Contents:

Protocol for paging Trauma team The Trauma Team Primary Survey Secondary Survey Radiology Placement Head injuries Spinal Injuries Chest Injury Blunt abdominal Trauma Penetrating abdominal Trauma Urological Injuries Eye Trauma

Hand Injuries Burns Carbon monoxide poisoning Obstetric Trauma Paediatric Trauma Paediatric resuscitation chart Hypothermia Universal Precautions Blood Alcohol Testing Patient transfers into Liverpool Patient transfers out of Liverpool Telephone numbers Acknowledgments

   It is the Team Leader's responsibility to coordinate the management plan and to organise placement.

   Patients Should Be Placed Or Have A Plan Of Management Initiated Within One Hour Of Arrival.

   The registrar may freely consult with other members of the team in order to devise this plan. Having one person responsible aUows identification of delays that should be recorded on the trauma response fo~L This information will then be used by the trauma committee to improve the response to trauma.

   At the end of one hour, patients should be stabilised, fully assessed and have a plan of management documented in the records. A decision should be made regarding which consultant(s) will be incharge of the case and this person should be informed. All multiply injured patients are admitted under the General Surgical VMO. Ideally the patient should be placed in one of the following locations:

• Intensive Care
• Operating Suite
• Transferred to the ward for semi-elective treatment of non urgent injuries
• X-ray department for diagnostic tests
• Transferred to another hospital

   All patients should have adequate venous access and a supply of cross matched blood arranged.

   Resuscitation should be completed prior to transfer.

Supervision of Trauma patients

   Until the Trauma team leader suspends a trauma call, the patient is considered critically ill and is at risk of sudden, unexpected deterioration. Because of this risk, continuous nursing and medical supervision is necessaIy.

   There should be a continuous nursing presence with all patients who are still subject to a trauma call, or who require main radiology procedures or transport within the hospital.

   When the patient is unstable (eg hypotension <100 systolic), oliguric, or deteriorating neurologically, a medical practitioner must also be present. When the patient is intubated, an I.C.U. or anaesthetic registrar must be present. When the patient is unruly, a Wardsman must also be present.

DELEGATION

   The Trauma Team Leader will delegate Medical Responsibility.

   The Senior Emergency Registered Nurse will delegate nursing responsibility, and when a staff shortage is expected, will inform the Assistant Director of Nursing.

TRANSFERS BETWEEN DEPARTMENTS

The following equipment should be available:

• Pulse oximeter
• Oxygen
• Suction
• Laerdal bag and mask
• Drugs - sedation and paralysing agents
• Guedels airway
• Colloids / blood

   These patients remain the responsibility of the Emergency Department team until discharged. All other personnel involved in the patients assessment, who feel they need no further involvement, must hand over in detail to the Emergency Registrar.

   If the patient deteriorates, the Emergency Registrar, in consultation with the senior Emergency Physician, should re-call the trauma team.

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