Trauma Transport Protocol

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Section 1 - ADMINISTRATIVE POLICIES

1.09 TRAUMA TRANSPORT PROTOCOLS

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.


Dispatch Procedures

Communications Center

  • Seminole County Public Safety E-911 Communications Center is located at 150 Bush Blvd. in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

List of information to be obtained from caller

  • Location of patient
  • Type of trauma (Circumstances)
  • Number of trauma victims
  • Extent and severity of trauma injury
  • Scene security / safety
  • Name of caller
  • Callback number

Method used to identify and dispatch the most readily available unit

  • The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
Seminole County Orange County
Lake Mary FD Maitland FD
Longwood FD Orange County Fire Rescue
Oviedo FD Winter Park FD
Sanford FD
Seminole County FD
  • The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

Process used to request assistance from emergency response agencies

  • Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
  • Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
  • Public utility agencies are requested when need is identified.
  • Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
COUNTY PRIMARY SECONDARY TERTIARY
SEMINOLE AIR CARE 3 (SSCH) AIR CARE 1 AIR CARE 2

All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.


Pre-Hospital Procedures

Adult Trauma Triage Criteria & Methodology The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

Adult Criteria

  • Meets color-coded triage system (see below)
  • GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
  • Meets local criteria (specify): Likely to require surgery within one to four (1-4) hours.
  • Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)
ADULT COMPONENT BLUE RED
AIRWAY1 RR ≥ 30 REQUIRES ACTIVE AIRWAY ASSISTANCE2
CIRCULATION SUSTAINED HR ≥ 120 BPM LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR
BP < 90 mm hg
BEST MOTOR RESPONSE BMR = 5 BMR OF ≤ 4
PRESENCE OF PARALYSIS OR
SUSPECTED SPINAL INJURY
LOSS OF SENSATION
CUTANEOUS TISSUE LOSS3 OR
GSW TO EXTREMITIES
AMPUTATION4 OR
2°/3° BURNS TO ≥ 15% TBSA OR
ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
LONGBONE FRACTURE SINGLE LONGBONE FX DUE TO MVA OR
FALL > 10’
SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
AGE ≥ 55
MECHANISM OF INJURY EJECTION FROM VEHICLE7 OR
DEFORMED STEERING WHEEL8


RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

Pediatric Trauma Triage Criteria & Methodology

  • The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

Pediatric Criteria

  • Meets color-coded triage system (see below)
  • Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)
COMPONENT BLUE RED
AIRWAY1 REQUIRES ACTIVE AIRWAY ASSISTANCE2
CONSCIOUSNESS SYMPTOMS OF AMNESIA
LOSS OF CONSCIOUSNESS
ALTERED MENTAL STATUS3
PRESENCE OF PARALYSIS OR
LOSS OF SENSATION
SUSPECTED SPINAL INJURY
CIRCULATION LOSS OF RADIAL OR PEDAL PULSES4 OR
SYSTOLIC B/P < 90 mm hg
FAINT / NONPALPABLE CAROTID PULSE OR
FAINT / NONPALPABLE FEMORAL PULSE OR
BP < 50 mm hg
FRACTURE SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) OPEN LONG BONE FX.5 OR
MULTIPLE FX SITES OR
MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)
CUTANEOUS MAJOR SOFT TISSUE DISRUPTION6 OR
2°/3° BURNS TO ≥ 10% TBSA OR
AMPUTATION7, OR
PENETRATING INJURIES TO HEAD, NECK OR TORSO8
SIZE ≤ 11 KILOGRAMS9 (Kg)

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

Issuing a Trauma Alert:

  • A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
  • To initiate a “Trauma Alert”:
    • Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
    • Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
    • Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – RADIO REPORT FORMAT (1.02).
  • The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

Transport Procedures:

All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.

  • Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
  • The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
  • The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
    • Total number of patients
    • Total number of trauma alert patients
    • Criteria by which the alert was called
    • Mechanism of injury
    • Additional resources needed

Guidelines for transportation are as follows:

  • AIR SUPPORT to a State Approved Trauma Center (SATC):
    • Air support response time is less than 30 minutes.
  • GROUND TRANSPORT to a State Approved Trauma Center (SATC):
    • The ground transport time is less than 30 minutes.
  • AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
    • The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
    • MCI situations*
    • GROUND TRANSPORT to an IRH nearest the scene of the incident:
    • When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
    • Lack of patent airway.
    • MCI situation*.

*For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.

  • If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.


Emergency inter-facility transfers of Trauma Victims:

  • In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.
  • Assess the patient upon arrival.
  • Transport to the facility where the patient has been accepted by physician.


List of Hospitals

TRAUMA CENTERS

  • The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
Orlando Regional Medical Center (TL I)

1414 South Kuhl Avenue

Orlando, Florida 32806


Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806

Central Florida Regional Hospital (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771


Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015

INITIAL RECEIVING HOSPITALS

  • The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
Seminole County

Florida Hospital Altamonte

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701


Central Florida Regional Hospital

1401 W Seminole Blvd

Sanford, Florida 32773


South Seminole Hospital

555 West State Road 434

Longwood, Florida 32750


Oviedo ER

8300 Red Bug Lake Road

Oviedo, FL 32765


Volusia County


Florida Hospital Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

Orange County


Florida Hospital Apopka

201 N. Park Ave

Apopka, Florida 32703


Florida Hospital East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822


Florida Hospital Orlando

601 East Rollins Street

Orlando, Florida 32803


Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792


Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000

Deviations:

Any deviation from these protocols will be documented and justified on the Patient Care Report.