Trauma

BIDMC is a Level 1 Trauma Center. The Departments of Surgery, Emergency Medicine, Orthopedics, Neurosurgery, Plastic Surgery, Radiology, and Anesthesia, along with Social Work and Physical Therapy work together in the Emergency Department and the Trauma Surgical Intensive Care Unit to provide leading edge trauma care. BIDMC acts as a tertiary care center that receives trauma patients from referring hospitals in the area.

Our Trauma Surgical Intensive Care Unit provides a comprehensive tertiary level of ICU care. This service, which integrates surgery and anesthesia critical care, provides state-of-the-art care for patients with postoperative cardiac and respiratory collapse, and coordinates multilevel care for patients with trauma and multi-organ failure.

Trauma Activation Criteria

As of 11/2015

Trauma Transfers:

Trauma Surgery/ACS no longer wants to be notified of routine Trauma Transfers in advance. So, Trauma Activations should only be called upon notification of a Trauma Transfer for Trauma STATS. If you have a routine trauma transfer (Basic Level), call the Trauma Activation upon EMS notification or upon arrival if there is no EMS notification.

Dashboard Prehospital Notification

To activate a trauma on the dashboard, which sends pages to the trauma team, click "Functions" on the left side of the Dashboard screen and click the "Prehospital Notification" button. This brings you to the Trauma Prehospital Notification screen, where you enter the Activation Level, Type of Injury, and more information. Once reviewed and submitted, this will send a page to the Trauma team (including attending) and will display this notification on the dashboard main screen.

Trauma Resuscitation Roles

The ED attending assumes attending leadership of the trauma until the Trauma attending arrives, upon which it has been customary to defer final management decisions to the Trauma attending. We have traditionally had a collegial relationship with our trauma surgery colleagues. Unless they are committing egregious errors in management, any controversial decisions faced during a trauma resuscitation are discussed collegially and ultimately deferred to the trauma attending. If you believe a mistake has been made, submit a "flag" on the dashboard and the case will be examined by our QA committee and possibly at M&M conference with the trauma team invited.

The EM and Trauma senior resident switch lead resident roles during trauma depending on the date. This table is posted just outside the trauma bay.

as of 7/2013

Admission

It is important to admit patients with traumatic diagnoses to a trauma service, NOT a medical service, unless trauma declines admission FIRST.

TRAUMA ADMISSIONS GUIDELINE

As of 7/2013

1) Patients admitted under trauma diagnoses will always be admitted to a surgical service.

2) The only exceptions will be patients with a documented medical diagnosis the care of which would independently lead to their admission to a Medicine Floor or ICU as agreed upon by the relevant surgical attending and the attending ED physician.

3) Patients with multiple significant (operative or disabling) traumatic injuries will all be admitted by the ACS.

4) Patients with a clear single system trauma will admitted to the relevant service on call that operates on that class of injury irrespective of whether that injury is operative.

5) Patients with one primary operative/disabling injury and a secondary injury that is not operative or disabling can be admitted to the ACS or the service caring for the primary injury at the discretion of the ACS attending. If the specialty service attending discusses the admission directly with the ACS attending and there is still disagreement, the patient should be admitted to the ACS and the disagreement referred to the division chiefs within 24 hours.

The ED Administrator 33450, Rich Wolfe, or Carlo Rosen should be called real-time with any difficulties in following this policy 7x24.

Special Cases

Mandible fractures: all mandible fractures that require admission should be admitted to ACS/Trauma, and they will consult OMFS.

  • If the pt is to be discharged, OMFS should see the patient (or at least their imaging) first and accept prompt follow up in their clinic.
  • If the pt is to be admitted, OMFS consultation is preferable but not required and should not delay transport upstairs.

Foot Fractures: consult Orthopedic Surgery, not Podiatry, for the following foot injuries. See "Important Info" on the Dashboard for more details.

  • Traumatic injuries to the hind foot and mid foot including lisfranc injuries
  • Patients with multiple metatarsal fractures