ECRN- Takes the radio call from EMS, categorizes the trauma patient, and notifies the
ER physician and charge nurse. For a category I trauma, the ECRN confirms categorization with the ER physician unless the patient is a traumatic arrest, has unstable BP X2 five minutes apart, or severe mechanism of injury resulting in GCS
<11. The ECRN asks the secretary to page the in-house trauma surgeon and activate a
Trauma code.
Charge Nurse- For multiple victims the charge nurse reassigns staff and designates which nurses and Patient Care Tech’s will care for the additional trauma patients.
Team Leader- The ER physician is the team leader until the Trauma surgeon arrives.
The team leader will direct the course of the primary survey and resuscitation. Team members must be ready to response to the team leader. All questions are directed to the team leader. All orders come from the team leader.
a. Primary Survey:
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.Receives verbal report from the ECRN or TNS prior to patient arrival
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Categorizes and assesses or has designee categorize and assess the patient within 10 minutes of arrival.
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Performs primary survey.
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Makes the decision for intubation or surgical airway.
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Decides on IV orders, and additional venous access.
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Decides on the amount and type of blood needed.
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Orders initial x-rays and determines the order of priority. Orders lab tests.
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Determines need for early peritoneal lavage or thoracostomy or FAST
exam.
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Determines need for arterial monitoring line.
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Inserts chest tube as needed.
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Calls out test orders to the Secretary
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Calls out medication, procedure orders, and assessment to TNS
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Consider critical care panel
b. Secondary:
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Performs secondary survey.
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Orders and determines priority of diagnostic tests and procedures.
Do not delay CT for Foley, EKG, etc.
Determines patient’s stability. Orders CT scan if VS are stable. Performs Fast Abdominal
Sonography for Trauma (FAST) or Diagnostic Peritoneal Lavage (DPL) for the unstable patient. FAST allows rapid and noninvasive determination of the presence of free intraabdominal fluid by ultra sound. FAST looks for injuries to the abdomen, heart, or pelvis.
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Examines films.
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Contacts consultants as needed.
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Decides on patient disposition and communicates such to unit secretary and primary nurse (TNS).
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Puts T-Sheet on the chart.
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ER Physician Team leader responsibilities end upon the arrival of the
Trauma surgeon.
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Makes sure all orders are given prior to leaving the trauma room
Reassess patient after each intervention and with any clinical change orders or performs appropriate treatment or test.
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Primary RN/TNS: Assigned as the trauma nurse before each shift a. Prior to arrival:
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Assembles trauma team and makes role assignments.
Physician, ER Tech, Second nurse if available, and ancillary departments.
If stable Vs notify CT as soon as possible. If unstable prepare for US.
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Confirms universal precautions for all team members.
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Reviews information from ambulance radio report.
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Dons protective eyewear, gown, mask, gloves and cap.
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Assures that the Trauma Code has been called over head.
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Assures that the Level I Infusor is in the room and an IV bag with large bore tubing is primed with IV access equipment. b. Primary Survey:
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Directs/supervises all non-physician personnel. Delegates duties as appropriate.
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Documents on the TFS as the assessment is being done
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Monitors vital signs. (Heart rate by monitor, pulse oximetry, BP, RR.) First three BP measurements are taken manually by ER Tech
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May insert IVs if a second RN is not available.
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Communicates with patient.
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Communicates assessments, interventions and change in condition to
the Team Leader.
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Accepts medication and treatment orders from Team Leader.
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Administers medications at direction of Team Leader if a second nurse is not available.
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Monitors effect of medications and treatments and communicates response to team leader.
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Assists with surgical airway as needed if a second nurse is not available.
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Prepared drugs for RSI if a second nurse is not available.
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Monitors left femoral pulse for rate and quality
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Communicates problems, needs, and current status to ED charge nurse. c. Secondary:
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Makes sure a rectal exam is done before the insertion of a Foley catheter
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Inserts orogastric/nasogastric tubes as directed by team leader if the second
nurse is not available.
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Ensures patient ID band is placed.
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Ensures that Trauma Flow Sheet is complete before patient leaves ER.
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Monitors neurologic condition: pupil size and reaction, mentation.
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Takes patient's temperature and institutes warming measures if needed.
Assisting Trauma RN (For Category I and if available for Category II)
Prior to patient arrival
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Sets up Level I Infusor and administers blood.
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Assures an IV bag with large bore tubing is primed and at bedside with IV access equipment.
