Trauma Activation

 

EMS providers shall assess each adult and pediatric trauma patient using the following criteria upon contact.

 

  • Once a level 1 trauma alert patient is identified in the field through assessment, a crew member must contact GMH via recorded line as soon as practical and provide a full report.
  • The words “Trauma Alert” must be included in the report.
  • All patients meeting the criteria listed below shall be transported to Greenville Memorial Hospital (Level 1 Trauma Center).
  • If patient refuses transport to GMH and is deemed a “Trauma Alert” by the EMS professional, a refusal must be signed for alternate transport destination after explaining the risk of “life and limb” to the patient.

 

Upon arrival in the Trauma bay EMS personnel will give a brief report to the trauma team by using the “M.I.S.T.” report.

 

  • Age and Sex
  • GCS (3-15)
  • Mechanism of Injury:
    • Blunt
    • Penetrating
    • Burn
    • Entrapment duration (PRN)
  • Injuries Sustained (Airway):
    • Patent
    • Compromised
    • Secured (Open, ETT, King)
    • does anesthesia need to come immediately
    • injuries identified or suspected
  • Hemodynamics:
    • Stable
    • Unstable
    • Does a surgeon need to scrub out of a case and come down immediately
    • The receiving medic may request a systolic blood pressure, but trauma services agreed to utilizing the term “stable or unstable hemodynamics
  • ETA

 

Trauma Criteria Level 1:

 

A Level 1 (Full) Alert should be activated on any patient meeting one or more of the following criteria:

 

  • Glasgow coma score (GCS) ≤ 11
  • Injury with associated Tachycardia and poor perfusion
  • Systolic BP < 90 or for PEDS ≤ 70 + 2x (age in years
  • Respiratory rate <10 or >29 or when the patient is in respiratory distress, has had a pleural decompression or is intubated.
  • Penetrating injury /wound to head, neck, torso, or extremities proximal to the elbow or knee
  • Paralysis related to trauma
  • Crushed, de-gloving, mangled, or pulseless extremity proximal to the elbow & knee
  • Thermal injuries including 2nd or 3rd degree burns ≥ 20% TBSA
  • Electrocution with high voltage: ≥ 220 volts or > than household current
  • Transferred patients receiving blood products related to trauma
  • Active bleeding requiring a tourniquet or uncontrolled hemorrhage if injury is proximal to the elbow and/or knee.
  • Discretion of any trauma team member

 

High Index of Suspicion / Factors to Consider (For activation or upgrade in activation)

 

  • Age > 55 years with significant mechanism of injury
  • Extrication time > 20 minutes
  • Cardiac or respiratory disease
  • Insulin dependent diabetes
  • Cirrhosis
  • Morbid obesity
  • Pregnancy
  • Immunosuppressed patients
  • Patient with bleeding disorder
  • Patients on anticoagulants

 

MIST REPORT