Preparation for receiving a trauma patient

Most major trauma patients will arrive by ambulance/helicopter with a pre-notification call to the Emergency Department so there is generally time for preparation of staff and equipment.

Trauma team activation criteria and Code Crimson criteria (where applicable) should be posted near the receiving radio for quick reference.

It can be useful to have a whiteboard in the trauma bay where patient demographic and injury/background details can be documented for team members to easily see.

 

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.\
• A Team Leader should be identified.
• 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.
• The Team Leader should then brief the team regarding the pre-notification information of the patient.  They should convey and synthesise all available information, outlining the potential life threats and should set immediate priorities for the team.   In many ways, this is equivalent to a surgical ‘time-out’ recommended by the WHO Safe Surgical Checklist.
• The Team Leader should update the plan and priorities as the case evolves and more information is received – in order to maintain a shared mental model for the team.

 

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
• Intraosseous kit available in room
• IV lines primed, IVFs on a pressure bag
• Rapid infuser primed if blood product use envisioned
• Un-crossmatched blood/blood products (Trauma “stat pack”) available if massive haemorrhage 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