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Adult Trauma: Trauma Team Response at University Hospital (5.1.10)

Adult Trauma: Trauma Team Response at University Hospital (5.1.10) - Policies, Clinical, UW Health Clinical, Emergency Response/Management

5.1.10


UW HEALTH CLINICAL POLICY 1
Policy Title: Adult Trauma: Trauma Team Response at University Hospital
Policy Number: 5.1.10
Category: UW Health
Type: Inpatient
Effective Date: March 10, 2016

I. PURPOSE

To define the roles of the members of the Trauma Team during a trauma resuscitation at the University
Hospital (600 Highland Avenue). By defining the specif ic responsibilities of each team member, the team
can w ork in a w ell coordinated manner providing optimal care to the traumatically injured patient.

II. POLICY ELEMENTS

The trauma team is activated to provide a rapid, systematic approach to caring for the trauma patient. In
order to provide optimal patient care, each team member has defined roles/job specif ic responsibilities.
Each team member should understand his/her responsibilities so that w hen the patient arrives, the
evaluation, stabilization, and treatment can be done in an eff icient and timely manner. Multiple tasks may
need to be completed on the trauma patient simultaneously. Flexibility and communication are very
important.

III. PROCEDURE

A. For all adult patients, 18 years and older, the follow ing team members w ill be activated via the trauma
pagers and w ill be present for each level of activation (for definitions of the levels of trauma response refer
to policy, Adult Trauma: Definition of a Trauma Patient).

Level I Level II Evaluation
Trauma Attending Surgeon Trauma Attending Surgeon ED Attending Physician
Emergency Department (ED)
Attending Physician
ED Attending Physician ED Resident
Trauma Chief Resident Trauma Chief Resident ED Nursing Staff
Emergency Medicine Resident Emergency Medicine Resident ED Social Worker
Trauma Resident Trauma Resident
ED Nursing Staff ED Nursing Staff
ED Tech ED Tech
Respiratory Therapist Respiratory Therapist
X-ray techs X-ray techs
ED Social Worker ED Social Worker
Medical Students Medical Students
Neuro Surgery Team Member
Orthopedic Surgery Team
member

Anesthesia Team Member

B. Trauma Team Responsibilities
i. Trauma Attending Surgeon:
a. Attends all Level I activations and w ithin 15 minutes of patients arrival time
b. Responsibility for the trauma patient(s)
c. Observe and supervise
d. Must be informed of all Level II traumas w ithin one hour of initial evaluation
e. Must evaluate all admitted Level II traumas w ithin tw elve hours of initial evaluation
f. Must be informed of condition and injuries of all Level II traumas w ithin tw o hours by the
Trauma Chief Resident
g. Must attend Level II traumas in the scenario of physiologic deterioration
h. Attend multiple-victim traumas
ii. ED Attending Physician:
a. Attends all Level I, II and evaluation (III)
b. Responsible for airw ay management w hen anesthesia team not present
c. Responsible for the patient in a Level I until Trauma Attending Surgeon arrives



UW HEALTH CLINICAL POLICY 2
Policy Title: Adult Trauma: Trauma Team Response at University Hospital
Policy Number: 5.1.10

