ED major trauma call

introduction

many hospitals implement a “trauma call” process to improve patient outcomes in high risk trauma which is activated when high risk patients are brought into the emergency department or when the ambulance clinician notifies the ED of the imminent arrival of such a patient
the process is designed to ensure early attendance by key staff to assist with timely management of these patients, including surgical registrar, anaesthetic registrar, ED registrar or consultant +/- ICU registrar.
the process is designed to alert the ED radiographer and the blood bank staff and potentially bed manager.
patients fitting these criteria should generally be managed in a resuscitation area

Respiratory rate <10 or >30 breaths/minute, or intubated.
Systolic blood pressure <80 mmHg.
GCS <12, or <13 with other injury; focal neurological deficit.
penetrating injury to trunk, head or neck;
blunt injury: significant injury to a region or injuries to 2 or more regions;
high speed MCA (>60kph);
ejection from vehicle; vehicle rollover; significant vehicle intrusion; delayed or difficult extrication;
fatality in the same vehicle;
impacts > 30 kph if either motor cyclist, pedal cyclist or pedestrian
fall from height >3 metres.
explosion.
burns to >30% of body surface area.
spinal cord injury.
consider activation for the following:
- co-morbidities, eg. age <10 or >65 years; pregnancy; anticoagulation.
- fall from a horse.
- limb-threatening injury, eg. severe open injuries or neurovascular impairment.

age	systolic BP	heart rate	resp. rate	GCS
0-2yrs	< 80 or absent radial pulse	> 160	> 60	< 10
2-5yrs	< 85 or absent radial pulse	> 140	> 40	< 10
5-12yrs	< 90	> 130	> 40	< 10
12-18yrs	< 100	> 120	> 40	< 10

or a high risk feature as for adult, or either:
- severe electric shock
- backed over by a car
- thrown over handlebars of bike
- multiple large scalp lacerations in small children.