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Sat Apr 7 19:33:03 BST 2007

I would suggest you not add mechanism as a major reason for activation

Mo

>From: johan.malmgren at vgregion.se
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: trauma-list at trauma.org
>Subject: Help with improving our trauma criteria
>Date: Thu, 5 Apr 2007 09:34:08 +0200
>
>Hi, I know these issues are discussed from time to time here.We're one of 
>the two major trauma-centres in Sweden, meaning about 1000 annual 
>alerts, of which some 80% blunt. The problem is with undertriage, and we're 
>remaking the algorithm, and I would appreciate some advice and inputs from 
>the list!   As of now, we have two levels, red and orange. The red ones 
>basiclly includes all possible staffmembers (2 surgeons, 2 
>anesthesiologists + 1 anesth nurse (compared to a RN), 1 orthopedic, 
>radiology and a lot of ER nurses.), so we're almost too crowded here.  The 
>orange is the interesting one. It includes a junior to senior surgeon 
>depending on time of day and pure luck, and a couple of ER-nurses. No 
>anesthesia, no traumasurgeon, no ortho, no radiology. The traumasurgeon and 
>Critical Care/Anesth guy on call are notified by phone but doesn't have to 
>attend the alert.  Our criterias for red alert are Vitals: SpO2 < 90% on 
>room air Compromised airway Resp freq > 25 Pulse > 120 BP < 90 RLS > 3 
>(would be comparable to GCS under about 10-11) Neurology   and/or Injuries: 
>Penetrating injury head/neck/torsoFractures in at least 2 long 
>bonesUnstable pelvisAmputation above hand/footBurn > 18% or 
>inhalationDrowning/hypothermiaFlail chestSpinal Cord Injury with 
>neurology. Now, what happens is that a considerable proportion of the 
>orange alerts ends up in ICU or even in acute surgery, which I would 
>consider an indicator of a undertriage-system. The criterias for orange 
>alerts are, and remember that these alerts basically brings no senior 
>competence at all to the ER: "If red alerts criteria are not by any mean 
>fulfilled, but the MoI was either of the following:MVA with either >50km/h 
>without seatbelt/airbag, or >70km/h with bealt or airbag.Pt had to be 
>extricated or vehicle has been tumblingMoped/motorcycle accident 
> >30km/hThrown out of vehicleOther person dead in same vehiclePedestrian or 
>bicyclist hit by motor vehicleFall from above 3meters" I'm thinking that 
>the problem might be with not having any mechanism per se as a criteria for 
>red alerts. Any input at all would be much appreciated! Also, if anyone of 
>You have their criteria easy at hand, I'd appreciate an off-list email with 
>them attached! /Johan MalmgrenMD, Dep of Traumatology, Critical Care & 
>AnesthesiologySahlgrenska University Hospital, Sweden 

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