Section: ADC Trauma ADC ED/TRAUMA POLICY AND PROCEDURE Policy 221 Subject: Trauma Team Activation Protocol/Roles & Responsibilities of the Trauma Team Trauma Coordinator UTMB respects the diverse culture needs, preferences, and expectations of the patients and families it serves to the extent reasonably possible while appropriately managing available resources and without compromising the quality of health care delivery. I. Title Trauma team Activation Protocol/Roles & Responsibilities of the Trauma Team II. Definition To provide an efficient coordinated approach to providers of care to the critically injured or multisystem trauma patients. III. GUIDELINES 1. Upon notification from pre-hospital providers of an incoming trauma patient or arrival of the patient, as defined in Criteria for trauma Team Activations, the emergency physician will call a Trauma Alert. All in-house should arrive within 10 minutes of the activation. All on call members should arrive within 30 minutes of activation. 2. If in the event the ED physician cannot meet the critically injured patient in the ED on their arrival, the ED charge nurse assumes care of the patient and calls for a trauma alert activation. All transfers on Trauma Activations should begin at the time of patient s arrival to the ED. 3. The Trauma Team will consist of the following individuals: a) Trauma activation, Full Initial Team, STAT Emergency Department Physician Emergency Department Charge Nurse Trauma Nurse 1 (ED RN) Trauma Nurse 2 Trauma Nurse 3 if needed (House Supervisor) Respiratory Therapist Radiology Technician UTMB Police Social Services if in house Ed Tech Phlebotomist Trauma Coordinator (if on duty) EKG Technician (as needed) House Supervisor b) Trauma Alert, Physician Consult as needed, Eval Orthopedic Surgery if available
ADC ED/Trauma Policy 221 Obstetrician (greater than 23 weeks gestation or as requested by the ED physician) L&D Nurse (greater than 23 weeks gestation or as requested by the ED physician) General Surgeon Trauma Team alerted to possible need for response IV. Preparation (Prior to Patient s Arrival) Role descriptions are not limited to: 1. Emergency Department Charge Nurse a) Immediately informs the ED physician b) Notifies the ED staff and the House Supervisor c) Manages resources to ensure arriving and current patient meds needs are met d) Answers the medical control call e) Receives the follow information: Mechanism and type of traumatic injury Status of airway, breathing, circulation and filed intervention Vital signs, RTS and GCS Identified/potential injuries Age Estimated time of arrival number of victims Inquiries to EMS at time of trauma alert notification the types of specialties needed on the patient s arrival Requests consults of on call teams as needed Activates trauma team after notification/approval of ED physician 2. ED Tech a) Records name and times of all physicians notification to include time called, time answered and time arrived b) Reports to the charge nurse the status of responses c) Reports to any area as requested by the charge nurse d) Performs duties as directed by the charge nurse and if asked to deviate from the ordered, by another entity, should consult the charge nurse. 3. Trauma Nurse 1 and Nurse 2 (Roles may be combined based on patient s condition or staff available) a) Complies with personal protective gear protocol b) Prepares room for patient arrival c) Prepares to assist in assessment and interventions of the airway, breathing and circulatory status. 4. Trauma Nurse 3 (Recorder) a) Assumes responsibility for recording b) Ensures trauma flow sheet is utilized c) Assures that all members of the trauma resuscitation team are dressed in protective gowns, gloves, goggles and masks d) Ensures crowd control issues are addressed 5. Respiratory Therapist a) Prepares the following equipment and assists with airway and ventilation 2
ADC ED/Trauma Policy 221 Airway and ventilation (mechanical airways, nasal trumpets, ambu bag and ventilator) Intubation (laryngoscope handle and assorted blades, stylets, lidocaine jelly and cetacaine spray, endotracheal and tracheostomy tubes) Suction (apparatus, canisters, tubing, tonsil suction, 14 and 10 catheters) Oxygen, pulse oximetry monitoring Acquires equipment and draws ABG s as requested and complete stat 6. Radiology Technician a) Prepares necessary films for radiographs b) Has portable x-ray machine at the bedside and ready for use c) Place x-ray plates to optimize portable film quality and patient management d) Has CT ready and available for immediate use. If a patient is getting scanned, the trauma patient takes priority e) Radiologist presence should the physical presence of the radiologist be requested by a member of the trauma team, the response time of the radiologist shall be no greater than 30 minutes. V. Initial Management (Upon arrival of the patient) 1. Pre-hospital providers will transport the patient into Trauma Room as directed and provide a) Name of the patient b) ABC status c) Approximate age d) Time incident occurred e) Mechanism of injury MVC Driver, passenger, pedestrian, unknown Speed, number of vehicles involved, point of vehicle impact - Lab belt, airbag, infant seat - Ejected, rollover, prolonged extraction - Multiple casualties from crash - Where located after collision Motorcycle Collision Driver, passenger, unknown Helmet, protective clothing Number of vehicles, where victim located after crash Gunshot or stab wound Self-inflicted Type of weapon (gunshot wound distance from assailant) Number of bullets fired (if known) Glasgow Coma Scale and Revised Trauma Score Police at scene Environmental circumstances 2. Emergency physician a) Assumes responsibility for the trauma patient b) Performs assessment, procedures and diagnostic tests 3