d. Responsible for all Level II and trauma evaluations until arrival of Trauma Attending,
hospital admission and/or discharge from the ED
iii. Trauma Chief Resident (PGY-4 or 5):
a. Attends all Level I and II trauma activations
b. Direct responsibility under supervision (Trauma Attending Surgeon or ED Attending)
c. Receives report from pre-hospital providers
d. Directs and orders major procedures
e. Monitors patients response to resuscitation
f. All consult s/orders for subspecialties
g. Communicates w ith patient’s families
h. Communicates w ith Trauma Attending Surgeon prior to admission to TLC
i. Authority to surgically intervene w hen attending is en-route
iv. Emergency Medicine Resident (PGY-2):
a. Primary evaluator for all traumas, alternating w ith General Surgery PGY-2-5
b. Verbalizes assessment for team aw areness
c. Performs procedures as directed by the Trauma Chief Resident
d. Responsible for documentation and orders
e. Remains w ith patient (or assigns PG-1) in CT or radiology as patient condition dictates
v. Trauma Service Resident (PGY-2-3):
a. Pr imary evaluator for all trauma activations and evaluations. Alternates role w ith
Emergency Medicine Resident PGY-2 or 3
b. Verbalizes assessment for team aw areness
c. Performs procedures as directed by the Trauma Chief Resident
d. Responsible for documentation and orders
e. Remains w ith patient (or assigns PG-1) in CT or radiology as patient condition dictates
vi. Trauma Service Intern (PG-1):
a. Secondary evaluator, rotating w ith Emergency Medicine PGY-1 residents
b. Performs procedures as directed by the Trauma Chief Resident
c. Responsible for documentation and orders
d. Remains w ith patient in CT or other diagnostic procedures outside the ED as patient
condition dictates
vii. Emergency Medicine Resident (PGY-1):
a. Secondary evaluator, rotating w ith Trauma Service Intern PGY-1 residents
b. Performs procedures as directed by the Trauma Chief Resident
c. Responsible for documentation and orders
d. Remains w ith patient in CT or other diagnostic procedures outside the ED as patient
condition dictates
viii. Anesthesia Team Member:
a. Responds to Level I Trauma activations
b. When requested by the Trauma Chief Resident or ED Attending w ill attend Level II
Trauma activations
c. Airw ay management in Level I Traumas. Anesthesiology Resident under supervision of
the Anesthesiology Attending, ED Attending, or Trauma Attending Surgeon
ix. Radiology Resident:
a. Review all f ilms
b. Notif ies Trauma Attending Surgeon or Trauma Chief Resident of any changes after
attending reads
x. ED Primary Nurse:
a. Receives pre-hospital report, prepares room, begins documentation
b. Collaborates w ith ED Attending, Trauma Attending Surgeon or Trauma Chief Resident to
clarify priorities, assignments and treatment plans
c. Receives orders from ED Attending, Trauma Attending Surgeon or Trauma Chief Resident
and communicates tasks to team members as indicated
d. Receives ID band from registration and gives to ED Tech
e. Responsible for complete and accurate documentation on the Trauma Flow Sheet in the
Trauma Narrator. Level I and II activations and trauma evaluations ( consults) must be
documented using the Trauma Flow Sheet
f. Monitors and verbalizes lab results to the ED Attending, Trauma Attending Surgeon or



UW HEALTH CLINICAL POLICY 3
Policy Title: Adult Trauma: Trauma Team Response at University Hospital
Policy Number: 5.1.10

Trauma Chief Resident. Records lab results.
g. Accompanies patient out of the ED for diagnostic procedures
h. Provides support to patient and family w hen appropriate
i. Responsible for completeness of Trauma Flow Sheet/documentation and charge forms, IV
labels
xi. ED Secondary/Recording Nurse:
a. Assists w ith removal of patients clothing
b. Applies monitors/NBP cuff/pulse ox
c. Obtains and communicates initial vital signs including f irst manual pressure, serial vital
signs, CMS checks, serial Glasgow Coma Score
d. Implements hypothermia measures (w arming blankets, room temp, Bair Hugger)
e. Rectal Temperature if applicable (post rectal exam)
f. NG and Foley as directed by the ED Attending, Trauma Attending Surgeon or Trauma
Chief Resident (if not done by PG-1)
g. Administers IV meds
h. Updated team on vital signs, interventions, response to interventions
i. Administers and regulates blood products w ith blood w armer and rapid infuser as
necessary
j. Administers tetanus prophylaxis, antibiotics and other medications as ordered
k. Anticipates procedures and prepares equipment as necessary
l. Labels all f luid bags and IV sites
xii. ED Care Team Leader:
a. Receives report about incoming trauma patient. Will level patient per activation criteria.
See UW Health clinical policy #5.1.7, Adult Trauma: Definition of a Trauma Patient.
b. Communicates patient report w ith ED Attending, Trauma Attending Surgeon or Trauma
Chief
c. Collaborates w ith trauma team regarding admission
d. Communicates w ith the OR care team leader/charge nurse
e. Provides crow d control
f. Interacts w ith EMS personnel and directs their activity
g. Assists in locating and notifying family members or delegates to social w orkers, ED case
manager or trauma coordinator
xiii. Operating Room Care Team Leader:
a. Responds to the Trauma Bay for Level I activations to assist w ith coordination of the
operating room, if needed
b. Will not be involved in direct patient care but serves as a direct communication contact
w ith the Trauma Attending Surgeon or Trauma Chief Resident
c. For a patient requiring an emergent Trauma Bay thoracotomy, the OR charge nurse w ill
either assist or assign a scrub tech/nurse to assist
d. Patients w ho require emergent surgical intervention w hen the OR is at maximum capacity
w ill be managed as outlined in Surgical Services Departmental policy #2.29, Operative
Triage of the Trauma Patient
e. Ensures communication w ith the trauma team is given to the anesthesia team especially
w hen the patient w ill be going to the OR from the Trauma Bay
xiv. ED Tech
a. If Level I Trauma: prepares cooler, receives initial 3 units O negative PRBC’s and 1 unit of
FFP, completes Blood Bank cooler validation form
b. Responsible for receiving and delivering all blood products to the Trauma Bay
c. Assists w ith unloading from Med Flight and other EMS
d. Assists w ith removal of Med Flight stretcher
e. Places ID band
f. Establishes IV access, assess patency of existing lines
g. Compression (CPR) if needed
h. May collect/label and send labs/urine
i. Assists w ith clothing removal
j. Collects and documents patients clothing, valuables
k. Assists w ith patient transportation
l. Assists w ith preparation of supplies and tray set-ups as needed



