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BUILDING YOUR TRAUMA
TOOL KIT-WHAT
ADJUNCTS ARE RIGHT
FOR YOU?
AMY KOESTNER, RN, MSN
OBJECTIVES
• Identifying equipment or items
needed in your trauma toolkit
• Describe your process for evaluating
the effectiveness of your trauma toolkit
• Describe the role of your trauma toolkit
beyond the ED
IMPORTANT ELEMENTS OF A TRAUMA
TOOL KIT
• Communication
• Hemorrhage Control
• Anticoagulation
HARDWIRING TRAUMA CARE
• Patient focused care
• Evidence based care
• Bench marked
• Exceeds ACS and State requirements
COMMUNICATE EXPECTATIONS
• Identify key areas of communication
opportunities
• Identify stakeholders
• Identify priorities of care
• Identify best practices currently in place
• Identify knowledge gaps
COMMUNICATION
• Key concept in care – throughout the
continuum
• Pre hospital → Pre-arrival → Trauma bay report
• ED resuscitation → ED hand off → In-patient
TRAUMA COMMUNICATION TOOLS
EMS checklist for trauma
Basics:
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Age
Complaint
Priority
Location (scene or transfer)
ETA
Trauma:

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Mechanism (energy involved)
VS (BP,HR,RR)
GCS
LOC? Y
or N
Presumed/obvious injuries
(deformities, open wounds, scene
blood loss)
Special circumstances (pediatric,
pregnant, anticoag, spinal cord, long
extrication, exposure, comorbidities,
etc
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RESPONSE TIME DOCUMENTATION
Hardwire documentation process
8
TRAUMA TEAM TIME OUT & SAFETY
BRIEFING
• Standard work for
roles
• Team Leader – starts
process
• All team members
identified and role
announced
• PTA information
• EMS report
TRAUMA TOOLS
10
TRAUMA ORIENTATION VIDEO
11
60 SECONDS OF SILENCE
• Structured EMS
report
• All team members
listening
• Then patient moved
to stretcher
• Assessment /
Interventions
• Plan of care
developed
TRAUMA BAY CARE & BEYOND
• Plan of care within the bay
• Plan of care post bay
SCENARIO
• 45 year old male unrestrained driver involved
in head-on MVC. Patient ejected from
vehicle. EMS on scene atf unconscious, GCS
= 6, BP 80/60, HR 132, RR 28 Pulse Ox 91% on
NRB.
• Assessment: Multiple facial lacerations and
swelling, breath sounds decreased on left
with crepitus, left arm large laceration with
active bleeding, abdomen distended, and
pelvis unstable when compressed.
ON SCENE CARE
• Airway → oxygen and intubation
• Breathing → assess findings &
interventions
• Circulation → stop the bleeding, assess
resuscitation needs
• Disability → assess & evaluate
intervention / resources
HEMORRHAGE CONTROL: TOOL BOX
• Tourniquet
• Quick clot
• Splinting
• Pelvic binder
• TXA
• MTP
TOURNIQUET USE
• Utilized by EMS
and hospital
environment.
• Criteria for
application &
removal
• B-Con program
POLICY & DOCUMENTATION
HEMOSTATIC AGENT
• Applied directly to area of bleeding
SPLINTING
• Assist with hemorrhage control
• Promote perfusion
TRANSEXAMIC ACID
Purpose
• Uncontrolled
vascular
hemorrhage
• Initiation of MTP
• Injury less than 3
hours
Factors
• Any age restrictions
• No evidence of
intravascular clotting
disorder (PE, DVT)
• Transport times
• Avoid with pt on
anticoagulation meds
or receiving PCC, factor
VIIa
TXA DOSING
Dosing:
Loading dose: 1 gram (mixed in 50 cc saline)
over 10 minutes
Infusion can be started at the receiving
facility and the dose will be 1 gram over 8
hours
Loading dose and infusion should be
documented and communicated at handoff
PELVIC BINDER
• Unstable pelvic fractures:
• A-P fractures –open book
• Shearing injury
PELVIC BINDER
• Placed by either EMS or trauma center
staff
• Good adjunct with resuscitation fluids /
blood products
• Early communication with orthopaedic
surgery, OR and /or IR for definitive care
• May be an indication for MTP activation
MTP FACTS
• Patient initially bleeds
at scene
• Receives crystalloid
en-route
• Receives blood in ED
or surgery
• What blood loss
defines massive
transfusion?
MASSIVE TRANSFUSION
• Early recognition,
initiation, and
management
• Role in Prehospital
• Triage to
appropriately
resourced trauma
center
• 1:1:1 ratio
MTP FORMS
27
REASONS WHY PEOPLE ARE ON
ANTICOAGULANTS
• Atrial Fibrillation
• DVT
• Mechanical heart
valve
• Stroke prevention
• Heart attack
• Heart failure
• Pulmonary Emboli
• Angina
• Stents
• Orthopaedic
procedure
• Wound care
• Just because…….
EMS ARENA
• Need for evaluation of all trauma
patients for: any co-morbidities or
significant medical history which
would be a predictor of
anticoagulation use(a fib, valvular
replacement, DVT, stroke, etc)
• EMS triage guidelines should
consider triage to trauma center
UNDER TRIAGE
• Transported to nontrauma centers
• under recognition of
co-morbidities /
meds
• Lack geriatric
specific training
• False sense of
security “they look
good”
• EAST guidelines
recommend
transport of pts >
70 yrs to a trauma
center
• PA state system
reported EMS less
likely to transport
to trauma center
UNDER TRIAGE IN ED
• Co-morbidities or significant
medical history –not
obtained or under
appreciated
• Lack a system approach to
evaluating pts
• Timing of CT scan
• Timing of initiation of reversal
• Cumbersome process or
approval needed to reversal
medication use
ANTICOAGULATION TOOL KIT
• Guideline for reversal & early identification
of patients
• CT availability
• Stat labs
• Adequate thawed FFP available
• Easy access to reversal medications
• Good linkage with pharmacy team
• Process in place to review cases and
identify opportunities
ANTICOAGULATION REVERSAL
ANTICOAGULATION TOOLS
• EMS assessment, early communication
and transport to trauma center
• System approach to triage of these
patients
• Develop & implement geriatric trauma
criteria or guideline that activates
resources
• Geriatric specific training.
CLOSING REMARKS
• Communication with accountability
• Collaboration across EMS and trauma centers is
essential to providing best practice
• Account for “geography” when looking at
resources and options
• Evaluate and re-evaluate tools and resources
• Continue to question…
QUESTIONS??