Implementation of a trauma code
DOI:
https://doi.org/10.51481/amc.v63i3.1069Keywords:
Trauma, code, emergency medical services, clinical protocolsAbstract
Objective: to develop a proposal of a trauma code accessible to the local characteristics of a tertiary general hospital (Hospital Calderón Guardia) based on the best clinical evidence available.
Methods: a literary search was made of national and international scientific papers regarding several aspects about trauma code, it´s implementation, it´s challenges, main benefits, and it´s limitations in 3 main web search portals: Scielo, PubMed and Ovid. We included paper studies in English and Spanish.
Results: Thirty scientific papers from index journals were selected for review and the following data were extracted: Trauma team conformation, trauma team activation criteria, levels for trauma team activation, local experience, and limitations. That information allowed us to identify 2 main beneficial elements: the conformation of the trauma team and the standardization of the specific criteria necessary for its activation. Also, we elaborated a proposal for a viable model in accordance with our resources.
Conclusion: according to scientific review, trauma code implementation in any institution associates a positive impact in clinical patient outcomes through 2 main mechanisms: the conformation of a multidisciplinary trauma team response of severe trauma patients, and the standardization of criteria for activation of the trauma teams. With these findings we elaborated a proposal adjusted to the needs and resources of Hospital Rafael Angel Calderon Guardia.
Downloads
References
Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Informe mundial sobre la violencia y la salud. Rev Inst Med Trop Sao Paulo. 2003;45(3):130-130.
Alvarado E, Velazquez L MK. El Trauma Como Problema De salud publica. Rev Medica Costa Rica y Centroam. 2018;625(3):39-45.
Granström A, Strömmer L, Schandl A, Östlund A. A criteria-directed protocol for in-hospital triage of trauma patients. Eur J Emerg Med. 2018;25(1):25-31.
Cameron M, McDermott KM, Campbell L. The performance of trauma team activation criteria at an Australian regional hospital. Injury [Internet]. 2019;50(1):39-45. https://doi.org/10.1016/j.injury.2018.09.050
Tignanelli CJ, Vander Kolk WE, Mikhail JN, Delano MJ, Hemmila MR. Noncompliance with American College of Surgeons Committee on Trauma recommended criteria for full trauma team activation is associated with undertriage deaths. J Trauma Acute Care Surg. 2018;84(2):287-94.
Harbrecht BG, Franklin GA, Smith JW, Benns M V., Miller KR, Nash NA, et al. Intubated Trauma Patients Do Not Require Full Trauma Team Activation when Effectively Triaged. J Am Coll Surg [Internet]. 2016;222(4):603-11. http://dx.doi.org/10.1016/j.jamcollsurg.2015.12.039
Sava J, Alo K, Velmahos GC, Demetriades D. All patients with truncal gunshot wounds deserve trauma team activation. J Trauma. 2002;52(2):276-9.
Connolly R, Woo MY, Lampron J, Perry JJ. Factors associated with delay in trauma team activation and impact on patient outcomes. Can J Emerg Med. 2018;20(4):606-13.
Vinjevoll OP, Uleberg O, Cole E. Evaluating the ability of a trauma team activation tool to identify severe injury: A multicentre cohort study. Scand J Trauma Resusc Emerg Med. 2018;26(1):1-8.
Dehli T, Uleberg O, Wisborg T. Trauma team activation - common rules, common gain. Acta Anaesthesiol Scand. 2018;62(2):144-6.
Hassan TB, Hickey FG. Trauma team concepts in the UK: tailoring resources to meet demand. J Accid Emerg Med. 1995;12(2):162-3.
Georgiou A, Lockey DJ. The performance and assessment of hospital trauma teams. Scand J Trauma Resusc Emerg Med. 2010;18(1):1-7.
Highley DA. Review of the composition and use of trauma teams within the Trent Region. J Accid Emerg Med. 1994;11(3):183-5.
Gerardo CJ, Glickman SW, Vaslef SN, Chandra A, Pietrobon R, Cairns CB. The rapid impact on mortality rates of a dedicated care team including trauma and emergency physicians at an Academic Medical Center. J Emerg Med [Internet]. 2011;40(5):586-91. http://dx.doi.org/10.1016/j.jemermed.2009.08.056
Maluso P, Hernandez M, Amdur RL, Collins L, Schroeder ME, Sarani B. Trauma team size and task performance in adult trauma resuscitations. J Surg Res [Internet]. 2016;204(1):176-82. http://dx.doi.org/10.1016/j.jss.2016.05.007
Zheng B, Panton ONM, Al-Tayeb TA. Operative length independently affected by surgical team size: Data from 2 Canadian hospitals. Can J Surg. 2012;55(6):371-6.
