trauma activation and stratification

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WE are a Level II Trauma Center, but function as a Level I (We are a
community hospital and our board certified critical care/general trauma
surgeons and OR team are in-house 24/7). 
The trauma alerts and the level of trauma severity (stratification) is
called by our EMS in the field. They make the determination of priority
(1, 2, or 3; 1 being the most acutely injured [usually CPR imminent or
in progress], 2 being unstable VS, severe penetrating injury, etc, and 3
being the most common encode priority). Of course we occasionally get
"drive-up's" in which case the ED staff calls the trauma alert.
Our entire trauma resuscitation team responds to the resuscitation area
for any and all trauma alerts. The trauma alert page to the in-house
trauma resuscitation team is activated ~ 5 minutes prior to the arrival
of the patient. 
Our med-com is in our ED, and when the field EMS notifies our ED via
med-com that a trauma alert is incoming, the ED staff takes the initial
information and, in turn, notifies the trauma resuscitation nurse(s),
who immediately report to the ED/resus room to prepare for the patient's
arrival. The resus nurses, in turn, notify the switchboard to page out
the "trauma alert", by digital/audio beepers to all resuscitation team
members and also overhead. The page identifies only the number of
patients arriving, whether they are pediatric or adult patients
(different team members respond to pediatric trauma alerts) and whether
the patient(s) are arriving by ground or air (security has to block
traffic for air arrivals). There is no indication of the severity
(stratification) of the trauma alert paged out, since all team members
respond to all paged trauma alerts, regardless of severity.
Hope this makes sense. I didn't realize how confused it sounds until I
started typing it, but it works very well for us. We are a 476-bed
community hospital and we see approximately 1200 - 1400 trauma alerts
per year. Additionally, we are a regional trauma referral center and a
regional pediatric trauma referral center, and we receive approximately
300 - 500 transfers per year. When these patients arrive, they are
greeted by the trauma resuscitation nurses who in turn notify the
in-house trauma surgeon who comes down and assesses the patient. The
transfers usually do not require/receive full trauma resuscitation team
activation.  



ROBIN STORY POWERS, RNC, BSN
Nsg. Care Coordinator - Trauma Education
St. Mary's Medical Center
901 45th Street
West Palm Beach, FL 33407
phone-(561)882-6355
fax-(561)881-0945
robin.powers at tenethealth.com
 
The information in this communication is confidential and is directed
only to those intended recipients.  Please do not forward this
communication without my permission.  If you have received this
communication in error, please notify me immediately and delete/destroy
this communication.

-----Original Message-----
From: John Stryker RN MS CNS [mailto:stryker.rn at myfastmail.com] 
Sent: Monday, October 02, 2006 6:24 PM
To: Trauma &amp Critical Care mailing list
Subject: trauma activation and stratification


I wanted to know what other trauma centers do when they get
radio/tele/phone calls for trauma and they take first report.



I have worked in one hospital where the nurse taking report from the
paramedics would classify the trauma based on criteria of badness, and
then it would be activated and paged out.  We had three levels, the
first based purely on mechanism (MVC with rollover, Ped vs. auto, GSW to
extremity), the second was mechanism and/or worrisome vital signs (GSW
to chest, Fall > than 20 feet, HR > 100, GCS < 13 etc.), and the third
was very bad vitals (BP < 90, GCS < 8, HR > 120).



I now work in a hospital which does not stratify the traumas and the
trauma surgeons want a detailed report passed on to them.  Does anyone
else do it this way, or do your nurses stratify and then activate based
on criteria, before trauma hears about it?  Does anyone else have
experience with it both ways, or worked to change from one to the other
and what was your experience?



Thanks,

John Stryker
-- 
  John Stryker
  please reply to:
  nursestryker at yahoo.com
  

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