trauma activation and stratification

[Juan Duchesne]

I definitively agree with K, here in MS we are trying to modify the
activation system where trauma surgery gets involved earlier for every
single EMS call from the scene.....but this is going to take a lot of
coordination and time in order to change the mentality around here among
our ED guys............ I will like to ask the senior members of this
e-mail list thoughts in regards to ATLS certification for activation MD
members in a level I trauma center.  I just found out that some of our
ED physicians and residents are not ATLS certified and are very
reluctant in getting the certification, their argument is that by having
an ED certification ATLS is just a waste of time.....???........ I
almost VOMIT when I heard that.......what is the consensus in regards to
ACS-COT verification for Level I status. Do you need to be ATLS
certified to be involved in trauma activations at a level I trauma
Center or even the kitchen cook can do ABC's in a level I trauma
center???
juan

Juan C Duchesne, M.D.
University of Mississippi Medical Center
Assistant Professor of Surgery/Trauma and Critical Care
2500 North State Street
Jackson MS 39216

>>> japrak at gmail.com 10/03/06 10:50 AM >>>
could you be kind to say who exacly is a part of your hospital's
trauma
team, besides nurses?what is then role of emergency medicine
phyicians,
becouse it is after all their department. l'm not saying that
incapable
staff should treat the patient, but just that EM docs should be engaged
in
treatment, and even play very significant role in hole process, at
least
while the patient is on their department. not all trauma patients are
just trauma patients,and they might be having a coronary artery
disease,
whose acute onset caused trauma in the first place. and also airway
managment and other non-surgical measures that politraumatized patient
needs.l'm just saying that there's more to treating trauma then just
operating.
ante


2006/10/3, Powers, Robin <Robin.Powers at tenethealth.com>:
>
> WE are a Level II Trauma Center, but function as a Level I (We are a
> community hospital and our board certified critical care/general
trauma
> surgeons and OR team are in-house 24/7).
> The trauma alerts and the level of trauma severity (stratification)
is
> called by our EMS in the field. They make the determination of
priority
> (1, 2, or 3; 1 being the most acutely injured [usually CPR imminent
or
> in progress], 2 being unstable VS, severe penetrating injury, etc,
and 3
> being the most common encode priority). Of course we occasionally
get
> "drive-up's" in which case the ED staff calls the trauma alert.
> Our entire trauma resuscitation team responds to the resuscitation
area
> for any and all trauma alerts. The trauma alert page to the in-house
> trauma resuscitation team is activated ~ 5 minutes prior to the
arrival
> of the patient.
> Our med-com is in our ED, and when the field EMS notifies our ED via
> med-com that a trauma alert is incoming, the ED staff takes the
initial
> information and, in turn, notifies the trauma resuscitation
nurse(s),
> who immediately report to the ED/resus room to prepare for the
patient's
> arrival. The resus nurses, in turn, notify the switchboard to page
out
> the "trauma alert", by digital/audio beepers to all resuscitation
team
> members and also overhead. The page identifies only the number of
> patients arriving, whether they are pediatric or adult patients
> (different team members respond to pediatric trauma alerts) and
whether
> the patient(s) are arriving by ground or air (security has to block
> traffic for air arrivals). There is no indication of the severity
> (stratification) of the trauma alert paged out, since all team
members
> respond to all paged trauma alerts, regardless of severity.
> Hope this makes sense. I didn't realize how confused it sounds until
I
> started typing it, but it works very well for us. We are a 476-bed
> community hospital and we see approximately 1200 - 1400 trauma
alerts
> per year. Additionally, we are a regional trauma referral center and
a
> regional pediatric trauma referral center, and we receive
approximately
> 300 - 500 transfers per year. When these patients arrive, they are
> greeted by the trauma resuscitation nurses who in turn notify the
> in-house trauma surgeon who comes down and assesses the patient. The
> transfers usually do not require/receive full trauma resuscitation
team
> activation.
>
>
>
> ROBIN STORY POWERS, RNC, BSN
> Nsg. Care Coordinator - Trauma Education
> St. Mary's Medical Center
> 901 45th Street
> West Palm Beach, FL 33407
> phone-(561)882-6355
> fax-(561)881-0945
> robin.powers at tenethealth.com 
>
> The information in this communication is confidential and is
directed
> only to those intended recipients.  Please do not forward this
> communication without my permission.  If you have received this
> communication in error, please notify me immediately and
delete/destroy
> this communication.
>
> -----Original Message-----
> From: John Stryker RN MS CNS [mailto:stryker.rn at myfastmail.com] 
> Sent: Monday, October 02, 2006 6:24 PM
> To: Trauma &amp Critical Care mailing list
> Subject: trauma activation and stratification
>
>
> I wanted to know what other trauma centers do when they get
> radio/tele/phone calls for trauma and they take first report.
>
>
>
> I have worked in one hospital where the nurse taking report from the
> paramedics would classify the trauma based on criteria of badness,
and
> then it would be activated and paged out.  We had three levels, the
> first based purely on mechanism (MVC with rollover, Ped vs. auto, GSW
to
> extremity), the second was mechanism and/or worrisome vital signs
(GSW
> to chest, Fall > than 20 feet, HR > 100, GCS < 13 etc.), and the
third
> was very bad vitals (BP < 90, GCS < 8, HR > 120).
>
>
>
> I now work in a hospital which does not stratify the traumas and the
> trauma surgeons want a detailed report passed on to them.  Does
anyone
> else do it this way, or do your nurses stratify and then activate
based
> on criteria, before trauma hears about it?  Does anyone else have
> experience with it both ways, or worked to change from one to the
other
> and what was your experience?
>
>
>
> Thanks,
>
> John Stryker
> --
> John Stryker
> please reply to:
> nursestryker at yahoo.com 
>
>
>
>
>
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