Hospital pre-alert & handover

The ambulance service will use the pre-hospital triage tool to determine the appropriate destination for the trauma patient at the roadside.  The ambulance will provide an ATMIST handover using the form below over the airwaves radio system to the receiving hospital.

Trauma Triage Tools for Adults and Paediatrics 

Record the following information during the pre alert from the Scottish Ambulance Service (SAS):

• Age and sex of the injured person.
• Time of incident.
• Mechanism of injury.
• Injuries suspected.
• Signs, including vital signs, and GCS.
• Treatment so far.
• Estimated time of arrival (ETA).
• Special requirements.
• Ambulance call sign.
• Name of person taking the call.
• Time of the call.

Pass the pre-alert form to the Trauma Team Leader (TTL) or Senior Nurse who will determine the level of trauma team response according to the:

Trauma team activation protocol for Royal Infirmary of Edinburgh.

Trauma team activation protocol for the Royal Hospital for Children & Young People.

Activate the Code Red Trauma Team if the patient has ALL of the following:

• Systolic blood pressure (BP) <90mmHg.
• Suspected or confirmed active haemorrhage.
• Unresponsive to volume resuscitation.

Royal Infirmary of Edinburgh.

• Code Red protocol

Royal Hospital for Children & Young People

• Activate Major Haemhorrage Protocol 
• Traumatic Haemhorrage Protocol

INITIAL PHASE

• Pack A: 4 x PRBC + 4 x FFP followed by Pack B empiric transfusion.
• Tranexamic Acid 2 x 1g bolus
  • May have been given in pre-hospital phase.
• Maintain Temp > 35°C.
• Maintain Calcium > 1mmol/l.
• Expedite definitive haemorrhage control.
• Anticipate Transfusion Requirements.

CLOTPro ALGORITHIM

ClotPro repeatable 15min after blood products to assess response and guide further therapy.

ClotPro guided therapy is in addition to the empiric transfusion strategy until definitive haemorrhage control has been achieved.

Thrombin Generation/Fibrinogen/Platelets

Fibrinolysis

• The TTL should be easily identifiable for receiving handover. 
• Address immediate life threatening pathology before handover.
• Handover should use ATMIST format.
• Handover should take no more than 30 seconds.
• Communicate further relevant information to the TTL or scribe later.