UW HEALTH CLINICAL POLICY 4
Policy Title: Adult Trauma: Trauma Team Response at University Hospital
Policy Number: 5.1.10

xv. Emergency Department Coordinator (EDC):
a. Obtains and enters demographic information ASAP
b. Will implement Unidentif ied Patient if information not readily available (refer to UWHC
policy #8.29, Unidentif ied Patient)
c. All Level I Trauma patients w ill be registered as a Unident patient
d. Delivers trauma admission pack and ID band to the recorder ASAP
e. Directs EMS, police, and family members and notif ies Care Team Leader of family’s
arrival
f. Obtains identifying information for registration purposes form personal effects received
from Trauma Team members
xvi. Respiratory Therapist:
a. Document PSI on portable oxygen tank on the trauma flow sheet
b. Reports ETT size, location, initial SaO2 and end tidal CO2
c. Assists w ith airw ay management, including assisting w ith all aspects of intubation
d. Sets ventilator or other oxygen delivery systems w ith setting provided from Trauma Chief
Resident
e. Ensures pulse oximeter and end-tidal CO2 monitors are available
f. Must be present for all Level I Trauma patients and may be excused only upon the
approval of the Trauma Attending Surgeon or Trauma Chief Resident
xvii. Radiology Technologist:
a. Responds to the Trauma Bay w ith portable machine
b. Processes initial images before taking other images
c. After CT, w ill take additional images in the Radiology Room
xviii. Social Work:
a. Communicates w ith patient’s family
b. Liaison betw een trauma team and family
c. Support to patient and families
xix. Pharmacist
a. Prepares medications as directed by the Trauma Attending Surgeon or Trauma Chief
Resident
b. Records medications given during codes, if applicable
xx. Trauma Program Manager
a. Resource for trauma team
b. Assist w ith communication

IV. COORDINATION

Author: Adult Trauma Program Manager
Senior Management Sponsor: SVP, Medical Affairs
Review ers: Adult Trauma Medical Director, Director of Surgical and Psych Nursing, Pediatric Trauma
Program, Manager and VP AFCH Clinical Operations
Approval committees: Adult Trauma Operations; Emergency Department Clinical Operations; UW Health
Clinical Policy Committee; Medical Board
UW Health Clinical Policy Committee Approval: February 15, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

V. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee



UW HEALTH CLINICAL POLICY 5
Policy Title: Adult Trauma: Trauma Team Response at University Hospital
Policy Number: 5.1.10


VI. REFERENCES

American College of Surgeons Committee on Trauma. Resources for the Optimal Care of the Injured
Patient: 2014. Chicago, IL, American College of Surgeons, 2014.
Surgical Services departmental policy #2.29, Operative Triage of the Trauma Patient
UWHC policy #8.29, Unidentif ied Patient

VII. REVIEW DETAILS
Version: Original
Next Revision Due: March 10, 2019
Formerly Know n as: Hospital Administrative policy #8.11