trauma activations

[EMS5]

Hey guys. I'm an EMT from a rural area, my station responds to 1500 calls/year. Our local trauma center (20mins away, level 3) is a 90k visit ER. they classify traumas as yellow and red, but no clear definition as to what is a "resuscitation"

in the level one centers who's EM sites advertise 3,000 trauma activations/year, is this all traumas that come through the door from a broken leg or mvc all the way up to penetrating chests with resuscitations? or is there lower level traumas that EM handles without activating the trauma team?

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[southerndoc]

Depends on the facility. We don't have a trauma system where I work. During residency, we had two levels of trauma: modified and full. A modified response was handled by surgery resident during the day and EM resident during the night (both were PGY-2's). The ED attending supervised. A full response got a surgery PGY-4/5, EM senior (PGY-3/4), ED attending, trauma attending, surgery intern, and a surgery PGY-2 not to mention a lot of nurses, x-ray techs, and even the radiology attending (who was there to coordinate CT scans and such). The EM resident handled the airway, except during the day when the full response got two EM residents (a PGY-2 that handled the airway and a PGY-3/4 that ran the full trauma).

Modifieds were based on criteria: ejection, prolonged entrapment, severe damage to vehicle, positive LOC, etc.

Fulls were based on physiologic criteria: paralysis, systolic BP <90, HR >110, RR > 26, etc.

Don't quote me on the exact criteria because it's been more than a year since I was a resident. I don't remember all the details of the criteria.

 

[EMS5]

Thanks. I was just trying to find out if the numbers that are reported are it, or if there are more than aren't technically "trauma activations".

 

[docB]

As far as the reporting goes anything that meets even the lowest level of trauma activation will be reported as an activation.

 

[Arcan57]

Trauma centers have to report x number of activations in order to stay accredited. This leads to an interesting dichotomy between the head of trauma who wants as many activations as possible to stay accredited, and the other faculty/residents who would prefer not to hear about a case unless the patient needs admitted (or preferably surgery). Of note, the mechanistic criteria has become markedly less useful over time for predicting severity of injury. What used to work for 70's (and early 80's) death-traps just isn't as effective in the land of crumple zones and airbags.

 

[deleted6669]

We use level 1 and level 2 trauma designations.
we have an in house trauma team that responds to all level 1's which are based on serious mechanism or obviously bad injuries.
level 2's are first evaluated by an md or pa and the trauma team consulted as needed. a lot of 2's become 1's after some minimal investigation.

 

[diphenyl]

We have 2 designation where I work, which is a level 2 trauma center, both of which are counted as activations: Tier 1 and tier 2. Criteria are as follows.

tier 2: Auto vs ped greater than 10 mph
any trauma resulting in a LOC
fall greater than 15 ft
motorcycle accident over 20 MPH
GCS< 13
MVC w/ death in same vehicle
unrestrained MVC
MD's discretion
Trauma surgeon has 30 min's to respond and see the Pt

tier 1:
GCS less than 8 at any time in the field
intubated pt
systolic BP <90
Hr<50 >130
GSW or stab wound to head/neck/chest/abdomen
MD's discretion
trauma surgeon has 15 min's to respond