Primary Survey
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Insert IVs
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Administers medications at direction of Team Leader
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Assists with surgical airway as needed
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Prepared drugs for RSI.
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Assesses oxygenation.
Secondary Survey
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Inserts Foley catheter, after rectal exam.
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Inserts orogastric / nasogastric tubes as directed by team leader.
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Does not leave the leave the Trauma Room without permission from the primary nurse
ER TECH: A PCT will be assigned to trauma at the beginning of each shift. The PCT assigned must check in with the team leader or TNS for each trauma code and get approval from the TNS prior to leaving the resuscitation:
Prior to patients arrival
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Checks daily that Foley catheter trays, NGT trays, thoracostomy trays, DPL tray, and minor suture tray are readily available.
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Checks bedside for equipment, including: working suction, Ambu bag with
O2, blood tubes, turns EKG monitor on
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Assures Level I Fluid warmer is in the room
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Dons protective eyewear, gown, mask, gloves and cap. b. Primary Survey:
 Stands at the patient’s side.
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Exposes the patient.
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Draws blood specimens.
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Controls bleeding from head and neck wounds.
 May start IV’s and insert a Foley cath after the rectal exam.
C. Secondary
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Anticipates and sets-up equipment and procedure trays.
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Assists with obtaining supplies and equipment.
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Performs other duties as directed by primary RN.
 assists with patient warming
Registrar: Gathers the patient information, enters the data and assembles the chart
Unit Secretary (Clerk)- (must check in with team leader or TNS and get approval prior to leaving the resuscitation):
Prior to arrival of the patient
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Category I Trauma- Makes sure all trauma team members have responded to the trauma code and calls team members that have not responded to the overhead page.
ER physician
Trauma surgeon
TNS
ED Patient Care Tech
ER Registrar
Bed Manager
Trauma Nurse Coordinator if in house
Respiratory therapist
Radiology Tech
CT Tech –On site 24/7
Lab Tech
EKG (should never delay CT scan unless ordered by the Team Leader)
Bed Access Operations Manager
Patient Representative
Chaplain
Security
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Submits orders for tests on the bedside computer
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Makes phone calls as instructed by the team leader
Respiratory therapist (must check in with team leader or TNS and get approval prior to leaving the resuscitation): a. Prior to arrival:
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Checks intubation equipment.
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Checks suction and oxygen.
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Dons protective eyewear, gown, mask, gloves and cap.
Primary Survey a.
Assists team leader at the head of the bed. b.
Performs manual bag ventilation. c.
Monitors respiratory status. d.
Provides ventilator set-up. e.
Suctions airway. f.
Coordinates ventilator set-ups for other areas where patient is to move. g.
Draws/runs ABGs as directed. h.
Communicates assessments and interventions to the team leader. i.
Assures critical care panel is completed and results reported if ordered j.
May be excused by team leader if patient is not intubated and no further respiratory interventions are needed.
Radiology and CT technicians (must check in with team leader or TNS and gets approval prior to leaving the resuscitation): a.
Performs portable x-rays if ordered: 3 views c-spine, PCXR, KUB, pelvis b.
CT c.
Dons protective eyewear, gown, mask, gloves and cap. d.
Films available on PAC unit.
Lab Tech: (Must check in with team leader or TNS and gets approval prior to leaving the resuscitation) a.
Brings two units O Negative Blood to the Trauma Code b.
Drawns the Trauma Profile which includes;
CBC
COMP
Amylase
Type and Screen
ETOH
INR, PTT c . Label tubes prior to leaving the trauma room d . Runs blood specimen tubes to lab and hands tubes to appropriate personnel
Chaplain / ED charge nurse / Patient Rep (when present): a. Assists with identifying patient. b.
Contacts patient family. c.
Keeps family informed of patient status. d. Coordinates family visits with team Leader and primary RN (TNS). e.
Facilitates the psychosocial care of patient, family and visitors.
Security a.
Manages crowd control in the lobby b.
Works with the Primary Nurse to assures that only approved visitors are allowed at the bedside c.
Anticipates potentially disruptive situations
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Others :
All others must remain away from the bedside unless directed by the team leader. The team leader may ask others to leave. Appropriate barrier protection, including protective eyewear, gown, mask, gloves and cap are to be worn by all team members having direct patient contact at any time during the resuscitation. The team leader has the authority and responsibility to remove from the bedside, any personnel without appropriate barrier protection.
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