Trauma Surgery ER Roles and Responsibilities

VBMC – Trauma surgery/ Emergency room responsibilities for trauma

Background: optimal care for the trauma patient is paramount in patient outcome. As such there is a requirement to delineate roles and responsibilities and management of trauma patients. Trauma patients are managed by both the emergency room physicians and trauma surgeons. This document is to define not only responsibilities and roles but also optimal time frames in the management of trauma patients by the trauma service.

For this document “trauma team”, refers to trauma surgeon, surgical resident physicians and physician assistants on the trauma service.

Three Distinct categories of patients will be managed through the emergency room.

-          Trauma activations

-          Trauma consultations

-          Transfers

 

1)   Trauma Activations

Trauma activations are defined as level one or level 2 depending on activation criteria as defined by the Valley Baptist Medical Center trauma team activation criteria.

Level 1 activation:

-          Patient will be directly attended to bedside by the trauma team and a trauma surgeon within 15 minutes of arrival.

Level 2 activation:

-         Patient will be directly attended to bedside by the trauma team and the trauma surgeon within 30 minutes of arrival.

  Trauma surgery responsibilities

-          Trauma surgeon will be primary physician in the management of the trauma patient.

-          Trauma team will be primarily responsible for all orders including labs and imaging.

-          Trauma order sets will be used for all trauma activations.

-          Trauma team will be responsible for any procedures required on trauma activation patients.

-          Trauma team will be responsible for calling all consultations regarding trauma activation patients.

-          Activation orders will be placed by the trauma team, however if available the ER will place the       activation orders – using only the trauma activation order set.

-          Trauma surgeon will be responsible for level of care on admission.

-          Trauma team will place admission orders – using only the trauma admission order set.

-          Before trauma team leaves the emergency room direct closed loop communication will be provided to the emergency room physician associated with the trauma activation delineating disposition for the trauma patient.

  Emergency room physician responsibilities

-          Emergency room physician will be responsible for airway management in complex trauma patients.

-          Emergency room physicians will be available to assist in management and resuscitation of patients.

-          Emergency room physician will be available for any additional procedures that may be required.

 

2)     Trauma Consultations

Trauma consultations will be called by the emergency room physician in situations where a patient has suffered a traumatic injury and requires trauma surgery for assessment and possible admission.

Trauma surgery responsibilities

-          Patient will be directly attended to bedside by the trauma team within one (1) hour of consultation.

-          Trauma consultation patients will be staffed directly with an attending trauma surgeon within the one-hour time frame window.

-          Admission or disposition plan will be provided with direct closed loop communication with the emergency room physician within this time frame.

-          All trauma consultations will be seen and attended to by trauma surgeons within six hours of admission.

Emergency room physician responsibilities

-         Emergency room physician will be primarily responsible for trauma consultation patient until admitted to the trauma service.

-        Additional consultations can be called by the emergency room physician if level of acuity dictates earlier intervention by sub specialist for the trauma service.

 

·         Direct communication between the emergency room physician and the trauma team will identify any specific imaging, laboratories, consultations that need to be ordered.

·         Trauma team will work in direct communication with the emergency room physicians to assist in management of trauma consultations.

·         If the trauma consultation patient requires admission to the hospital for ongoing care the trauma team will assist in defining appropriate level of care and take over all responsibilities as outlined in the trauma activation responsibility section.

 

3)     Trauma Transfers

Trauma transfers defined as any trauma patient transferring from a facility outside of Valley Baptist medical center Harlingen.

All trauma transfers from outside facilities will be discussed with trauma surgeon before transfer by either the transferring facility or transfer center.

·      As trauma transfers are coming directly to the trauma service for assessment, all roles, and responsibilities as per activation responsibilities will be maintained for the trauma service.

-        Trauma transfers will be attended to by level of acuity and injury severity score.

-         If a trauma meets activation criteria at the transferring facility, it will be activated appropriately at VBMC as the receiving facility as the patient is transferring for a higher level of care.

-        Trauma transfers will be activated as per appropriate trauma activation level depending on trauma surgeon discretion and trauma activation criteria.

o   Trauma transfers that meet activation criteria will be managed per activation criteria outlined above.

o   If patient does not require trauma activation, they will be managed as a trauma consultation per criteria outlined above.

Conclusion:

Integrated management of trauma patients by the trauma surgery service and emergency room physicians will ideally lead to more optimal management and timely management of trauma patients.

At all times key facets of this management must consider:

-       Trauma activations are not to be downgraded unless agreement between the trauma surgeon and the ER physician.

-       Any member of the trauma team/ ER team can upgrade the trauma to a higher level of activation – including Trauma surgeon, Er physician, trauma resident/ PA, ER nurse

-        Closed loop communication between the trauma service and emergency room services.

-        Utilization of the MIST protocol for communication regarding the trauma patient

-        Patients that meet activation criteria will be activated at appropriate activation criteria level.

-        Trauma activation will at no time be cancelled or downgraded by a resident physician or physician assistant on the trauma service.

-        "Time to assess patients” should be always adhered to by the trauma service. If there are delays in care, delays in attendance to trauma, or any issue regarding interaction with the trauma team that should be escalated by the emergency room manager to the trauma medical director for direct review.

-        Admissions should be made expeditiously with all appropriate orders placed by the trauma team as the admitting service. If admission is not to the trauma service, this should be discussed in direct communication with the emergency room physician.

-        Disposition should not be delayed unless significant findings or laboratory results are still pending. i.e. Disposition should not be delayed for final imaging results in situations where there is low suspicion of injury by both the emergency room physician and trauma surgeon.