Preparation for receiving a trauma patient

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.

 

Team preparation

• 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

• Gloves
• 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.

 

Equipment preparation

 

Based on the prehospital notification and the need for various interventions, equipment should be prepared, which might include

• Advanced airway equipment
  • Guedel/nasal airways
  • Suction
  • Nasal prong oxygen/hudson mask
  • Bag valve mask
  • Video or direct laryngoscope
  • Endotracheal tubes of appropriate size
  • LMA
  • 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
• Drugs
  • Tranexamic acid
  • RSI drugs
  • Analgesia
  • Antiemetic
• Pelvic binder (place on bed)
• Thoracostomy/thoracotomy tray available
• Ultrasound turned on and ready to scan