Trauma call and Code Crimson Protocol

A “trauma call” should standardise the in-hospital response to trauma patients. A trauma team is mobilised to receive the patient. Other services (eg: radiology, blood bank etc) may also be notified.

 

 

A mandatory trauma call should be placed if any of the following criteria are met

 

1. R40 call – status 1 or 2 trauma patients

 

2. Abnormal physiology*

• Respiratory rate <10 or >29
• Systolic BP <90mmHg
• HR >120 bpm
• GCS < 13

* if recorded at any time from the point of injury

 

3. Injury patterns

• Penetrating injury to the head, neck or torso
• Flail chest
• Airway obstruction
• Suspected complex pelvic injury
• Two or more proximal long bone fractures
• Traumatic amputation proximal to knee or elbow
• Major crush injury
• Penetrating trauma to a limb with arterial injury
• Crushed, mangled, amputated or pulseless limb
• Paraplegia or quadriplegia
• Major burns
  • >20% in adults (>10% in paeds), or airway burns

 

Discretionary trauma calls

A discretionary trauma call can be considered by a senior clinician based on mechanism, physiology, co-morbidities or a combination of these. 
Examples include:

• Fall > 3 meters
• Entrapment > 30 minute
• Cyclist or motorcyclist versus car
• Pedestrian versus car or train
• Relative hypotension
• Ejection from a vehicle
• Fatality in the vehicle
• Patient anticoagulated or on beta blockers
• Elderly patient with moderate trauma
• Pregnant patient with moderate trauma

 

4. Transfers

 Major trauma patients transferred from another hospital to the Emergency Department should be received by the trauma team.

 

5. Multiple casualties

When the Emergency Department is forewarned of the imminent simultaneous arrival of four or more trauma patients, irrespective of their suspected injury severity

 

 

Code Crimson

‘Code Crimson’ is a term that has commonly been used by hospital-based teams managing trauma patients with life-threatening haemorrhage that is refractory to resuscitation. The aim of the trauma Code Crimson activation is to get senior decision makers and facilitators to the patient in the resuscitation room to facilitate rapid access to theatre for rapid surgical control of haemorrhage in hospitals that have this capacity.

Criteria for Activation

A trauma Code Crimson call is made either by HEMS, ambulance paramedics, or once the patient is in ED and assessed as potentially requiring surgical intervention to control haemorrhage post trauma.

Assessment is based on the four parameters of the Assessment of Blood Consumption score (ABC). This assessment is made after initial resuscitation with intravenous fluids and or blood.

1. Penetrating mechanism of injury
2. Systolic Blood pressure of 90 mmHg or less
3. Pulse of 120/ min or more
4. Positive trauma E-FAST ultrasound scan

1 point is scored for each parameter met.

If the patient scores ≥ 2 points they meet the criteria for Code Crimson activation.

Code Crimson activation alerts senior decision makers (eg Surgical, ED, Anaesthetic SMO) in addition to standard Trauma Team members.  It also activates hospital MHP protocols and alerts radiology of the arriving patient.  The goal is that senior decision makers are present and involved on the arrival of a shocked patient and make a rapid decision to either take the patient to OT for control of haemorrhage or to continue to CT.