Level I Trauma Center Response

1. Level I Trauma Center Response Benjamin L. Eithun, MSN, CRNP, RN, CPNP-AC, CCRN, TCRN

2. Level I Trauma Center Resources • Level I trauma centers are required to have a large number of resources on call 24/7 • Emergency Department equipped for emergent care • EM Providers • Surgeon coverage (in house or available within 15 min) • Anesthesia

3. Level I Trauma Center Resources • Neurosurgery • Orthopedic surgery • Specially trained RNs, RTs, Techs • Radiology services • Emergent Operative Capabilities • Blood bank

4. Mass Casualty Response • At a minimum we train annually for a surge of patients • In reality we train every Friday/Saturday night • Most MCI responses are geared toward blunt mechanism

5. Active Shooter Response • Emergency Department Response • OR Response • Hospital Response • Corporate Response

6. Emergency Department Response • Critical patients unrelated to the incident still need care • Non-critical patients are relocated as able • Additional resources are considered • Trauma bays prepped for incoming patients • Belmont rapid infusers

7. Emergency Department Responses • Blood bank is notified and starts the process of getting additional blood available. • 10 units of blood kept in the ED at all times • Additional providers are notified and respond to the trauma bays • Supplies are brought up (chest tubes, central lines etc)

8. Operative Room Response • Any OR without an ongoing surgery is put on hold for the trauma team. • Additionally trauma OR is available and staffed 24/7 • Injuries dictate the pans that are opened/counted etc

9. Hospital Response • ICUs and Wards start identifying patients who can be discharged or transferred to make room for incoming patients • Staffing is considered to accommodate the surge in patients • Labor pool is activated to call in additional staff and repurpose current staff in non-patient care roles.

10. Incident Command • Incident Commander • Operations • Planning • Logistics • Administration/Fiance

11. Corporate Response • Serve a variety of functions in an incident • Security • HR • Supply Chain • Business Continuity • Media/Information sharing

12. Typical Decision Making • Fluid situations • Often limited time to respond, decisions must be made quickly so need to ensure you have the right decision makers • Information comes from a variety of sources, what do you trust and what do you share

13. MCI Blunt V. Penetrating • Typically blunt mechanism traumas have a larger percentage of patients requiring medical management • Penetrating traumas have a larger likelihood of being operative • In mass casualties, what normally would be emergent might have to wait 24 hours (tourniqueted extremities)

14. Re-Triage • An additional triage will happen at the hospital to match the patients with the resources required. • Colored based triage might differ from hospital based (Trauma Red Might be a level II or a Trauma Yellow might be a level I)

15. Additional Considerations • Family re-unification • Violent incidents might require additional security challenges • Aggressor might not be known/identified • Often the person/people who caused the incident will need to be treated as well • Worried Well

16. Penetrating Trauma

18. High Velocity Injuries

19. Traumatic Arrests • Airway • Blood, vomit, teeth, foreign objects • Breathing • Airway obstruction, Head injuries • Circulation • Bleeding, Cardiac Stun, Arrhythmias • Consider crush injuries especially if given etomidate

20. Treatment • Blunt • If arrest in field, high mortalitiy • PALS/ATLS • Penetrating • If they arrest in the hospital or shortly before arrival, consider resuscitative thoracotomy

21. Resuscitative Thoracotomy

22. Internal Defibrillation

23. Cross Clamp Aorta

24. Internal Cardiac “Massage”

25. Pericardial Tamponade

26. Penetrating

27. Where is the end of this knife?

28. Neck Injuries

30. Thoracic Trauma

31. Gunshot Wounds Aren’t the Only Issue