Rainer TH, Cheung NK, Yeung JHH, Graham CA. Do trauma teams make a difference? A single centre registry study. Resuscitation. 2007;73(3):374-81.
Raley J, Meenakshi R, Dent D, Willis R, Lawson K, Duzinski S. The Role of Communication During Trauma Activations: Investigating the Need for Team and Leader Communication Training. J Surg Educ [Internet]. 2017;74(1):173-9. http://dx.doi.org/10.1016/j.jsurg.2016.06.001
Cherry RA, King TS, Carney DE, Bryant P, Cooney RN. Trauma team activation and the impact on mortality. J Trauma - Inj Infect Crit Care. 2007;63(2):326-30.
Helling TS, Nelson PM, Shook JW, Lainhart K, Kintigh D. The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients. J Trauma. 2003;55(1):20-5.
Ahmed JM, Tallon JM, Petrie DA. Trauma Management Outcomes Associated With Nonsurgeon Versus Surgeon Trauma Team Leaders. Ann Emerg Med. 2007;50(1):7-13.
&NA; Resources for Optimal Care of the Injured Patient. Vol. 7, Journal of Trauma Nursing. 2000. 56 p.
Kuo SC, Kuo PJ, Hsu SY, et al. The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system. BMJ Open. 2016;6(6):e011072.
Helling TS, Nelson PM, Shook JW, Lainhart K, Kintigh D, Highley DA, et al. Trauma team size and task performance in adult trauma resuscitations. Scand J Trauma Resusc Emerg Med [Internet]. 2018;55(1):25-31. https://doi.org/10.1016/j.injury.2018.09.050
Wuthisuthimethawee P. Trauma team activation criteria in managing trauma patients at an emergency room in Thailand. Eur J Trauma Emerg Surg. 2017;43(1):53-7.
Dehli T, Monsen SA, Fredriksen K, Bartnes K. Evaluation of a trauma team activation protocol revision: A prospective cohort study. Scand J Trauma Resusc Emerg Med [Internet]. 2016;24(1):1-7. http://dx.doi.org/10.1186/s13049-016-0295-3
Dehli T, Fredriksen K, Osbakk SA, Bartnes K. Evaluation of a university hospital trauma team activation protocol. Scand J Trauma Resusc Emerg Med. 2011;19:1-7.
Tsuei BJ. Assessment of the pregnant trauma patient. Injury. 2006;37(5):367-73.
Van Laarhoven JJEM, Lansink KWW, Van Heijl M, Lichtveld RA, Leenen LPH. Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma. Injury [Internet]. 2014;45(5):869-73. http://dx.doi.org/10.1016/j.injury.2013.12.010
Dinh MM, Oliver M, Bein KJ, Roncal S, Byrne CM. Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre. EMA - Emerg Med Australas. 2012;24(4):401-7.
Linder F, Holmberg L, Bjorck M, Juhlin C, Thorbjornsen K, Wisinger J, et al. A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - The TRAUMALERT study. Scand J Trauma Resusc Emerg Med. 2019;27(1):1-10.
Jenkins P, Rogers J, Kehoe A, Smith JE. An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre. Emerg Med J. 2015;32(5):364-7.
Ryb GE, Cooper C, Waak SM. Delayed trauma team activation: Patient characteristics and outcomes. J Trauma Acute Care Surg. 2012;73(3):695-8.
Kohn MA, Hammel JM, Bretz SW, Stangby A. Trauma Team Activation Criteria as Predictors of Patient Disposition from the Emergency Department. Acad Emerg Med. 2004;11(1):1-9.
Ciesla DJ, Pracht EE, Tepas JJ, Namias N, Moore FA, Cha JY, et al. Measuring trauma system performance: Right patient, right place - Mission accomplished? J Trauma Acute Care Surg. 2015;79(2):263-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Acta Médica Costarricense
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Los autores que publican en la revista Acta Médica Costarricense pueden distribuir, copiar, remezclar, retocar, leer, descargar, imprimir, buscar y crear a partir de su obra de modo no comercial, indicando los créditos a la revista y sus autores y compartir su obra en las mismas condiciones. Para ello se aplica la licencia Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional(CC BY-NC-SA 4.0)
