UK Healthcare
Adult and Pediatric Multi-Trauma Casualty Plan
The
details delineated in this document provide guidance for the initial response
of the trauma team in a multiple casualty situation.
Activation:
There are 2 Activation types: 1) Multi-Trauma 2)
Code Yellow
The Trauma Attending or Pediatric
Surgery Attending (rounder during day and call person at
night) may activate Multi-Trauma Response per the Event Report
given by the ED Charge Nurse or the ED Attending. The Trauma Attending or Pediatric Surgery
Attending may delegate a surrogate to activate Multi-Trauma Standby as
well.
Upon patient arrival or Event Report confirmation,
the Trauma Attending or Pediatric Surgery Attending and the ED Attending
together will 1) Deactivate Standby or 2) Initiate Multi-Trauma or 3) Initiate
Code Yellow. See Diagram. Since Multi-Trauma Response is not a Code
Yellow, it does not activate the Hospital Incident Command System (see Code Yellow policy # A12-055 for more
details).
Consider multi-trauma activation with 5-6 Adult or 3-4
Pediatric Trauma Alert Reds or more within an hour or at the discretion of
the Trauma Attending or Pediatric Surgery Attending based on the Event Report
and Resource Assessment. The ED
Attending and/or HOA may consider elevating or activating Code Yellow based on
the likelihood of a larger casualty load or when ≥ 3 trauma surgeons (or ≥ 2
pediatric surgeons) are required to respond.
The ED Clerk will page:
“Multi-Trauma Alert” or “Multi-Trauma Alert Standby” to both the adult
and pediatric trauma pagers. Code Yellow
is a hospital-wide overhead page.
Awareness:
The Trauma Attending (or surrogate) or Pediatric
Surgery Attending (rounder
during day and call person at night) will notify the following of
Multi-Trauma Standby and relay the Event Report:
Backup
Trauma Surgeon
Pediatric Surgery Attending (rounder during day and call person at night)
The ED Charge Nurse PCA (or surrogate) will ensure
notification of the following:
OR Front Desk (323-5631)
HOA (797-9219) or digital pager
(330-6855)
ICU Charge Nurse (218-8100 or 218-8200)
The Pediatric Surgeon is notified by the trauma pager of the
multi-trauma/code yellow.
The PICU Team Leader (notified by the trauma pager
alert) will notify the following of the Multi-Trauma Activation:
PICU Attending
Pediatric
DCN
The OR Front Desk will notify the following of
Multi-Trauma Standby, Activation, or Code Yellow:
1.
Anesthesia Attending on Call (AOC)—who will
notify the following:
a.
Anesthesia Chandler OR Director
b.
Anesthesia Chairman
2.
OR Medical Director
3.
Perioperative Enterprise Administrator
Preparation:
Multi-Trauma Standby:
<Emergency Department>
The Charge Nurse will coordinate with the HOA for bed
assignments for patients needing admission.
The ED Attending will evaluate patients for discharge. Patients in the ED Trauma Bays will be facilitated
first and further movement will be defined by the Event Report and Resource
Needs.
<Operating Room>
The OR will assess Resources: OR Space and Staff. The OR will HOLD Selected Scheduled Preop
Patients from entering the OR if able until further determination of the Alert
<Trauma/Surgical Adult 7th
Floor Intensive Care Unit>
Trauma/Surgical ICU Charge Nurse presents the HOA with a
list of patients for discharge home/transfer to another ICU/downgrade to the
floor or progressive. This Triage List
should be generated with physician input at the beginning of each shift and
adjusted as needed.
<Trauma
ICU and Ward Provider Teams>
Bed
capacity on trauma ward and ICU will be needed for any mass casualty response,
particularly in a Code Yellow response. On-duty providers, especially APP's,
should report to 00.123 for staging the immediate response. Providers should
rapidly assess the ward and ICU census for potential discharge and begin
working with patients, families, nursing and case managers to facilitate any
possible discharges and create bed capacity. APP's should be prepared to be
deployed to perform initial clinical assessment and care (in ED), ICU care (in
PACU), preop care (in holding) or continued inpatient care (ED observation or
inpatient units.
<PICU>
The Pediatric DCN with the HOA will evaluate the list of
patients for discharge home or transfer within the pediatric hospital by
downgrade.
