Most major trauma patients arrive by ambulance/helicopter with a pre-notification call to the Emergency Department so there is generally time for preparation of staff and equipment.
It can be useful to have a whiteboard in the trauma bay where patient demographic and injury/background details can be documented.
- Trauma team members should endeavour whenever possible to arrive to ED prior to patient arrival – in order to have time to prepare themselves and the trauma room for the incoming patient.
- All team members should introduce themselves to the team leader – name, role and rank.
- Stickers with the team member’s role and name worn on the outside of the PPE are helpful and encourage direct communication.
- The team leader should assign any unfilled roles. He/she should then brief the team regarding the pre-notification of the patient. They should convey and synthesise all available information, outlining the potential life threats and immediate priorities for the team. In many ways, this is equivalent to a surgical ‘time-out’ recommended by the WHO Safe Surgical Checklist.
Personal protective equipment
Universal precautions should be undertaken by all patients managing the trauma patient
This should include
- Plastic apron or (preferably) full impermeable gown
- Eye protection
- Lead aprons + thyroid shield for staff members that might remain in the room when xrays taken
Respiratory protection should be used currently for any patient in whom there is a possibility of respiratory infection (eg Covid-19). A surgical mask should be the minimum PPE, with an N95 mask used if an aerosol generating procedure is envisioned.
Standard hand hygiene rules apply – use hand gel before and after any contact with the patient or the environment/specimens.
Based on the prehospital notification and the need for various interventions, equipment should be prepared, which might include
- Advanced airway equipment
- Guedel/nasal airways
- Nasal prong oxygen/hudson mask
- Bag valve mask
- Video or direct laryngoscope
- Endotracheal tubes of appropriate size
- Surgical airway kit available
- IV insertion equipment prepared
- IV lines primed, IVFs on a pressure bag
- Rapid infuser primed
- Un-crossmatched blood/blood products available if massive transfusion anticipated or any episode of prehospital hypotension
- Tranexamic acid
- RSI drugs
- Pelvic binder (place on bed)
- Thoracostomy/thoracotomy tray available
- Ultrasound turned on and ready to scan