For a trauma team to run effectively there must be an identifiable leader who will direct the resuscitation, assess the priorities and make critical decisions. 15Good communication between the trauma team members is vital, as is ensuring that local senior staff are aware and can provide additional support if required.
Once the initial assessment and resuscitation is underway, is it important to plan the next steps in immediate management. Priorities for care must be based on sound clinical judgement, patient presentation and response to therapies. Awareness of limitations in resources as well as training in the emergency field is vital. If escalation of care to senior staff is warranted, then do so early in the patient care episode. Do not wait until the patient deteriorates to ask for assistance.
Front line clinical staff should initiate contact with ARV early in the patient care pathway or, more importantly, as soon as it is identified that the patient meets the major trauma transfer criteria. This is important as they may have sustained injuries beyond the clinical skill set of the hospital or urgent care centre. ARV can be contacted at any time throughout the patient care episode to offer or coordinate clinical advice and consultation. ARV coordinators can facilitate a three-way conversation between the referral health service, specialist resources and ARV consultant to discuss the best, timely management of the patient.
The decision of when to transfer an unstable patient should ideally be made by the transferring and receiving clinicians in collaboration with the retrieval service. Clear communication is crucial; the transmission of vital information allows receiving clinicians to mobilise necessary resources while the inadvertent omission of such information can delay definitive care. Information should be conveyed in both verbal and written form (via the patient record) and should include the patient’s identifying information, relevant medical history, pre-hospital management, evaluation and treatment (including procedures performed and imaging obtained).
There are many different types of structured handover. ISBAR & IRMIST-AMBO being two of the most common. ARV recommends using the IRMIST model of clinical handover:
Identification: Introduce / identify clinician/self & their role, intro of the patient – age, sex, name.
Retrieval: Reason for retrieval, from which referrer.
Mechanism of Injury / presenting complaint: Specific explanation of the patients presenting problem and history of presenting complaint.
Injuries / Interventions: Information relating to injuries. Complete top to toe summary. Include what interventions have been performed to help stabilise the patient – e.g. Size 8 ETT.
Signs / Symptoms: Looks at the assessment of the patient, requires details of the patient current vital signs and GCS.T
Treatments / Trends: Identifies the treatment that was required – e.g. sedation / paralysis & how the patient’s condition has changed. Point of transition of responsibility and accountability for patient care.
A llergies: Include what type of reaction.
Medication: Patients usual medication.
Background History: Patients medical history.
Other information: Relevant social information. 16
It is important that additional communication with the ARV coordinator is initiated when there is:
Major clinical developments such as significantly abnormal diagnostic tests and new clinical signs.
The need for major interventions prior to the retrieval team arriving (for example, intubation or surgery). This will ensure the retrieval team is prepared, the patient receives the appropriate care en-route and the patient is referred to the correct facility.