1. Prehospital Alerts and Communications

2. 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 

3. 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 

4. 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

5. 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 

6. 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.

7. Critical Medical
Unstable Vital Signs
Seizures
AMS
Code/ROSC

8. Miscellaneous
Stroke OB
PERT
PUMP
ARTIC

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

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

11. 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