ADC ED/Trauma Policy 221 c) Communicates information regarding the ANC assessment and interventions to the consulted Surgeon d) Observes team functioning and ensures protocols are implemented properly e) Assists consulted Surgeon with any procedures as requested f) Ensure cervical immobilization until the C-spine is cleared 3. Trauma Nurse I (Team Leader/Nurse assigned to Trauma Room) a) Assumes responsibilities to the left side of the patient b) Performs primary and secondary patient assessments upon arrival of trauma patient c) Establishes intravenous (IV) lines, if not present from pre-hospital treatment and draws blood during IV insertion d) Removes clothing, valuables and gives them to the Trauma Nurse 3 to be listed on ED record and then placed in clothing bag and/or given to family or security e) Assists ED Physician with secondary survey f) Gives medications and administers blood and blood products per physician order g) Assists with the insertion of any central line, on the left side of the patient h) Assists with left chest tube insertion i) Assists with sonography as appropriate j) Ongoing physical assessment after primary and secondary assessments completed by the physician k) Informs recording nurse of all procedures performed l) Serves as center for all communication m) Serves as patient advocate and relays information to the charge nurse n) Ensures family is updated on condition o) Notifies receiving team of patient s resuscitation and status (OR, ICU, general unit or transfer facility) 4. Trauma Nurse 2 a) Assumes responsibility to the right side of the patient b) Assists Trauma Nurse 1 with primary assessment c) Establishes intravenous lines, if not established prior to patient arrival and draws blood during IV insertion d) Connects patient to the cardiac monitor, respirations, ventilation, heart rate, perfusion and blood pressure every 5 minutes until condition stabilizes then every 15 minutes. Takes temperature e) Assists with any central line on the right side of the patient f) Inserts nasogastric tube g) Inserts foley catheter h) Assists with right chest tube insertion i) Ensures fracture stabilization and wound care on right side of patient j) Informs recording nurse (Trauma Nurse 3) of all procedures performed 5. Trauma Nurse 3 (Recorder) a) Record time of arrival and receives/records EMS report b) Signs EMS patient information sheet c) Documents status of ABD s and interventions d) Records all vital signs, Glasgow Coma Scales, Revised Trauma Scores, orders, lab results, medications, procedure, etc. on the trauma flow sheet and completed the Trauma Flow Sheet e) Communicates tot the Radiology Department and Operating Room as decisions are made regarding diagnostic testing and operative status 4
ADC ED/Trauma Policy 221 f) Remains with the patient till Trauma Nurse 1 (leader) is able to take over recording process after the patient has been stabilized, or until patient is transferred, goes to OR/ICU g) Responsible for witness signature of all necessary permits for diagnostic and operative procedures h) Communicates all necessary information to consultants, Emergency Department Charge Nurse and ancillary personnel as requested ***Trauma Nurse 2 and Trauma Nurse 3 will drop out of the Trauma Room after initial assessment/resuscitation procedures or as the patient improves or as requested by Trauma Nurse 1 (Leader) 6. Charge Nurse a) Responsible for assisting the Trauma Nurse 1 with communications as noted above b) Assures that Pastoral Care has been notified (if available) c) Ensures family notification and communication is appropriate 7. Phlebotomist a) Receives blood from the resuscitation nurses and labels the appropriate blood tubes b) Places identification band on patient s wrist if patient is not yet registered c) Draws blood or collects blood vials if IV lines were established prior to the patient s arrival. Including but not limited to: PT PTT Type and Cross Blood Cultures Chemistries CHC Bedside Finger Stick Glucose d) Sends blood to lab and completes stat e) Assists physician with femoral stick procedure and places blood in appropriate blood tubes f) Implements massive transfusion policy when requested by physician 8. Radiology Technician a) Brings portable x-ray machine into room or utilizes build in x-ray equipment b) Performs x-ray ordered c) Ensures spinal precautions are maintained as appropriate 1. ED Tech a) Assist Charge Nurse and Ancillary Personnel as requested b) Responsible for all documentation and security of all valuables and personal items 2. EKG Technician a) Obtains 12-lead EKG when directed 3. UTMB Police a) Assists with visitor control b) Address hostile behavior and security needs as appropriate 5
ADC ED/Trauma Policy 221 VI. VII. Additional References Dates Approved or Amended Include origination date, dates of major or minor revisions and dates reviewed without changes. Originated: Reviewed with Changes Reviewed without Changes 1/2016 VIII. Contact Information Andrea Anderson, RN Trauma Coordinator at Angleton Danbury Campus, ext.2524. 6