Prehospital Alerts and Communications

Trauma Team Activation Delta Trauma (Tier I) Trauma Alert:  * Suspected Spinal Cord injury/Paralysis  * Hemodynamic instability  * Two or more proximal long-bone fractures  Patients < 65 years of age with SBP <90mmHg  * Major thermal or chemical burns (combined partial or full thickness burns) ≥ 20% TBSA  Patients ≥ 65 yrs of age with SBP <110mmHg)  * Heart Rate >120 bpm (with at least one other delta criteria)  * High voltage electrical burns (≥ 500v), including lightening injury  * Respiratory Rate <10 or ≥ 30 bpm  * Mangled extremities or amputations above the knee/elbow  * Respiratory compromise, airway obstruction or intubation  * Tourniquet required for control of bleeding with a trauma mechanism  * Glasgow Coma Score ≤ 8 with mechanism attributed to trauma  * Transfer of patients from outside hospitals who are receiving blood to maintain hemodynamic stability * Severe facial trauma  * Penetrating trauma (GSW/SW) to the head, neck, chest abdomen axilla or groin  * Flail chest/sucking chest wounds 

Trauma Team ECHO Trauma (Tier II) Alert: * Loss of consciousness with persistent AMS (GCS ≥9 – 14)  * Burns Inhalation injury with NO respiratory distress – OR  – * Heart rate > 120 with NONE of the above delta criteria  Circumferential burns to extremities – OR  – Burns in an enclosed space (e.g. house fire) (unless meets delta criteria) – OR  – * MVC/MCC  Ejection from vehicle – OR – Burns 10 ≤ 20 TBSA-combined partial or full thickness thermal or chemical Does not include first-degree burns  Separation of rider from motorcycle/scooter  * High speed crash (> 40mph) – AND  – * Crush injuries with significant mechanism  Major deformity of vehicle – OR  – * Suspected pelvic fractures who are hemodynamically stable  Intrusion >20 inches into passenger compartments – OR – * Distal extremity amputations (except digits)  Rollover * Age ≥ 65 (any mechanism of injury) and known use of anticoagulants/antiplatelet agents (Coumadin, Plavix, Xarelto, Pradaxa)  Death of an occupant in the same vehicle  * Stab wounds or deep penetrating wounds above the elbow or knee  * Hanging/strangulation without any airway/respiratory compromise  * Auto-pedestrian/auto-cycle injury with significant impact (≥ 20 mph)  * Drownings/near drownings with injury mechanism (unless meeting delta criteria) * Falls ≥ 20 feet Falls from horses or other animals 

Trauma Team Additional Notifications  Pregnancy An ECHO trauma team activation should be considered the following populations with ANY mechanism of injury: Pregnant patients ≥ 20 weeks gestational age will have an OB activation paged out simultaneously with the ECHO or DELTA trauma activation. The OB team responds per the OB activation guideline Age ≥ 85  End stage renal disease requiring dialysis  SNF/functionally dependent state  Unclear mechanism or limited history of the injury/poor historian  Multiple co-morbidities  Burns Burns < 10% TBSA (partial/full thickness) should have a burn consult

Cardiac Alerts □ Chest pain is the patient’s chief complaint ALPHA alert will be called via *500 for any patient meeting ALL of the following criteria:  □ Chest pain is the patient’s chief complaint  □ 12 Lead ECG automatic interpretation: ***Acute MI***  □ Age ≥ 30 years  OR  □ EMS Physician or Critical Care air/ground transport crew notification of STEMI through independent ECG interpretation and patient assessment 

Cardiac Alerts BRAVO alert will be called via *500 for any patient meeting the following criteria:  □ 12 Lead ECG automatic interpretation: ***Acute MI*** with Age <30 AND chief complaint of chest pain  OR  12 Lead ECG automatic interpretation: ***Acute MI*** with Age ≥30 but does not have chief complaint of chest pain  □ PARAMEDIC (EMT-P) or INTERMEDIATE (EMT-I) interpretation of 12 Lead ECG AND clinical assessment concerning for STEMI  VCU Communications Room staff will direct any concerns to the Communications Medical Director, his/her designee OR the VCU Emergency Department AIC.

Critical Medical Unstable Vital Signs Seizures AMS Code/ROSC

Miscellaneous Stroke OB PERT PUMP ARTIC

ED Communications Transfer Center Comm Room BFF Nurse Attending Green/Yellow teams

Your Turn ASCOM vs. Through Secretary Recorded Line Clearly state your last name and your supervising attending Listen to the report from EMS

Your Turn EMS Report should include situation, findings, vital signs, and a request for orders Consider the patient, provider, distance to care, etc. Treat the patient as you would in the ED