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

The direct HOTLINE number is (02) 9828 3666.

All trauma transfers to Liverpool must be directed to the ICU Resuscitation Registrar. The transferring hospital need only make one phone call to that registrar. If a bed is not available at Liverpool it is the registrar's responsibility to find a bed elsewhere.

As a tertiary referral centre for trauma we accept all patients except the following:

• Spinal injuries with cord lesions
• Burns

We accept major paediatric trauma for stabilisation abut will then transfer to a specialised paediatric unit. (Older children - check with ICU.)

If you are being referred a trauma patient from another hospital, you need to get a good idea of the patient's injuries and current status. All trauma referrals should be directed to the resuscitation registrar in intensive care.

QUESTIONS YOU NEED TO ASK

1. What is the history of the trauma and how long has the patient been there?
2. List of injuries - are they fixed and stable or unfixed and unstable?
3. Airway- secured?
4. Breathing - oxygenation, ventilation satisfactory. Respiratory pathology fixed.
5. Circulation - stable BP, pulse, peripheral perfusion, urine output, temperature. What intravenous access do they have, fluids received, blood availability.
6. Neurological - GCS, localising signs, pupils
7. Radiology - C-spine, CXR, Pelvis.
8. Blood - FBC, ABG, UEC, LFT, AMY
9. Does the patient need medical retrieval?
10. Medications given or taking, past medical history.

All patients who are intubated and ventilated and ABC unstable need a medical escort (who is skilled at ABC and can re-intubate if ETT falls out). An intern or nurse in the back of an ambulance is not enough, so find out about the resources of the referring hospital. If in doubt suggest a medical retrieval by road or air depending on appropriateness.

* If there are obvious deficiencies in management (e.g. not intubating a head injury with localising signs), see if they can be rectified. If not, a retrieval team should be sent.

After accepting a referral, the following persons must be informed.

• ICU
• Emergency registrar
• Surgical registrar
• Orthopaedic registrar
• CT Department
• Theatres
• Switchboard operator

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