INDEX

Trauma



Trauma Coverage

Resident Coverage:

  • Trauma Shift, Noon-Midnight

  • Pod 3 Resident, Midnight-Noon

  • Even Days: EM Resident leads trauma resuscitation.

  • Odd Days: EM Resident handles airway/procedures.


Attending Coverage:

  • The Trauma attending is in charge of all trauma resuscitations.

  • Pod 3 attendings respond to traumas but serve mainly as an educational role for the ED trauma resident.


Pod 3 Coverage:

  • When the Pod 3 Resident is needed in the trauma bay, attendings will continue care for any new or existing patients in the pod.


Thursday Mornings (No EM Residents):

  • Trauma residents and attending cover all trauma alerts

  • Anesthesia covers all airways on Thursday mornings

  • ED attendings should be available to assist if needed


Team Positions for Even/Odd Days:

 

Trauma Alert Criteria

Trauma alerts are generally activated in the field by EMS, however these are general guidelines for making a patient a trauma alert on arrival:

  • Burn Alert Criteria

  • SBP less than 90

  • Respirations less than 10 or greater than 29

  • HR greater than 120

  • GCS 12 or less

  • Significant blood loss/shock

  • Level of consciousness: responds only to pain or not at all

  • Flail chest

  • Penetrating injury proximal to knee or elbow

  • Head penetration

  • Amputation

  • Long bone fractures

  • Pelvic fracture

  • Paralyzed limbs

  • Motorcycle/bicycle, thrown at least 10 feet

  • Auto vs Pedestrian, thrown at least 10 feet

  • Ejection

  • Fall greater than 20 feet

 

Downgrades

Trauma alert downgrades must involve a discussion and agreement between the EM and trauma attending/fellow.

 

Trauma-Specific Guidelines

 

Procedure Documentation

All intubations performed by ED residents and supervised by ED attendings should be documented in a procedure note and sent to the ED attending.

  • Use the “ED Procedure Note” template.

  • Importantly, this note contains the proper attending attestations and it defaults to the “Emergency Department” note type, which pushes the note to our coders for billing.

  • Forward to the ED attending as usual and the attending will need to add an attestation for the procedure.

All other procedures performed during trauma resuscitations should be documented and sent to the trauma attending per documentation guidelines of the Trauma department. One exception to this would be if the trauma attending was upstairs and the ED attending was the only attending-level staff present.


KEYWORDS: trauma, trauma alert, trauma alerts, criteria, alert criteria