MATAGORDA REGIONAL MEDICAL CENTER TRAUMA TEAM ACTIVATION CRITERIA
LEVEL 1 TRAUMA ACTIVATION CRITERIA PRIMARY SURVEY: PHYSIOLOGIC
AIRWAY – Respiratory compromise or intubated
***(excludes CPR in progress from blunt injury) BREATHING – Respiratory rate <10 or >29 in adults (any sign of respiratory insufficiency in children: hypoxia, accessory muscle use, grunting) CIRCULATION – Confirmed SBP <90 mmHg in adults and age-specific hypotension in children DEFICIT – GCS ≤9 attributed to trauma
SECONDARY SURVEY: ANATOMIC
GSW injury to neck, chest, or abdomen or extremities proximal to the elbow/knee ED Physician’s discretion (must be documented) CPR in progress (penetrating injury)
SPECIAL CONSIDERATIONS Deterioration of previously stable patient Transfers in requiring blood to maintain vital signs EMS scene activation
SURGEON and CRNA MUST BE CALLED IMMEDIATELY FOR LEVEL 1 ACTIVATION AND MUST ARRIVE WITHIN 30 MINUTES (includes transfers and admissions) Operating Room crew will be called and placed on ALERT for Level 1 Activations *******************NOTE******************* CPR IN PROGRESS from BLUNT INJURY IS A LEVEL 2 - UNLESS ED PHYSICIAN DETERMINES SURGEON IS REQUIRED, THEN IT IS UPGRADED TO A LEVEL 1 with surgeon (30 minute response)
LEVEL 2 TRAUMA ACTIVATION CRITERIA ***(WITH or WITHOUT SURGEON)***
MECHANISM OF INJURY – does not have to wait for test results to be activated Falls: adult 3 x height; any height if anticoagulated and head trauma; child >10 ft or 3 x height High-risk auto crash: IE: moderate to high speed; striking another car or object; activated by EMS, etc. Intrusion of vehicle >12” in occupant compartment; or >18” in other site Ejection (partial or complete) from automobile Death in same vehicle/incident Auto vs. pedestrian/cyclist thrown, run over, or with significant (>10 mph) impact Motorcycle crash > 10 mph High-energy dissipation or rapid decelerating incidents: IF THE ED PHYSICIAN Ejection from motorcycle, ATV, animal, water craft, etc DETERMINES THAT AN Striking fixed object with momentum URGENT SURGICAL CONSULT Blast or explosion IS NECESSARY, MAXIMUM RESPONSE High-energy electrical injury TIME OF THE NOTIFIED SURGEON WILL Burns >20% TBSA (second or third degree) and/or inhalation injury Suspicion of drowning, hanging, or hypothermia BE Suspected non-accidental trauma 60 MINUTES TO BEDSIDE.
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ANATOMIC
Two or more long bone fractures (humerus, femur, radius/ulna, or tib/fib) Penetrating injury to head, neck, or trunk – if deficits noted – upgrade to Level 2 with Surgeon Blunt injury to head (with deficits) or neck or trunk Multiple rib fractures (greater than 2) Pregnancy >20 weeks with traumatic injury DOCUMENT ANY CHANGES TO LEVEL ACTIVATION CPR in progress from blunt injury EMS provider judgment
LEVEL 3 TRAUMA EVALUATION All traumatic injuries that require non-emergent evaluation by a trauma surgeon, and are admitted to the hospital must be seen by the surgeon within 12 hours of admission. IE: FX ribs admitted for OBS ALL ADMISSIONS FOR MAJOR TRAUMA MUST BE TO THE TRAUMA SURGEON – excludes isolated Ortho injuries that go to the Hospitalist with consult to Orthopedic Surgeon
REVISED 6/22/16 DH