II. Indications
- Trauma Evaluation at Trauma Level III Emergency Department
III. Protocol: Trauma Evaluation
- Approach
- Medical provider immediately at bedside to perform Primary Survey and Secondary Survey
- Full TTA or Partial TTA determined based on evaluation (if not already defined by EMS report)
- Criteria
- Emergency Department Provider, charge nurse or EMS judgement
- Life or limb saving intervention required
- Serious injury mechanism
- Death in same passenger compartment
- Extrication >20 minutes
- Unrestrained (without seatbelt) at freeway speed
- Automobile versus pedestrian or Bicycle accident (esp. >5 mph)
- Motorcycle, dirt bike, ATV or Snowmobile accident at >20 MPH with rider separation from the vehicle
- Fall from height
- Age >55 with either serious comorbid condition or on Anticoagulation therapy (e.g. Warfarin)
- Age 5 years or less
- Other indications
- Emergency air medical transport initiated by EMS
- Penetrating limb injury
- Emergency Department Provider, charge nurse or EMS judgement
IV. Protocol: Full Trauma Team Activation (Full TTA)
- Approach
- Full Trauma code called
- Response by 2 medical providers and 2 RNs, surgeon, Anesthesia, pharmacy and ER technician
- Also responding: Respiratory therapy, radiology, phlebotomy, security
- Goal to transfer to Level I or Level II Trauma facility within 30 minutes
- Criteria
- Emergency Department Provider judgement
- Life or limb saving intervention required
- Airway compromise (including intubation in the field)
- Penetrating or crush wounds to the head, neck, chest, Abdomen or genitalia
- Glasgow Coma Scale (GCS) <8 attributed to Trauma
- Traumatic paralysis or absent pulse in any extremity
- Unstable Pelvic Fracture or bilateral Femur Fractures
- Trauma in Pregnancy >24 weeks AND Vaginal Bleeding or contractions attributed to Trauma
- Decreased perfusion or signs shock (based on at least 2 consecutive BPs or Heart Rates)
- Age <1 year
- Systolic Blood Pressure<70 mmHg
- Heart Rate (HR) >180/min or <80/min
- Age 1-2 years
- Systolic Blood Pressure<75 mmHg
- Heart Rate (HR) >180/min or <70/min
- Age 2-5 years
- Systolic Blood Pressure<80 mmHg
- Heart Rate (HR) >180/min or <60/min
- Age >6 years
- Systolic Blood Pressure<90 mmHg
- Heart Rate (HR) >160/min or <60/min
- Adults
- Systolic Blood Pressure<90 mmHg
- Heart Rate (HR) >120/min
- Age <1 year
- Emergency Department Provider judgement
V. Protocol: Partial Trauma Team Activation (Partial TTA)
- Approach
- Partial TTA called within Emergency Department
- Immediate response by a medical provider, 2 RNs, ER technician, radiology, phlebotomy
- Goal to transfer to Level I or Level II Trauma facility within 120 minutes
- Alternatively, may admit to presenting hospital with surgical Consultation
- Criteria
- Emergency Department Provider judgement
- Glasgow Coma Scale (GCS) <14 attributed to Trauma
- Focal neurologic deficit attributed to Trauma
- Asphyxiation attributed to Trauma (e.g. Drowning, hanging)
- Severe Hypothermia related to Trauma (core Temperature <34 C or <94 F)
- Ejection from vehicle
- Burn Injury >20% body surface area
- Severe orthopedic injury
- Falls
- Age under 18 years old
- Fall from height >2x greater than the patient's own height
- Age 18 years old or older
- Fall from height 15 feet or more
- Age under 18 years old