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UWHC,UWMF,

Policies,Clinical,UW Health Clinical,Emergency Response/Management

Adult Trauma: Definition of a Trauma Patient (5.1.7)

Adult Trauma: Definition of a Trauma Patient (5.1.7) - Policies, Clinical, UW Health Clinical, Emergency Response/Management

5.1.7


UW HEALTH CLINICAL POLICY 1
Policy Title: Adult Trauma: Definition of a Trauma Patient
Policy Number: 5.1.7
Category: UW Health
Type: Inpatient
Effective Date: March 10, 2016

I. PURPOSE

To identify patients based on physiological abnormality/injury and/or mechanism of injury that w ould activate
the appropriate tier of trauma response from the University Hospital (600 Highland Avenue) trauma program.
The f ield triage criteria w ere approved by UWHC Trauma Operations Systems Committee based on
recommendations from the American College of Surgeons, Committee on Trauma (ASC-COT).

II. DEFINITIONS

University Hospital has a three tiered trauma team response:
A. Level I
B. Level II
C. Trauma Evaluation (Consult)

Level I is based on physiologic abnormalities requiring an emergent trauma team evaluation. This level
utilizes the full trauma team response, including activation of the trauma pagers w hich notif ies the entire
trauma team including the Trauma Chief Resident, Trauma Attending Surgeon, Respiratory Therapy,
Surgery, CT scan, Anesthesia, Neuro Surgery, Orthopedic Surgery, etc. The Trauma Attending Surgeon w ill
respond to the Emergency Department w ithin a 15 minutes response time.

Level II includes patients w ho do not meet Level I criteria and have multi or single system type injuries.
Specif ic mechanism and comorbidities are considered for activation of a Level II response. A Trauma Chief
Resident w ill respond to the Emergency Department w ithin a 15 minute response time. All other services
w ill be consulted as needed. The trauma pagers are utilized for the initial response.

Trauma Evaluation is any patient w ho does not f it the criteria for the above tw o response levels but has
minor injuries that may need to be admitted for a short hospitalization.

III. POLICY ELEMENTS

The Level I Trauma activation criteria are based from the minimal activation criteria from the American
College of Surgeons.

IV. PROCEDURE

A. Level I trauma activation w ill be paged based on the follow ing criteria:
ξ Unstable Airw ay (including combitube, King airw ay, etc.) ***Please include any type of supraglottic
airw ay present in the page
ξ Intubated and transported from the scene
ξ Respiratory compromise or obstruction
ξ CONFIRMED systolic blood pressure <90 at any time
ξ Transfer patients from other hospitals receiving blood to maintain vitals
ξ Penetrating w ounds to head, abdomen, neck, chest, back and/or f lank
ξ Penetrating w ounds proximal to the elbow and or knee (new criteria 2015)
ξ GCS <8 w ith mechanism attributed to trauma
ξ Crushed or mangled extremity
ξ Flail Chest
ξ Amputation proximal to w rist or ankle
ξ Tw o or more proximal long bone fractures
ξ New limb paralysis and/or sensory deficit above w rist or ankle
ξ Tourniquet application prior to arrival
ξ If ≥20 w eeks pregnant gestation and meets any Level I or Level II activation criteria (Refer to UW
Health clinical policy #5.1.3, Care of the Pregnant Trauma Patient in the Emergency Department at
the University Hospital). Use Level I Pregnant Trauma Paging List (#0288)



UW HEALTH CLINICAL POLICY 2
Policy Title: Adult Trauma: Definition of a Trauma Patient
Policy Number: 5.1.7

ξ Victims of hanging must be activated as a Level I if they meet any of the above criteria
ξ Trauma Attending Surgeon/ED Attending Physician/ED CTL Discretion
B. Level II trauma activation w ill be paged based on these criteria:
ξ Combination burn/trauma
ξ Pelvic Fracture
ξ Open or depressed skull fracture
ξ Ejection from automobile
ξ Death in same passenger compartment
ξ Extrication time >20 min
ξ Falls >20 ft.
ξ Rollover
ξ High speed auto crash (>40 mph)
ξ Pedestrian throw n or run over
ξ Motorcycle/ATV/snow mobile crash >20 mph or w ith separation of rider from vehicle
ξ Electrical current exposure
ξ Respiratory Rate <10 or >20
ξ Heart Rate >100
ξ Age >65 w ith 2 or more rib fractures
ξ Current anticoagulation usage w ith a traumatic mechanism: [e.g. w arfarin (Coumadin), dabigatran
(Pradaxa), apixaban (Eliquis), edoxaban (Savaysa), rivaroxaban (Xarelto), argatroban, bivalirudin
(Angiomax), enoxaparin (Lovenox), dalteparin (Fragmin), fondaparinux (Arixtra), heparin,
clopidogrel (Plavix), prasugrel (Eff ient), ticagrelor (Brilinta), cilostazol (Pletal), dipyridamole
(Persantine), etc.)]
ξ Trauma Attending Surgeon/ED Attending Physician/ED CTL Discretion
C. Trauma Evaluation is a trauma patient not meeting Level I or II trauma team activation. The patient may
have been evaluated at another referring facility and is being transferred to University Hospital for further
evaluation. These patients w ill not exhibit physiologic abnormalities and should have only single system
injuries. Initial evaluation w ill be performed by the ED Attending and the subspecialty service and admitted to
the appropriate surgical sub specialty.
D. Any patient w ho meets the criteria w ill have the appropriate level of response activated; this includes
patients w ho are transported via EMS, helicopter, personal vehicle or w alk-in.
i. Patients arriving via personal car or w alk-in to the ED, shall be triaged and if he/she meets the
criteria activation, the appropriate level of activation w ill be initiated follow ing the regular procedure
but w ill have “Trauma activation level here in ED NOW” in the page.
ii. The patient w ill be taken to the trauma room and c-spine w ill be immobilized as needed. Maintain
full spine precautions as needed.
E. If there is deterioration in a patient’s condition during EMS/helicopter transport or after patient arrival in the
Emergency Department, the appropriate level of activation w ill be initiated. When paging, note Trauma
Upgrade and the Level of the activation.
F. See Appendix A for full trauma team activation table (Utilized by ED CTL staff).

V. COORDINATION

Author: Adult Trauma Program Manager
Senior Management Sponsor: SVP Medical Affairs
Review ers: Adult Trauma Medical Director
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.

VI. APPROVAL



UW HEALTH CLINICAL POLICY 3
Policy Title: Adult Trauma: Definition of a Trauma Patient
Policy Number: 5.1.7


Peter New comer, MD
UW Health Chief Medical Officer

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

VII. 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.
UW Health Clinical policy #5.1.3, Care of the Pregnant Trauma Patient in the Emergency Department at
University Hospital

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