Download Trauma Activation Guideline

St. Joseph Mercy Hospital
TRAUMA PROGRAM
Guidelines for Team Responsibilities in an Alpha (Level 1) Trauma
Activation
At Bedside:
Always Check-in:
3-4 physicians
2 RN’s
1 Tech
Emergency Medicine (E.M.) attending
E.M. Senior Resident
Surgery/Trauma Service attending
Trauma/ASP Chief
ASP Junior Resident
PHYSICIANS:
3-4 physicians:
1.) Team Leader—Usually the Trauma/ASP Chief (or Senior Resident)
2.) Airway—EM Attending or EM Junior Resident
3.) Procedures—One or two ASP Junior Residents and/or EM Junior Resident
Supervising:
E.M. Attending until Trauma Surgeon (Attending) arrives.
Surgery Attending
Trauma Chief
Team Leader
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Identifies self to Primary Nurse and other trauma team members as Team Leader.
Gets report from EMS.
Performs or assigns a primary and secondary ATLS survey; informs Primary Nurse of findings.
Runs resuscitation and directs procedures using ATLS guidelines for assessment and management.
Orders labs and xrays and prioritizes them; communicates with Radiologist re: sequence of
films/results of films.
Notifies the O.R. if need for surgery determined.
Directs consults, as needed.
Maintains crowd control. Assesses number of personnel present and limits number who are directly
involved in trauma care. Excuses other team members when no longer needed. Controls noise and
excessive conversation.
Talks to family.
Procedure MD
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Performs components of a primary and secondary ATLS survey, as assigned; informs Primary
Nurse of findings.
Places lines, NG tube, and chest tubes. Places thermistor foley or directs ED tech to do so.
Performs DPL, Ultrasound, as directed.
Draws blood sample if RN/tech unable.
Draws ABG’s if RT unable.
Airway MD
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Assesses and manages airway.
Maintains C-Spine precautions.
Assesses GCS.
Inserts NG or OG tube.
Assures protection of patient’s airway (ie. If patient on backboard, make sure head blocks and
backboard straps are in place and secure, so that backboard can be tipped to the side should patient
start vomiting).
NURSING:
Primary Trauma RN
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Assists in the set-up of the Trauma Room prior to the patient’s arrival (including Level-1 Fluid
Warmer).
Takes report from pre-hospital personnel.
Identifies self to trauma team members as Primary Nurse.
Functions as the primary scribe (record keeper).
Remains with patient at all times--until patient is admitted to a bed or transferred.
Must record times of arrival of pt., Trauma (ASP) resident, Trauma (ASP) attending, and any
specialty consultants.
Must record patient’s initial temperature, VS, and GCS. Continuously charts procedures, labs
sent, VS, GCS, meds given, and I&O. VS and GCS will be recorded at least q 1 hr., even if the
911 patient is stable.
If hourly GCS assessment is not possible due to neuromuscular blockers or sedation, RN will
indicate this in the GCS section of the Trauma Flow Sheet.
Passes medications to the secondary RN or administers medications if needed.
Assists with crowd control. Assesses number of personnel present and limits number who are
directly involved in trauma care. Directs observers (e.g. medical students, EMT students) to
appropriate out-of-traffic location.
Assures that blood and urine samples are ordered and sent to the lab.
Assists with hemodynamic procedures if requested by secondary RN.
Makes arrangements for the patient to go to special procedures.
o Assures airway protection during road trips, e.g. if patient is on the backboard, makes
sure that head blocks and backboard straps are in place and secure, so that backboard can
be tipped to the side should patient start vomiting.
o Takes jump box along on road trips.
Assures chain of evidence for any evidence collected and awaiting pick-up by law enforcement.
Determines status of family notification by conferring with Mental Health Worker.
Confers with Trauma Chief or attending re: appropriate time for family/S.O. to visit.
Gives report to O.R. or to receiving unit, including status of family notification, evidence
collection, spinal clearance, I &O totals, as well as VS, GCS, known injuries, interventions,
procedures, and overall patient status.
Secondary Trauma RN
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Works with the Primary RN by providing hands-on care of the trauma patient.
Establishes rapport with trauma patient and explains trauma procedures.
Establishes IV access, or places second IV line, and obtains blood work. Sets up Level I infusion,
if directed.
Assists with removing clothing and completing evidence collection kit when indicated.
Assists with systematic trauma survey (assessment) and reports findings to the Trauma Team and
the Primary RN.
Administers medications and blood products as ordered.
Assists with any procedures performed in the trauma room.
Restocks Trauma Room with E.D. tech after trauma patient leaves the department.
E.D. Trauma Tech
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Assists in the set-up of the Trauma Room prior to the patient’s arrival.
Obtains a manual BP, respiratory rate, heart rate, and temperature and reports findings to the
Trauma Team and the Primary RN.
Removes patient’s clothing; applies warm blankets or Bair Hugger.
Places patient on the cardiac monitor.
Obtains blood specimen when necessary; enters labs and x-rays into the computer.
Runs specimens to the lab, as needed.
Inserts thermistor foley catheter, when directed to do so (if not already done by trauma resident).
Completes the valuables-check list.
Obtains any other necessary supplies not found in the trauma room.
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Restocks the Trauma Room along with the Secondary RN, after the trauma patient leaves the dept.
Everyone
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Assists with removal of clothing.
Contributes to crowd control.
Keeps noise to a minimum.
Follows only Team Leader.
Mental Health Worker
 Contacts family or significant other, if not already present.
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Acts as liaison between family and Trauma Team--getting and giving information.
Provides emotional support.
Notifies Pastoral Care, as needed.
Initiates Social Work consult for all ALPHA trauma activation patients who are being
admitted.
Written: 3/99
Approved:6/99
Revised 08/04
Revised 03/06