Planning and Communication
For effective management of trauma, an identifiable leader should direct the resuscitation, assess the priorities and make critical decisions.21 Good communication between the trauma team members is vital, as is ensuring that local senior staff are aware and can provide additional support as required.
Once the initial assessment and resuscitation is underway, is it important to plan the next stages in management. Priorities for care must be based on sound clinical judgement, patient presentation and response to therapies provided. 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: do not wait until the patient deteriorates.
Frontline clinical staff should initiate contact with PIPER early in the
management of the patient or, more importantly, as soon as it is evident that the patient’s injuries meet the major trauma transfer criteria or the patient may have sustained injuries beyond the local capabilities and resources. PIPER can be contacted at any time to offer and coordinate clinical advice.
PIPER coordinators can facilitate a three-way conversation between the referral health service, specialist clinical resources and PIPER consultant to discuss the best and 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 resources whereas the lack of such information can delay definitive care. Information should be conveyed in both verbal and written (via the patient record) form and should include the patient’s identifying information, relevant medical history, pre-hospital management and emergency department evaluation and treatment (including procedures performed and imaging obtained). All imaging should be sent with the patient. Electronic transfer alone is unreliable.
Complete and clear verbal communication of information among individuals is facilitated by the use of the acronym “ISBAR”. The following are stated:
Identify: Who are you and what is your role in the management of the patient? (Use at least three patient identifiers)
Situation: Current situation of the patient
Background: The clinical background/context
Assessment: What the problem is
Recommendation: What would you recommend? Identify risks – patient and occupational health and safety. Assign and accept responsibility/accountability.22
It is important that additional communication with the PIPER coordinator is initiated whenever there is:Situation: Current situation of the patient
Background: The clinical background/context
Assessment: What the problem is
Recommendation: What would you recommend? Identify risks – patient and occupational health and safety. Assign and accept responsibility/accountability.22
- Significant deterioration in:
- respiratory status
- oxygenation
- heart rate
- blood pressure
- conscious state
- Major clinical developments such as abnormal results of diagnostic tests and appearance of 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 and the patient receives the appropriate care en route.