Early Activation

Emergency medical services should notify the receiving hospital that a paediatric trauma patient is on their way. This information may be 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.
Once notification has been received it is important to:

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

Obtaining an estimation of the patient’s weight from the treating paramedics is useful at this stage, where possible.
It is important to note any vehicle restraints or protective clothing worn.

2. Activate the trauma team and available support departments (medical imaging, pathology). In small health service settings this may only consist of a clinician and a nurse. Ensure adequately trained personnel with experience in paediatric resuscitation are present. 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.
3. Allocate roles and specific tasks to the team. Ensure effective communication between all parties involved in managing the trauma. Use closed-loop communication to ensure accuracy in information shared between staff. Repeat instructions, make eye contact and provide feedback. Misinterpreted information may lead to adverse events.
4. Prepare the trauma bay to receive the patient. Prepare and check equipment, documentation and age-appropriate medications.
5. Make sure necessary resuscitation equipment is available and easily accessible in a range of sizes.
6. Estimate the child’s weight using the following formulae:

• Age 0-1: weight = (age/2)+4.
• Age 1-5: weight = (agex2)+8.
• Age 6-12: weight = (agex3)+7.

And calculate:

• The amount of fluid bolus at 20 mL/kg.
• The endotracheal tube size (age / 4) + 4 (use ½ size down if using microcuff ETT where available).
• The depth of endotracheal tube insertion:

• Drug doses that are likely to be needed.

7. If the weight is not known, or cannot be accurately estimated, Broselow tape and trolleys/bags may be useful tools. Ensure the tape is rolled out on the receiving bed, ready to use.
8. Ensure all staff involved in patient care are wearing gloves, aprons and eye protection. Personal protective equipment is vital in the care of trauma patients. Lead aprons should be available where x-rays are taken in the resuscitation room.

All paediatric major trauma will require transfer to the Royal Children’s Hospital. Early consultation with PIPER is essential (phone PIPER on 1300 137 650.)

• Early retrieval activation ensures access to critical care advice and a more effective retrieval response.
• Early activation and timely critical care transfer improves clinical outcomes for the patient.

If you are undecided, call PIPER, who can provide expert guidance and advice over the phone.