CUH MTC Operational Policy

Background

This page is summarised from PPG-CUH-EMD-7.

Philosophy of care at CUH MTC

"Deliver exceptional care for major trauma patients. This care should be of the highest quality, delivered with respect dignity and kindness in a safe environment. It should be individually tailored for the needs of each patient and will involve their carers and relatives."

As the MTC and 'hub' of the South trauma Network, CUH will:

Function as a specialised centre for the management of seriously injured patients across the South Trauma Network
Have a clinical culture and management system that reflects the importance of integrated trauma care
Provide an integrated trauma service responsible for the ongoing care of all trauma patients in the hospital
Standardise delivery of acute rehabilitation services to improve clinical outcomes for all trauma patients
Centralise services to ensure a critical mass of work to gain experience in the care of seriously injured patients
Support the regional TUs, pre-hospital care and rehabilitation providers in the region to optimise the trauma chain of survival
Have robust trauma clinical governance and performance improvement programmes and assist in delivering quality assurance and quality improvement across the network
Have active and relevant research, education and injury prevention programmes that support trauma care across the region

Patient reception and flow

Reception & Resuscitation

Transfer of patients to the CUH MTC

Patients who fulfil trauma triage tool (TTT) criteria for major trauma and are within 45 minutes road ambulance drive time to CUH will be brought to CUH direct from the scene. NEOC will pre-alert CUH ED. The pre-alert will activate either a local emergency trauma team or a hospital-wide trauma team based on the TTT.

Secondary Transfers

Transfers requiring immediate transfer for time critical surgery (e.g. craniotomy/burr hole) will come via Protocol 37 and require pre-alert and Trauma Team assessment on arrival
Patients with complex trauma care needs will, until capacity, both staff and infrastructure allows, these cases will be discussed and specialist consultation will be required to inform transfer decision
It is the MTC TTL's responsibility to agree a transfer decision within 30 minutes of the original call
If the patient has an isolated injury that may require non-time critical speciality surgery, then the Trauma Unit can contact the relevant MTC speciality directly to discuss the case. If that speciality Consultant/Registrar agrees that the patient needs management in the MTC, then it is the responsibility of the speciality team to inform the TTL. The TTL can decide if the patient should come via resusc or go directly to an in-patient trauma bed. and the patient will be admitted directly to a ward (rather than coming from an inpatient bed in a Trauma Unit to an ED trolley in the MTC). Out of Hours the patient should come in via ED. This must be communicated with IPTS and Bed Management Team
All trauma transfers, unless directed to an in-patient trauma bed, will be reviewed in the resuscitation room trauma bays on arrival

Escalation process for decision to accept/not accept

Consultant to consultant discussion, escalate to relevant Clinical Director

Arrival

Pre-hospital communication

Tetra pre-alert will be used for primary and secondary transfers
TTL to be alerted from same and he/she will decide as to local ED trauma team or hospital-wide trauma team activation made (IAEM position paper)
Pre-alert details must be captured on the Traumadoc (page A, page B)
Once a trauma call is activated, all team members must attend the resuscitation room in ED immediately and report to the scribe to document their name, position and grade. Team members should wear appropriate PPE and role/name stickers
The TTL will brief the team and allocate roles

Initial assessment and stabilisation

All pre-alerted major trauma patients, and those attending as secondary transfers, will be received in the resuscitation room in the ED. Those patients triggering the trauma triage tool and who are pre-alerted, plus any other circumstance deemed appropriate by the TTL, trigger activation of a Trauma call. This will be achieved via the Acute Floor Information System (AFIS) telecoms with a request "Adult Trauma Team to ED Resusc please". The Trauma Team assembles in advance of arrival
If any patient has not been pre-alerted and is deemed to be an unrecognised major trauma case after arrival in ED, a call will be activated at that point in time

Trauma Teams

Adult TT consists of:

Trauma Team Leader (EM Consultant or credentialled senior registrar)
Anaesthetist (Registrar ± Consultant)
EM Registrar
Trauma and Orthopaedic Registrar
General Surgery Registrar
2 EM Resusc nurses
Scribe Senior EM Resusc Nurse
HCA
Porter

Additional

The following should be informed of the trauma call and will attend as per the demands of the patient:

CT radiographer and Radiology Registrar
ICU and Theatre Shift Leader
Bed Manager
Blood Transfusion, Haematology, Biochem. & Micro. Labs
ED CNM2 and (out of hours) ADON and Night Super
The ITU Consultant on-call receives trauma calls (to facilitate early admission planning). Likewise, other specialities such as Neurosurgery, Cardiothoracic etc. are called as required

Paediatric Trauma Team Composition:

Trauma Team Leader
Anaesthetic registrar ± Consultant Anaesthetist
EM Registrar
Paediatric Registrar
Trauma and Orthopaedic Registrar
2 Paediatric ED nurses
PCCU nurse (if available)
ED Nurse in charge
Scribe (usually ED Resusc senior nurse)
Radiology registrar (as and when required)

Obstetrics

If the patient is pregnant please request "Obstetric Trauma Team to ED Resusc please". This team will consist of the following additional members:

Obstetric registrar
Midwife
Neonatal Resusc. Team
PED Senior nurse

TTL and patient flow

The Role of the TTL

The Team Leader will lead the initial care of the seriously ill patient by coordinating staff and resources. Roles and responsibilities include the following:

Initiating Trauma Team activation according to protocol
Assigning roles to staff
Leading/ managing the reception of all major trauma patients regardless of pre-alert
Making decisions in conjunction with specialist teams and trauma referral guidelines
Prioritising investigations and treatments
Ensuring team wear personal protective clothing, allocated roles are clear and personal introductions are made
Approval of out of hours admissions to Poly-Trauma Unit (PTU) and allocation of named Speciality Consultant
Receiving trauma related calls for primary or secondary transfers of trauma patients from TUs 24/7

Patient disposition

The TTL will be supported by the institution in resolving disposition issues that occur for trauma patients. These can be re-explored at the MDT the following morning
The patient will be placed under the 'best fit' team on their first night before being redistributed through the MDT in the proceeding days based on clinical need

Temporary ID

If a temporary ID ("Bravo Bravo")/MRN is issued, it is recommended that the patient continues under the temporary MRN for approximately 12 hours from their time of registration to ensure all diagnostics are consistently registered against 1 patient identifier.

CUH MTC