Trauma Activation Criteria

 Trauma Alert Red-Mandatory

Any one of the following:

1. Confirmed SBP<90 at any time
2. Gunshot wounds to the neck, chest or abdomen or extremities proximal to the elbow/knee
3. GCS <9 at any time with mechanism attributed to trauma, not related to sedation.  Excludes patients with brief LOC now at baseline
4. Intubated patients transferred directly from scene
5. Pulseless extremity
6. Tourniquet use to control bleeding
7. Patients with respiratory compromise or obstruction or are in need of an emergent airway
8. Includes intubated patients who are transferred from another facility with ongoing respiratory compromise Does not include intubated patients from referring facility who are stable from a respiratory standpoint
9. Transfer trauma patients receiving blood to maintain vital signs
10. All Trauma Codes
11. Emergency Medicine Attending discretion

Response/Resources activated for TA Red:

Trauma Surgery Attending

Trauma Surgery Chief Resident

Anesthesiology Attending

Emergency Medicine Resident

ED Nurses

ED Technician

ED Paramedics

Radiology Technologist

CT Scan Technologist

Respiratory Therapist

Blood bank Refrigerator

Operating Room Charge Nurse notified

Operating Room made available

Chaplain

2. Trauma Alert Criteria

Any one of the following:

·       Any intubated trauma patient

·       Respiratory Rate <10 or > 30

·       GCS < 12

·       Penetrating head trauma

·       Stab wounds to neck, chest, back, abdomen or pelvis

·       Known Spinal Cord Injury

·       Pregnant trauma patient > 23 weeks

·       Age > 65 with significant chest, abdomen, pelvic or extremity injuries

·       Known anticoagulant use, with GCS < 15

·       2 or more proximal extremity fractures, ANY open PROXIMAL fractures and/or any pelvic fractures

·       Amputation above ankle or wrist

·       All intubated Burn Patients

·       20% BSA with 2nd or 3rd degree burns

·       Suspected Inhalation injury: enclosed house fire, elevated CO2, singed facial/nasal hairs.

·       All High Voltage Electrical Injuries. Voltage > 220 amp

·       Emergency Medicine Attending discretion

Response/Resources activated for TA:

Emergency Medicine Attending

Trauma Surgery Chief Resident

Emergency Medicine Resident

OB Chief Resident *if applicable

ED Nurses

ED Technicians

ED Paramedics

Radiology Technologist

Respiratory Therapist

CT Scan Technologist

Blood Bank Refrigerator

Chaplain

4. Downgrading and Cancelling

Trauma activations are intended to bring valuable human and material resources to the injured patient and over-triage is encouraged. Trauma activations are, therefore, costly. Consider downgrading or cancelling an activation in the following circumstances. Such downgrades should only be made after ATLS assessment and screening imaging (if necessary). Downgrades and cancellations are at the discretion of the attending, fellow or senior resident from GS or EM:

1. Downgrading:

i.                High voltage injuries that are stable upon arrival

ii.                Patients with an initial SBP < 90 who have not had an additional SBP <90

iii.                Attending discretion

2. Cancelling:

i.                Suspected inhalation burns that arrive with no sign of physical burns, < 20%, or no evidence of inhalation

ii.                Patients found on ATLS assessment to have issues that are not related to trauma (i.e. patient became syncopal and fell related to a ruptured AAA and has no injuries related to the fall)

iii.                Anticipated discharge

iv.                Attending discretion

v.                Pts alerted on potential criteria or mechanism that arrive stable and after ATLS assessment appear minimally injured

vi.                Penetrating injuries that are superficial

Updated March 24, 2023