Trauma Transport Protocols

Updated June 2013: Oct 2014; Oct 2015; Oct 2016

Purpose

These protocols are made by the North Texas Regional Advisory Council (NTRAC), and are to serve as guidelines for the entities involved in the NTRAC. The RAC is establishing minimum standards for the region. Each entity may write their own protocol/policy based on the RAC plan, but they should not deviate from what RAC has outlined.

Trauma Diversion Protocol

1. The NTRAC TSA-C has approved and given these guidelines as minimum standards for the Diversion Protocols, for it’s member entities to be put on diversion status. Each entity may write their own protocol/policy based on the RAC plan, but they should not deviate from what RAC has outlined.

2. Each medical facility in the NTRAC TSA-C will designate a person (ED Physician, CEO, etc.) to be responsible for decision regarding diversion of trauma patients.

3. Acceptable reasons for diversion are as follows:

a. Internal disaster

b. Exhaustion of resources

c. Loss of critical equipment, etc.

4. Each facility must keep records showing why they were on diversion.

5. A call down/notification list is to be posted in each hospital. This will include the neighboring hospitals and lead hospital. All appropriate agencies and facilities will be contacted as soon as a hospital requests diversion status. The entities will be notified promptly once the hospital is off the diversion status.

6. Each facility must have Policies and Procedures for plans to open up critical care beds as necessary.

7. Each facility must have a local mass casualty protocol and know how to activate the region wide mass casualty plan.

8. The lead trauma facility must notify the other NTRAC TSA-C hospitals if they go on diversion status.

9. The diversion status may be overridden by the Chief of Medical Staff/Medical Director of the Emergency Room, upon request of the hospital administrator, in the events, i.e.; regional disaster, multiple neighboring facilities requesting diversion status, etc.

BYPASS PROTOCOL FOR TRAUMA PATIENTS

Purpose: The purpose of trauma team initiation (calling a “trauma alert”) is for the efficient and effective care of the trauma patient who may require a multidisciplinary approach to care. This patient may also need to be taken expeditiously to the OR and/or transferred “STAT” having been stabilized as well as possible.

The trauma alert procedure includes physiologic and anatomic criteria for recognition of the major trauma victim who requires triage to a facility which can provide specialized care (Some of these are referred to under Patient Profile).

In order for a “Trauma Alert” to be initiated, EMS must coherently relay pertinent information to online medical control at the nearest medical facility, if available. In the event that a physician is not readily available, the EMS crew must strictly adhere to their own written protocols, until contact with a physician is made.

Method of Initiation:

The Trauma Alert criteria are self-evident, and all EMS providers, Emergency Department Personnel, and Hospital Personnel, that interact in the care of the Trauma Patient should be aware of and in agreement with the team approach to trauma care.

Refusal:

All medical directors should establish policy in the event of patient refusal to allow for transport to recommended facility or refusal to transport. This is especially important in the case of Pediatric Traumas.

Patient Wishes:

The personal wishes and desires of the patient must be taken into consideration as delegated by law, and allowed by local policies and procedures. Critically injured patients should be coaxed, begged, and bargained into transport to the nearest facility with a physician if possible, but never forced. In the event that a patient is unable to make their wishes know, local policy and procedures will be followed as established.

Air Medical Transport:

Local medical control should be contacted, when appropriate, for concurrence with any air transport decisions.

If it is evident that the patient condition warrants immediate transport to a tertiary care trauma center, EMS may activate air transport, if available.

If the ETA of air medical transport is greater than the ground transport time to the nearest emergency department, the patient should be transported via ground ambulance to the ED, and air transport be directed to that facility.

Patient Profile

1. Anatomic Criteria:

1.1  Any penetrating injury except to the arm, hand, or foot.

1.2  Flail Chest

1.3  Multiple trauma with burns > 10%, or inhalation injury.

1.4  Two or more long bone fractures, or femur fracture.

1.5  Amputation proximal to the wrist or ankle.

1.6  Pelvic or acetabular fracture.

1.7  Traumatic neurological deficit.

1.8  Evidence of on-going blood loss.

1.9  Crush injury to torso.

2. Physiologic Criteria:

Adult Patient:

2.1  Blood pressure less than 90 systolic

2.2  GCS less than 10

2.3  Respiratory rate less than 10, greater than 29

2.4  Airway compromise requiring pre-hospital intubation

Pediatric Patient:

2.5  Heart Rate >180

2.6  Systolic BP <70 mmHg + (age in years X 2)

2.7  Any airway assistance other than simple facemask or nasal cannula

2.8  Pedi GCS <10

3. Mechanism of Injury:

3.1  Gunshot wound or penetrating trauma to head, neck, torso, or abdomen.

3.2  Falls greater than 20 feet (>10 feet for patients <14 or >65 years of age)

3.3  Death of an occupant in the same vehicle involved in a MVC

3.4  Intrusion into the passenger space of the vehicle >20 inches

3.5  Any patient requiring extrication >15 minutes

3.6  Auto-Pedestrian accident

3.7  Ejection from the vehicle

3.8  Motorcycle accident >20 mph with separation of the rider from the motorcycle

3.9  Vehicle rollover without restraints

3.10  >20 mph acceleration or deceleration as pedestrian or unrestrained passenger

3.11  Run over by motor vehicle

3.12  Lightning/electrocution injury

4. General suspicion on the part of the physician.