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TRAUMA POLICIES

These pages are excerpted from the Trauma Resident Handbook, Rhode Island Hospital Department of Surgery, Division of Trauma - updated 2001. The policies herein are intended to serve as guidelines only. Individual circumstances need to be considered as there may be times when it is appropriate or desirable to deviate from these guidelines. These educational guidelines will be reviewed and updated routinely.

Immediate Attending Presence - Level 1A (page AAA-4900)
Immediate Trauma Attending presence is required for the following major pediatric trauma cases:

1. ED systolic blood pressure:
   

   <45 mmHg	if 0-3 months old
   <60 mmHg	if 3-12 months old
   <70 mmHg	if <4 years old
   <80 mmHg	if >4 years old

2. Gunshot wound to the abdomen
3. Penetrating wound to the neck
4. Burns >40% total body surface area
5. Electrical injuries involving high tension wires
   

If these criteria are met, the Fellow or Chief surgical resident will be responsible for paging (page AAA-4900) and calling the Trauma Attending. This notification time will be documented on the Trauma History and Physical. The Trauma Attending must be present before, or at the time of arrival of the patient, and this time must be documented on their progress note in the patient's medical record.

Attending Notification
On-call attending must be notified immediately for any trauma patient meeting the following criteria:

1. Thoracic gunshot wounds
2. Stab wounds to the neck, chest or abdomen
3. Major pelvic fractures
4. Spinal injuries
5. Major blunt thoracic trauma
6. All patients going to the operating room regardless of the service.

On-call attending must be notified promptly of all admissions. No exceptions.

General Policies

• A complete trauma history and physical is required for all trauma admissions.
• The ED attendings accept all trauma transfers from outlying hospitals and immediately notify the trauma resident of patient's pending arrival. If there is a problem, call the trauma attending.
• A resident must accompany and stay with a trauma patient traveling from the Emergency Room or special care unit to CT, special procedures, or the OR, even if a consulting service is involved. Exceptions are nonintubated, stable non-PICU patients.
• All consults must be cleared by a trauma attending prior to consultation with the exception of the following:
  1. Neurosurgical consultation for head and spinal trauma
  2. Orthopaedic consultation for fractures
  3. Plastic Surgery consultation for facial fractures
  4. Ophthalmologic consultation for ocular trauma
• The Pediatric Surger/Trauma Service will continue to round and document their findings for three days after transfer of a patient to a subspecialty service.
• Patients must not be transferred out of a special care unit without notification and approval of the trauma attending.
• Acute ethanol intoxication is a diagnosis and should be provided on the discharge summary when applicable.
• When a patient is transferred from the trauma room to the urgent area of the Emergency Department, the trauma resident must inform the ED attending of the patient's status and pending workup, and document the results of his/her evaluation (including primary and secondary survey).
• Trauma patients 17 years of age and older are admitted to the adult service. Any patient >35kg may be admitted to the TICU at the discretion of the attending.
• If any questions arise regarding patients <17 years of age, ask!
• Clinical Social Work (CSW) referrals for trauma patients are not automatic. Request CSW consults for patients, when required, within 24 hours of patient admission.
• Patients admitted to the PICU should have the tertiary survey form filled out within the first 48 hours or before discharge from the PICU.
  

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