Multi-Trauma Activation or Code Yellow:
Back-up Personnel Notification:
The Blue Surgery Backup system will be utilized for a
Multi-Trauma Alert. During the day,
trauma surgeon responders: 1. Trauma Floor
Surgeon, 2. EGS ICU Surgeon, 3. Other Backup Surgeons. During the night, trauma surgeon responders: 1. Blue Night Surgeon, 2. Trauma Day Floor
Surgeon, 3. EGS ICU Surgeon. For event
notification, we will use the UK alert system with rosters tailored to the
level of response needed (faculty only, faculty + residents, faculty +
residents + APP’s).
During the day, the Pediatric
Surgery rounding attending will be the first responder followed by the add-on
PDS surgeon, followed by blue surgery back-up.
At night, the Pediatric Surgery on-call attending will be the
first responder, followed by blue surgery back-up.
The ED will utilize the ED personnel call tree (including
techs, nurses, and physicians) as needed and contact security to notify of the
event (3-6152).
The OR Front Desk and Anesthesia will utilize their
Personnel Call Tree as needed.
The Blue ICU Charge Nurse will activate the ICU personnel
call tree and setup another ICU if necessary in the PACU staffed with current
ICU nurses after reassigning patient ratios.
Responding ICU nurses may then staff the PACU ICU and stay for the
length of a regular shift or until relieved by another nurse.
Personnel Response:
Trauma surgeons can park behind security and should notify
security on arrival. Additional surgical
support should report to A.00.123.
Security should only allow ED staff and trauma surgeons into the Adult Trauma
Bay unless otherwise authorized. A PRA
and/or Radio will assist in communicating responding surgical resources to the
ED Controller for allocation. All
responding personnel should report directly to their patient care areas as
directed by their supervisors and avoid the ED Trauma Bays.
Triage:
Please see ED Policy #ED 12-02 for details. Triage should occur outside the ED preferably
in the Direct Admit Ambulance Bay by the SORT nurse and ED chief resident or
attending. The triage process will
also determine whether decontamination should occur. If so, this would occur prior to entry into
the ED and the SORT team will manage through their normal process.
Initial Assessment Location and Responding Physician Service:
Red Patient—ED
Adult or Pediatric Trauma Bays—Trauma Surgery Services
Yellow Patients—ED Trauma Bays—ED Services.
Green patients—Hold in ED Lobby
until after Red/Yellow disposition complete, then ED Services to evaluate in
the following areas.
Adult Trauma—ED
Main Treatment Rooms
Adult Psych—ED
Behavioral Safe Rooms
Pregnant
Females—Obstetric: Labor and Delivery
Pediatric—Pediatric ER including Results Pending ED Room
Expectant Black—ED Treatment Rooms
(40s/50s)—Trauma Surgery Services to evaluate after Red disposition complete
Black: Morgue
Disposition Areas:
Needs OR: Preop Holding or PACU if not OR directly
Needs ICU: 7th Floor ICU/PICU or PACU
Needs
Floor/Progressive: ED OBS
Patient Tracking:
Standard patient registration with
Greek names will occur. Once the first
round of greek names is exhausted, we will add numbers to the name (Alpha
2). Internal movement will be tracked
using markers on the trauma bay work area window. The event will be recorded by paper charting
and scanned into the record post-hoc. We
will utilize the paper Trauma H&Ps in the trauma bay for the medical
charting which will travel with the patient.
Orthopaedic surgery trauma mass casualty response:
1.
Critical personnel include the
orthopaedic surgery attending on call, the chief resident, and the junior
resident. UK is
one of the busiest fracture centers in the nation, and thus maintains a high
degree of day-to-day preparedness for fracture care. Fracture stabilization and
surgical care are available 24/7 with three OR’s dedicated every day Monday
through Friday.
2.
The orthopaedic trauma team is usually
stationed in the trauma suite charting area. They can be immediately contacted
by use of the orthopaedic surgery consult pager. Additional orthopedic surgical resources in
the form of faculty and residents, can easily be summoned through a call tree employing
the orthopedic chief residents and orthopedic trauma faculty.
3.
Initial triage is performed by the
orthopaedic surgery junior resident and/or the orthopaedic surgery chief
resident. The
established mass casualty incident trauma plan would be used, including ambulance
bay triage by an emergency physician. Priorities are examination, timely administration
of antimicrobial therapy for open fractures, splinting, timely wash out of open
wounds and then prioritization based upon severity. The emergency department
physicians in conjunction with the orthopedic trauma service manage a large
volume of fractured patients at baseline so readiness is maintained.
4.
Coordination of secondary procedures is
done through daily checkout rounds held at 0630 in person and via zoom.
Code Yellow Response Only:
Overflow Treatment Areas:
Red/Yellow: Critical Care Bays then Preop holding area.
