Trauma Systems Triage & Transport Decisions Brian J. Burrell RN, NREMT-P Program Manager, Tulsa Life Flight

Trauma Systems Components –Injury Prevention –Pre-hospital Care –ED care –Interfacility transport –Trauma Center (Definitive care) –Rehab –Data collection

Trauma Centers Levels (State VS ACS) –1 definitive, fully capable –2 definitive, fully capable, no research –3 minor trauma, some surgery –4 limited trauma, no surgeon Qualifications –Essential –Desired Roles

Transport Considerations Level of receiving facility Mode of transportation Closest appropriate facility

Trauma Triage MULTI-SYSTEM BLUNT OR PENETRATING TRAUMA WITH UNSTABLE VITAL SIGNS  Hypotension-systolic BP <90mmHg  Respiratory compromise Respiratory rate 29  Glasgow Coma Scale Score <14 ANATOMICAL INJURY  Penetrating injury to the head, neck, torso, groin  Combination of burns >20% or involving face, airway, hands, feet or genitalia  Amputation above wrist or ankle  Paralysis  Flail chest  Two or more obvious proximal longbone fractures (upper arm or thigh)  Open or suspected depressed skull fracture  Unstable pelvis or suspected pelvic fracture Rapid transport to the Regional Trauma Center Prompt transport to the Regional Community Hospital

The Need for Air Medical Transport Most Air Medical Helicopters can be requested by ANY ANY first response agency! General Guidelines for calling: Multi-system Trauma with unstable vital signs Respiratory Compromise Glascow Coma Score less than 14

Time Dependent Penetrating Trauma Burns more than 20% Amputation (above wrist or ankle) Paralysis Flail Chest Two or more long bone fractures Open or depressed skull fracture Unstable or suspected pelvic fracture Near Drowning

Time Dependent Cont. Abdominal or Thoracic aneurysm Acute intercranial bleed Status asthmaticus Croup/Epiglottitis Cardiogenic Shock Post Cardiac Arrest Acute MI

Communication The communication specialist will need to know: Agency requesting Call back phone number Location of the scene Number of patients and condition Radio Freq and ground contact.

Golden Rules of Air EMS No smoking within 50 feet of the aircraft Protect yourself and patient during takeoff and landing Keep bystanders away from the aircraft Approach?Approach? Secure loose items on scene and your person Stay calm and professional Use hearing protection

Landing Zone Preparation Day 60x60 foot square area Night 100x100 foot square area Look for overhead obstructions –Power lines & Towers –Light poles –Trees Ground debris Landing surface

Safely Landing The Helicopter Communicate with the aircraft Secure Loose Objects Protect yourself and patient Do not approach the aircraft unless directed by a flight crewmember. Why do we worry about safety??

This is why!

Helicopters A- Star

Helicopters

Bell Jet Ranger (206) Dangers

MD 900

Tulsa Life Flight BK-117

Can you see the Towers?

Responsibility

THANK YOU!! Be Safe!!