Purpose:
To meet 4.15 from “Resources for the Optimal Care of the Injured Patient, 2022 Standards” by the American College of Surgeons Committee on Trauma Verification Review Committee. CD 4.15 states “Level I and II trauma centers must have the necessary human and physical resources continuously available so that an endovascular or interventional radiology procedure for hemorrhage control can begin within 60 minutes of request.”
Criteria:
The 60-minute requirement should be considered for the following patients undergoing hemorrhage control:
All trauma patients who require interventional angiography within the first 24 hours of arrival and have active extravasation from the abdomen, pelvis, chest or proximal extremity AND exhibit one or more of the following:
Shock (eg: SBP <90, tachycardia, persistent lactic acidemia)
Require blood products within the first 4 hours of admission
Intraoperative consult for acute traumatic hemorrhage
STAT IR Process:
TS Attending/Fellow/Chief/Junior/Critical Care APP calls IR APP to convey criteria are met and provides a direct call back number for communication
o 7A-5P: In house (859 330-1729)
o 5P-7A: IR on call APP/Resident (859 330-1729)àV1 on call IR Attending (In lightning bolt, UKMD can connect directly)
IR Attending calls TS for discussion
TS conveys to the IR Attending that criteria are met for STAT Trauma IR intervention
(provides MRN and patient location)
IR Attending/TS discuss findings – Consensus (emergent vs urgent) is achieved
If case is deemed urgent and not emergent document classification accordingly and do not proceed with ‘Taxi and Hold’ STAT IR Process
TS writes note documenting consensus and IR team call-in if EMERGENT
IR Attending to initiate call-in process for IR staffing
TS assigns Resuscitationist (Trauma Junior and/or Critical Care APP) who:
Activates MTP (calls blood bank 3-5401 and enters order)
Notifies the Trauma DCN (562-6811)
Consultant Starts Epic Emergent group chat (Trauma DCN, Trauma and IR Attendings, Candice Reynolds, Resuscitationist)
Trauma DCN will assign ICU RN to the patient
Immediate transport to IR room 29/30 (“TAXI AND HOLD”)
Anesthesia services may be utilized in STAT Trauma IR cases at the discretion of the IR or Trauma Attending. If Anesthesia services are being utilized, the IR Attending or TS Point Person will call the OR front desk to speak directly with the Anesthesia Board Runner.
TS Resuscitationist accompanies patient to the IR suite and all team members assist to transport the patient onto the IR table
Quick prep in IR with expedited case start similar to stroke cases
Additional Notes:
Given the stat nature of the procedure, cases that qualify for STAT Trauma IR consult based on the criteria above are considered life threatening with implied consent as per KRS 304.40-320
Room 9 will be the designated IR suite
If Anesthesia will be providing critical care support in the IR suite the anesthesia cart will be prepped and available for use at all times in the IR suite, confirmed ready by the Anesthesia Safari Tech
Times will be documented for the following and tracked through the PIPS process:
Time of IR Consult
Consensus time
Patient arrival time in IR suite
Puncture time – Needle
Revised 4.13.26
