II. Indications: Decide early if transfer to Trauma Center is appropiate
- Among other criteria, Glasgow Coma Score <= 8 should be cared for at Trauma Center
- Focus on speed and efficiency
- Do just enough to allow safe transport to definitive care
- Call for transport early in course
- If available, a second provider in the Trauma Evaluation can break-off to contact the Trauma Center
- Relay a focused hand-off (MIST mnemonic: Mechanism, injuries, symptoms/signs, treatment)
III. Evaluation
- Perform Primary Survey and Secondary Survey
- Examine all areas (arm pits and back, Breasts, butt cheeks and sac)
IV. Imaging: Obtain focused imaging only (for stabilization only, not diagnosis)
- See Trauma Evaluation for imaging precautions
- Make electronic copies (e.g. CD) of all imaging to send with patient
-
CT Head
- Indicated in Altered Level of Consciousness (evaluate for Intracranial Bleeding such as Epidural Hematoma)
- Obtain CT Cervical Spine at same time as CT Head (if indicated)
-
Chest XRay
- Repeat again after intubation and Nasogastric Tube placement
- Consider Pelvic XRay (if suspicion of Fracture)
- Focused assessment sonography for Trauma (FAST)
V. Management: Focus on acute stabilization and Resuscitation to ensure safe transport
- Airway: RSI and Intubation (or surgical airway)
- Indicated in unstable airway, respiratory distress, Altered Mental Status (GCS <11)
- Secure an Advanced Airway prior to transport if any chance it will be needed en-route
- Definitive airway management is very difficult en-route (especially on air transport)
- Confirm Endotracheal Tube position (including with Chest XRay prior to transport)
- Ensure adequate sedation and analgesia for transport
- Secure patient's hands with soft restraints to prevent self-Extubation
-
Chest Tubes (if indicated)
- Especially for air transport during which even a small Pneumothorax is likely to expand
-
Vascular Access and Hemorrhage Management
- Secure intravenous lines (minimum of 2 lines, as large bore as possible)
- Write numbers (1, 2, 3) on the Intravenous Fluid bags (helps track total crystalloid administered)
- Start Blood Products prior to transfer if indicated OR
- Give transport Paramedics blood to start if needed in route
- Use O- for women (or O- or O+ for men) if Transferring before type specific blood available
- Apply Tourniquets if needed to control life threatening bleeding
- See Tourniquet and Hemorrhage Management for precautions
- Major Fracture stabilization
- Pelvic stabilization (Pelvic Binder) for suspected Pelvic Fracture
- Splinting (large bulky splints to prevent Fracture movement in transport)
- Traction Splinting
- Avoid procedures that may be deferred to the accepting facility
- Environment
- Maintain patient warmth (monitor patient Temperature)
- Tubes
- Other measures
- Consider Seizure Prophylaxis
- Tetanus Prophylaxis
- Antibiotics if indicated
VI. Management: Transfer documentation
- Patient evaluation including SAMPLE History (including Anticoagulant use), dosing weight, Vital Signs, exam, GCS
- Imaging studies burned to CD or DVD as well as radiologist reports (if available)
- Diagnostic testing results (EKG, Labs)
- Interventions (medications, procedures)