Trauma teams

North of Scotland major trauma guidelines
NHS Grampian

Trauma team leader

An ED consultant will be TTL and should utilise the leadership and trauma experience of other specialty and ED Consultants if present. They will be present in advance of the patient arriving for all Standard and Code Red Trauma Teams. The TTL should:

  • Provide expert management of the trauma patient during resuscitative phase
  • Prepare the team prior to patient’s arrival
  • Manage the patient in the resuscitation room
  • Care for the patient during transport and CT
  • Handover care clearly
  • Remain Hands Off
  • Communicate clearly to the team
  • Decide which diagnostic and therapeutic interventions need to be performed and in what order
  • Ensure accurate documentation in the medical record
  • Protect the safety of the trauma team.

Trauma team leader training

All TTL must complete and be up to date with TTL competencies. This can be achieved by attending ETC or equivalent training courses.

Emergency department nurses

Aim to complete trauma nurse competencies and attend a TNCC course or equivalent.

Thoracotomy capability

The trauma team leader will ensure there is thoracotomy availability in every enhanced and code red trauma team. This will be documented in the trauma booklet.

Pre-arrival checklist

The Trauma Team Leader will complete the pre-arrival checklist below.

 

TTL pre-arrival checklist - adult trauma

Staff

Time/tick
Trauma call 2222 Adult code red trauma call ARI Resus  
Adult Trauma call ARI Resus  
Other Specialties Consider if multiple pts. Plastics 4316  
Neurosurgery 2334  
Cardiothoracic 2799  
Assign medical roles    
Assign nursing roles    
Assign Scribe  
Don appropriate PPE, Apply Role label and print name on PPE  
Ensure staff sign in  

Blood
Code Red Protocol – activated when called by prehospital team  
Major Haemorrhage protocol – activated when patient arrived  
Extreme circumstances – unable to wait for SNBTS sample – request “Bulk shipment of Emergency blood”  

Equipment – Trauma cabinet
Disrobe Trauma shears  
On bed/ ambient Trauma mattress  
Blue bed cover placed over trauma mattress  
Bair hugger under body  
Pelvic binder on bed  
Turn up ceiling radiant heater  
A Airway trolley with kitdump performed  
Check Video laryngoscope – battery  
Suction check  
B NRB mask O2 attached and at 15 litres  
BVM to hand – O2 attached 15 litres  
Ventilator – checked and on standby  
C Level one/Blood warmer – on and run with saline  
Cannulation kit - blood tubes – pink, purple, blue, green.  
Appropriately sized IO needle and drill battery check  
Ultrasound switched on and gel  
Trauma chest drain – Unisurge kit  
Thomas splint/CAT tourniquet  

Drugs
RSI drugs See RSI drug drawing guide Fentanyl – 500mcg in 10mls  
Ketamine – 200mg in 20mls  
Rocuronium – 100mg in 10mls  
Metaraminol – 10mg in 20mls  
Ephedrine – 30mg in 10mls mg in 10mls  
Propofol Infusion  
Consider metaraminol infusion  
Others TXA – within 3 hours of injury – clinical concern ongoing haemorrhage Bolus 1g given over 10 minutes Infusion – 1g in 500mls saline - 8 hours (62.5mls/hr.)  
Analgesia IV Paracetamol 1g in 100mls (body weight >50kg)  
IV Morphine 10mg in 10mls  
Antibiotics for open fracture Asap, aim for <3 hrs from injury for KPI Co-amoxiclav 1.2g  
Clindamycin 600mg IV - If penicillin allergic  

Others
Add details to the ATMIST board  
Pre book patient on TRAK – call reception 53306/50506  
Book as unknown patient if unable to confirm details  
Request trauma CT  
Request bloods  
Ensure correct trauma documentation  
Add major trauma consultation – bone icon  

Perform Team brief

STAND DOWN CODE RED once appropriate. Return & preserve blood products as able.

Trauma team document: sign in sheet

The scribe should also complete the Trauma Team Document.

Trauma team sign in sheet: ARI