication (greater than 20 minutes)
• Fall from height greater than 20 feet for an adult or greater than 10 feet for a child
• Pedestrian or bicyclist run over, thrown, or hit by automobile traveling >20mph
• Falls with head injury and while on anticoagulation including, but not limited to Coumadin(Warfarin), Pradaxa(Dabigatran), Eliquis(Apixaban), Xarelto(Rivaroxaban), Lovenox(Enoxaparin) or Savaysa(Edoxaben). Excludes anti-platelet drugs like aspirin, Plavix and Brilinta.
  
  

Other Considerations

• Head injury while on warfarin
• Pt already receiving blood
• Pt who, in the prehospital provider’s opinion, is rapidly deteriorating
• Multiple casualty incidents where it is difficult to immediately determine extent of all pts.

Other Important EMS Considerations

• Bridgeport Hospital is the designated destination for critically ill / injured children or any patient with burns. Pt may be brought to SVMC if the pt does not have a secure airway or is otherwise too unstable to be transported to BH.
• Whenever possible, keep family members together.

When giving your patch, please remember to include, at minimum:

• Chief Complaint
• Mechanism of Injury
• GCS
• Significant findings / injuries
• Vitals
• ETA

I. Upon arrival at ED:

• Only those EMS personnel directly involved in patient care should be in the trauma room.
• The paramedic should give full verbal report to the ED physician and/or Trauma surgeon.
• The paramedic should stay with the patient until cleared by the ED physician or trauma surgeon.
• The EMS crew may assist with patient care as directed by the ED physician and/or Trauma surgeon.
• Crew members remaining in the trauma room to assist with patient care are responsible for obtaining their own additional PPE, such as lead shields, as appropriate.
• EMS crew members that are needed for another EMS response will be relieved immediately upon notification to the ED physician and/or Trauma Surgeon.
• Please try to complete your run form before leaving. If this is not possible the run form must be completed as soon as possible.