TIPS FOR TRAUMA RADIO REPORTS
By Sharon Perry, Trauma Program Manager, MMC
Have you ever wondered what the MICN is doing on the other end of the radio
while you are giving your radio report? Do you wonder if anyone cares what
information you are sharing, or not sharing? Why do the hospitals need a radio report
and what do they do with the information?
Radio reports can come in a variety of content and length, and it can be difficult
sometimes for pre-hospital providers to find a happy medium between too much and too
little information. While it is important that you paint the best picture you can of the
patient’s condition, at the same time it is important that you ensure that you aren’t tying
up the radio for other crews that may need to report on a critical patient, or cause the
MICN to lose interest in your ramblings and miss or skip vital trauma triage information.
Brief, formal radio reports (we discourage the use of a cell phone) with concise content
allows more time for you to provide patient care, and assures you don’t lose the
attention of the MICN on the radio.
In a trauma system, EMS personnel are first to assess a trauma patient and
make the decision that the patient needs to come to a trauma center based on prehospital trauma triage criteria and judgment. During your radio report, the information
you provide our trauma centers will determine the level of trauma team response,
surgeon response, if our operating room holds cases, and if our radiology department
delays CT scans. Trauma is a surgical emergency, and trauma patients require timely
operative care for the best outcome. Information provided in your radio report allows
the trauma centers to use their internal trauma triage criteria to assure a timely
resuscitation and transition to the operating room for the best outcomes.
During recent trauma quality meetings, the trauma program managers have
identified a trend in essential information missing from our radio reports. Hypotensive
episodes, Glasgow coma scores, mechanism, and assessment findings have all
surfaced as these cases were reviewed and discussed. In addition, many times
pertinent findings by the ground crews, such as hypotensive episodes, were not
communicated to the flight crew during the hand-off which were causes for undertriages and delays in care such as blood transfusions, and operative care. Despite the
EMS agency sending out memos periodically over the last two years, we seem to still
be having a fair amount of opportunities for improvement, so I hope everyone who
transports trauma patients find this information useful.
Mountain-Valley EMSA policy 330.10 Ambulance Report Format states that
“Standard patient reports to a Base Hospital or Receiving Facility should be no longer
than 30-40 seconds”. Included in the policy is a suggested format, similar to what our
trauma centers are looking for in a concise MIVT report.
Mechanism: Mechanism and pattern of injury. Knowledge of the mechanism of
injuries and specific injury patterns (e.g. type of motor vehicle impact) will help to
predict certain injuries.
Injuries: What is the patient’s chief complaint and your major/significant findings
that would allow us to accurately triage this patient?
Vitals: All vital signs including a GCS (worse and best), and any episodes of
hypotension. This information is used to activate our surgeons and provide
timely operative care to our most critical trauma patients before they
decompensate in our trauma rooms.
Treatment: Any treatment initiated and patient response.
The American College of Surgeons and the Center for Disease Control require
trauma centers to use field radio report information to accurately triage to their internal
trauma activation criteria. The highest level of criteria is listed specifically both in the
CDC guidelines, and in the American College of Surgeons “Resources for Optimal
Care of the Trauma Patient 2006” Although DMC and MMC may have different internal
trauma triage/activation policies, the highest level of activation (Tier 1 at MMC, and
Level 1 at DMC) all include the same anatomical and physiological criteria.
1. Confirmed systolic BP <90 at any time in adults and age specific hypotension
in children.
2. GSW to the neck, chest or abdomen
3. GCS less than or equal to 8 with mechanism attributed to trauma
4. Transfer patients from other facilities requiring blood to maintain vital signs.
5. Respiratory compromise/obstruction and/or intubation in a patient who is not
transferred from another facility
6. Spinal cord injury as evidenced by paralysis or loss of sensation
7. Unstable pelvic fractures
8. Two or more proximal long-bone fractures
9. Open or depressed skull fracture
10. Amputation proximal to the wrist or ankle
This list of anatomical and physiological injuries are true surgical emergencies and
require immediate operative care for optimal outcomes. As field personnel, you are the
first line of the assessment of actual or potential injuries and without complete and
accurate communication via your radio report, the morbidity and mortality of our trauma
patients immediately takes a turn for the worst.
A trauma program is a system, and in addition to great care and rapid transport,
it also takes teamwork and strong communication from field through rehabilitation or
discharge. You are at the front line, you pull the trigger for exceptional care, and you
make a difference. Something as simple as appropriate field triage to a trauma center,
or spending 30 seconds on the radio painting a picture for our MICNs is vital.
Glasgow coma scales, specifically the motor score, can predict the need for
operative treatment and outcome in many instances. It is vital that this is included in
your trauma radio reports, even for the frail elders that take a tumble and hit their head.
We want to know the best and the worst scores during your time with these patients.
We recommend you place a cheat sheet in your ambulances for a quick and accurate
reference.
Blood pressures are extremely important as patients tend to initially be in a
decompensatory state, then will start to compensate and slowly decompensate again if
shock is not quickly recognized and treated. One episode of hypotension prior to
initiation of transport and treatment may make a difference if the patient receives
damage control surgery in 20 minutes or an hour and twenty minutes. In addition, the
CDC has recognized our increasing elderly trauma population, and has placed in their
field treatment decision guideline the following; “Risk of injury/death increases after age
55. Systolic BP <110 may represent shock after age 65”. Our trauma data review has
shown us that quite a few of our under triages have been in this group, so heads up.
The Trauma Program Managers and Medical Directors feel that we have an
exceptional trauma system here in our region, and it all starts with your rapid
assessment, transport and communication. Our surgeons and trauma nurses
appreciate a concise radio report with pertinent information to accurately triage our
incoming trauma patients. Glasgow coma scales must be included in a trauma radio
report, as well as any episodes of hypotension from the first responders, ground and/or
air crews. This vital information will assist the trauma centers to provide immediate
resuscitation and surgical care to our critical trauma patients which will certainly
contribute to the quality of care we provide in our trauma system.
Here are some tips for all your radio reports that you may find helpful:
*Plan ahead. Practice in your mind if time permits
*Be orderly & concise in your presentation (goal <30 seconds with max <60 seconds)
*Omit no important details-Vitals, GCS, pertinent positives
*Avoid all irrelevant details-START triage, abrasions, PMH (unless pertinent) this can be
given at the bedside after arrival
*Use a notepad to help you recall information-2 inch tape on your pant leg also works
*Practice
You are the eyes and ears of the trauma center until you arrive at the hospital, so
it is your job to paint the best picture you can of the patient’s current condition.
Remember, the MICN is looking for information for internal triage, surgeon activation,
and the need to pre-order uncrossmatched blood to treat shock so we can provide the
time sensitive continuum of care needed for the best outcome for our trauma patients.
Thank you all for being such an important part of our local trauma team.