Early Activation

Emergency medical services responding to the scene will notify ARV and the receiving hospital that a trauma patient is on their way. This may be a major, metropolitan or regional trauma service or sometimes an urgent care service, depending on distance, facilities available and the patient’s condition. Notification information is crucial to managing a severely injured patient and can allow for communication to vital members of the response team as well as time to prepare the department for the patient’s arrival.

The following sequence of actions should take place upon initial notification:

1. Gather vital information from the notifier using the MIST mnemonic:

2. Personal protective equipment is vital in the care of trauma patients. Ensure all staff involved in patient care are wearing gloves, aprons and eye protection.
3. Activate the trauma team and available support departments (medical imaging, pathology). In smaller health service settings this may only consist of a clinician and a nurse. Additional staff may be gathered from wards or on call. It may be necessary to utilise the skills of all available resources including emergency response personnel in the initial trauma management.
4. Set up the trauma bay to receive the patient, including equipment checks, documentation, medications and resuscitation equipment.
5. Designate roles and specific tasks to staff and maintain an approach based on teamwork. Ensure good communication between all parties involved in managing the trauma. Use closed-loop communication, which ensures accuracy in information shared between response staff. Repeat instructions, make eye contact and provide feedback. Misinterpreted information may lead to adverse events.
    

If there is no prior notification of the patient, then rapid activation of the trauma team request must take place and any additional resources notified. If it is anticipated that transfer to a major trauma service will be required, early retrieval activation is essential (phone ARV on 1300 368 661).

• Early retrieval activation ensures access to critical care advice and a more effective retrieval response which leads to improved clinical outcomes for the patient.

If you are undecided, call the ARV coordinator, who can provide expert guidance and advice over the phone or via tele or videoconference, and link to a major trauma service as required.

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Ambulance handover

On arrival at the emergency department, a structured handover is provided by the paramedics to the treating team, using the IMIST-AMBO format.⁵ The timing of the handover will be dependent on patient clinical stability and requirements. If the patient is stable, it may be best to perform the handover before placing the patient on a trolley. If the patient is unstable or critically unwell, it may be necessary for the patient to be transferred to the trolley so the team can continue management and intervention, while the team leader receives the handover.

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Reception and resuscitation

The reception and resuscitation of major trauma patients involves simultaneous assessment and management, with multiple activities occurring in parallel. Resuscitation follows the standard ABCDE approach, with some modifications based on recognising and treating immediate life threats that are unique to trauma patients, and preventing secondary complications.
The response to resuscitation will vary depending on the injuries sustained, the treatment administered or omitted as well as other factors such as the patient’s age and medical comorbidities.
Ongoing resuscitation is guided by the response to treatment and the need for definitive management.
Assessment must also be made of medical conditions and comorbidities that may have preceded or contributed to the patient sustaining an injury, especially in in elderly patients. Cardiac or neurological events leading to syncope or falls are common events that predispose to injury in older patients.
Ensure the patient is correctly identified and appropriate patient identification labels applied.

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