Basildon EM Handbook 2018

Major trauma team

March 2018 | by EMauthor

Activation of any medical alert pager should not be taken lightly. After a trauma-call activation, the hospital trauma team should attend promptly. This consists of the following:

•A senior emergency physician who will act as team leader (should be present prior to team's arrival)

•A dedicated ED nurse (should be present prior to team's arrival)

•An airway/C-spine physician (will attend from CCU)

•A senior surgeon who will perform the primary survey

•A senior orthopaedic surgeon who will examine the spine

•A junior surgeon who will normally act as scribe

Housekeeping

•It is best practice that the clinician who activates the trauma team is the attending clinician for the trauma team (leader)

•Trauma team leader should be a senior emergency physician with a minimum of ATLS or equivalent and leadership experience

•After activation of trauma alert, assist with preparation in the resuscitation room (do not wait for the team to arrive first)

•Handover from the pre-hospital team should be a single handover after the entire team is present. Treat the pre-hospital team with utmost professional courtesy.

Common issues

•Delays with the team arriving: specialties should be fast-bleeped if late arrival is an issue.

•The airway / CCU physician must remain to provide MILS while the patient is log-rolled where applicable

•The EM doctor must accompany the patient to CT for MILS where applicable

•Imaging requirements are a team decision. The relevant team must review the appropriate imaging (i.e. orthopaedic or surgical) and arrange admission where applicable.  

•As the team leader do not forget to document in the pro-forma!

Referral to MTC

A trauma patient may require referral and transfer to the Major Trauma Centre (Barts Health NHS Trust: Royal London Hospital) or neuro centre (Queen's Hospital, Romford). Referral details are in the resuscitation room wall. Consultant to consultant referrals are preferred where practical but the teams are very approachable. Examples for referral include;

•Penetrating Injuries to head, neck, torso and extremities proximal to elbow or knee

•Chest wall Instability or deformity (e.g., flail chest)

•Two or more proximal longbone fractures

•Open fractures Gustilo classification > 2

•Crushed/ de-gloved/ mangled or pulseless extremity

•Amputation proximal to wrist or ankle

•Pelvic fractures

•Open or depressed skull fracture

•Paralysis (Consider Queens)

•Life-saving treatment such as damage control surgery not available in BTUH < 30 mins

•Polytrauma making local management impractical.

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