Trauma SystemsTriage & Transport Decisions

Brian J. Burrell RN, NREMT-PProgram Manager, Tulsa Life Flight

Trauma SystemsTrauma Systems

• Components– Injury Prevention– Pre-hospital Care– ED care– Interfacility transport– Trauma Center (Definitive care)– Rehab– Data collection

Trauma CentersTrauma Centers• Levels (State VS ACS)

– 1 definitive, fully capable– 2 definitive, fully capable, no research– 3 minor trauma, some surgery– 4 limited trauma, no surgeon

• Qualifications– Essential– Desired

• Roles

Transport ConsiderationsTransport Considerations

• Level of receiving facility

• Mode of transportation

• Closest appropriate facility

Trauma TriageTrauma TriageMULTI-SYSTEM BLUNT ORPENETRATING TRAUMAWITH UNSTABLE VITAL SIGNSHypotension-systolic BP<90mmHgRespiratory compromiseRespiratory rate <10 or >29Glasgow Coma ScaleScore <14

ANATOMICAL INJURYPenetrating injury to the head,neck, torso, groinCombination of burns >20% orinvolving face, airway, hands, feet or genitaliaAmputation above wrist or ankleParalysisFlail chestTwo or more obvious proximallongbone fractures (upper armor thigh)Open or suspected depressedskull fractureUnstable pelvis or suspected pelvic fracture

Rapid transport to the Regional Trauma

Center

Prompt transport to theRegional Community Hospital

The Need for Air Medical TransportThe Need for Air Medical Transport

• Most Air Medical Helicopters can be requested by ANYANY first response agency!

General Guidelines for calling:

• Multi-system Trauma with unstable vital signs• Respiratory Compromise• Glascow Coma Score less than 14

Time Dependent Time Dependent • Penetrating Trauma

• Burns more than 20%

• Amputation (above wrist or ankle)

• Paralysis

• Flail Chest

• Two or more long bone fractures

• Open or depressed skull fracture

• Unstable or suspected pelvic fracture

• Near Drowning

Time Dependent Cont.Time Dependent Cont.

• Abdominal or Thoracic aneurysm

• Acute intercranial bleed

• Status asthmaticus

• Croup/Epiglottitis

• Cardiogenic Shock

• Post Cardiac Arrest

• Acute MI

CommunicationCommunication

The communication specialist will need to know:

• Agency requesting

• Call back phone number

• Location of the scene

• Number of patients and condition

• Radio Freq and ground contact.

Golden Rules of Air EMSGolden Rules of Air EMS

• No smoking within 50 feet of the aircraft• Protect yourself and patient during takeoff and

landing• Keep bystanders away from the aircraft• Approach?Approach?• Secure loose items on scene and your person• Stay calm and professional• Use hearing protection

Landing Zone PreparationLanding Zone Preparation

• Day 60x60 foot square area

• Night 100x100 foot square area

• Look for overhead obstructions– Power lines & Towers– Light poles– Trees

• Ground debris

• Landing surface

Safely Landing The HelicopterSafely Landing The Helicopter

• Communicate with the aircraft • Secure Loose Objects• Protect yourself and patient• Do not approach the aircraft unless directed

by a flight crewmember.

• Why do we worry about safety??

This is why!This is why!

Helicopters A- StarHelicopters A- Star

HelicoptersHelicopters

Bell Jet Ranger (206)Dangers

MD 900 MD 900

Tulsa Life Flight BK-117

Can you see the Towers?Can you see the Towers?

ResponsibilityResponsibility

THANK YOU!!THANK YOU!!

Be Safe!!Be Safe!!