Green: Wait in Pav A Lobby (by Registration) for a
larger group
Peds: Results Pending ED Room
Consider APP or Medicine Services to assist in the evaluation
of Green patients or existing ED patients.
Code Yellow Admin Areas
(see Code Yellow policy # A12-055 for
more details)
Hospital
Command Center N102
ED Resource
Center ED
Conference Room (A.00.415)
Inpatient
Discharge Point Pavilion H
Lobby
Family
Center Pavilion
A Auditorium
Media
Center CTW
315
Surgical/ED
Physician Pool A.00.123
Patient Care Roles and Responsibilities
(Multi-Trauma or Code Yellow)
ED Surgical Controller: Initially the On-call Trauma Attending with
Blue Surgery Residents will assess the initial Reds for Disposition. The Trauma Attending or Surrogate will remain
in the ED Trauma Bays until relieved by another Responding Trauma
Attending.
·
Rapidly assess and move patients to the OR, ICU,
Floor, or Admission Holding Area.
·
Ensure minimal diagnostic resources
utilized.
o
Avoid MRI, CT, and Xrays.
o
Ultrasound will be the tool of choice (3-4 in
the ED)
·
Ensure minimal laboratory resources are
utilized.
·
Deny any Backward Flow into the ED
·
Communicate with the OR Controller and ICU
Controller regarding Patient Needs
·
Communicate Resource Needs with the ED Resource
Center
OR Controller:
The OR Director, Trauma Surgeon, or Surrogate who is ideally not
directly involved in patient care. This
may be the Anesthesia Attending On Call.
·
Prioritize Operative Interventions in the
Casualty Staging Area (PreOp)
·
Encourage Damage-Control Surgery Only
·
Communicate with the ICU Controller for Postop
Patient Needs
·
Communicate Resource Needs with the ED Resource
Center
ICU (Trauma/Surgical) Controller: Critical Care Surgeon or Surrogate. May consider the Trauma/Surgical ICU Charge
Nurse or a surrogate.
·
Assess Current ICU patients for
discharge/transfer
·
Assess Resources: Space, Personnel
·
Manage Patients in the ICU and PACU (after the
OR)
·
Communicate Resource Needs to the ED Resource
Center
ED Resource Center Team: The Representatives from the following
departments will report to A.00.415 which will serve as the Resource
Center. The goal of this team is to
assess current resources, receive requests from clinical staff, and distribute
personnel/equipment as needed. This team
will determine when activation of a full enterprise response is indicated. The ED Director will notify the following
services to staff the ED resource center.
Appropriate personnel from the ED resource center would assume their
role within the incident command system as defined per policy.
ED
Director
Trauma/Surgical
Services Nursing Director
HOA
Materials Supervisor (ADD PHONE NUMBERS)
EVS Supervisor
Transport Supervisor or designee
Security
Respiratory Supervisor
OR designee
Family liaison- to be assigned
based on resources available
Security:
Restriction of entry: Security personnel will control points of entry around the ED including the ambulance bay, ED lobby, and trauma bay Pav A doors. Security personnel will allow Trauma Attendings and ED personnel through the doors. Other surgeons or personnel will be directed to report to A.00.123 for further instructions and standby. Further security resources will be distributed based on event needs at the direction of the Security supervisor in the ED Resource Center.
Communication/Radios:
For purposes of direct
communication and in the event of cell phone signal loss, the radios currently
held in the ED will be utilized. Voceras
will be utilized for communication amongst ED personnel and OR personnel if
available. The following groups will
hold a radio provided by the ED:
1. ED
Resource Center
2. ED
Surgical Controller
3. OR Controller
Event Debrief:
Patient Tracking Debrief:
To be held in A.00.123 at the conclusion of the event. The Trauma Attending will notify the ED Clerk
to page a message to the adult and pediatric trauma pagers. For example, “Multi-Trauma Debrief at 0900 in
A.00.123”. The goals are to review the
event patient census including location, injuries, and pending procedures. The Multi-Trauma and Code Yellow debrief for
patient census will be the same process.
Event Process Debrief:
This is especially for a Code Yellow but may include
Multi-Trauma Activation. To be held in
Pavilion A Auditorium a few days after the event and de-escalation. All participants in the event will receive
email or phone communication regarding details of the debrief time and
location. The goals are to review
casualty load, outcomes, event process, and lessons learned.
Drafted 2013 C Talley/A
Bernard/L Fryman. Updated 10/6/14 S Priest. Updated 11/12/23 A Bernard/A Van/C
Reynolds; Revised 9-25-24 by A Bernard/C Reynolds/A Doud
