ILLINOIS REGION 4 TRAUMA PLAN - Anderson Hospital



ILLINOIS REGION 4 TRAUMA PLAN

APPROVED

November 6, 1997

January 24, 2005

REVISED

September 2009

June 3, 2014

ILLINOIS REGION 4 TRAUMA PLAN

TABLE OF CONTENTS

SECTION PAGE

1. Purpose ----------------------------------------------------------------------- 3

2. Authority ---------------------------------------------------------------------- 3

3. Boundaries ------------------------------------------------------------------- 3

Hospitals ------------------------------------------------------------- 3

4. Participants in Trauma Region Plan -------------------------------------- 6

5. System Management ------------------------------------------------------- 8

6. Pre-Hospital Care ----------------------------------------------------------- 10

7. Trauma Care --------------------------------------------------------------- 11

8. Pediatric Care --------------------------------------------------------------- 12

9. Inter-Hospital Transfer --------------------------------------------------- 13

10. Data Collection ------------------------------------------------------------- 16

11. Quality Assurance -------------------------------------------------------- 18

12. Region-wide Disaster Preparedness Plans ----------------------------- 19

13. Appendix I Minimum Trauma Field Triage Criteria ------------------- 20

14. Appendix II Start Triage Plan (For Mass Casualty Incident) -------- 21

15. Appendix III Trauma Transfers in ED > 2 hours Audit Filter Sheet 24

16. Appendix IV Transfer to Trauma Center form --------------------------25

ILLINOIS REGION 4 TRAUMA PLAN

Section 1. Purpose

Participants in the Trauma System of Region 4 of the State of Illinois share a commitment to the organized, comprehensive and timely care of persons who are injured and critically ill. They believe that the ability to respond appropriately to the needs of trauma victims require the cooperation and skills of the entire healthcare team.

Section 2. Authority

This Trauma Region Plan is developed under the authority of the Illinois Administrative Code, Title 77, Chapter 1, Subchapter F, Part 515.220

The plan establishes and implements agreements of cooperation for the review and coordination of services within the Trauma Region 4

Section 3. Boundaries

A. Region 4 boundaries include the following counties:

Madison, St. Clair, Monroe, Randolph, Bond, Clinton, Washington

B. A listing of all hospitals in the region and hospitals affiliated with the region are as follows.

Madison County

Alton Memorial - Resource Hospital

Alton, Illinois

Saint Anthony’s Health Center - Resource Hospital

Alton, Illinois

Gateway Regional Center - Associate Hospital

Granite City, Illinois

Anderson Hospital - Resource Hospital

Maryville, Illinois

St. Joseph’s Hospital - Participating Hospital

Highland, Illinois

Bond County

Greenville Regional Hospital - Resource Hospital

Greenville, Illinois

St. Clair County

Touchette Regional Hospital - Participating Hospital

Centreville, Illinois

Memorial Hospital - Resource Hospital

Belleville, Illinois

St. Elizabeth’s Hospital - Associate Hospital

Belleville, Illinois

Clinton County

St. Joseph’s Hospital - Participating Hospital

Breese, Illinois

Monroe County

None

Randolph County

Red Bud Regional - Participating Hospital

Red Bud, Illinois

Randolph County (Con’t.)

Sparta Community Hospital - Participating Hospital

Sparta, Illinois

Chester Memorial Hospital - Participating Hospital

Chester, Illinois

Washington County

Washington County Hospital - Participating Hospital in Region 5 by waiver

Nashville, Illinois (Resource Hospital-Good Samaritan)

Greene County

Boyd Memorial Hospital - EMS Region 3 per EMS Act

Carrollton, Illinois

Macoupin County

Community Memorial Hospital

Staunton, Illinois

Fayette County

Fayette County Hospital

Vandalia, Illinois

ST. LOUIS MISSOURI TRAUMA CENTER HOSPITALS

Saint Louis University Hospital - Level I Trauma Center

Barnes Hospital - Level I Trauma Center

Cardinal Glennon Children’s Medical Center Level I Pediatric Trauma Center

St. Louis Children’s Hospital - Level I Pediatric Trauma Center

Mercy Hospital Burn Center

Section 4: Participants

ILLINOIS REGION 4 REGION TRAUMA COMMITTEE

Southwestern Illinois EMS System:

Resource Hospital

Memorial Hospital

EMS Medical Director: Craig Brummer, MD Designate: Delwin Merchant, MDEMS Provider: Jason Laut, EMT-P Designate: Kimberly Howell, RN, PhD

Associate Hospital

St. Elizabeth’s Hospital

Administrator: Mary Ann Reese CEO Designate: Rachelle Leach, MD

Nursing Director: Shelley Harris, RN, CNO Designate: Tim Claxton, RN

Anderson Hospital EMS System:

Resource Hospital

Anderson Hospital

EMS Medical Director: Chris Cruz, MD Designate: Jean M. Day

EMS Provider: Chris Jamruck, EMT-p Designate: Eric Brandmeyer

St. Joseph Highland

EMS Medical Director: Matt Moslener

Nursing Emergency Management: Connie DeProw

Associate Hospital

Gateway Regional Hospital

EMS Medical Director: Jeffrey Arendale, MD Designate:

EMS Coordinator: Jeanine Gilmeister, RN, ED Director Designate:

Alton Memorial EMS System:

Resource Hospital

Alton Memorial Hospital

EMS Medical Director: Angela Holbrook Designate: Debbie Woelful

EMS Provider: Jason Bowman, EMT-P

Associate Hospital

Fayette County Hospital

Administrator: Greg Stornes

ED Manager: Tina Evans, RN, MSN

St. Anthony’s EMS System

Resource Hospital

St. Anthony’s Health Care Center

EMS Medical Director: George Hevasey , RM

EMS Provider: Maurice Hand Designate: John Pieput

Administrator:

Resource Hospital

Greenville Regional

EMS Medical Director: Michael Bond, MD Designate: Lucas Emerick

EMS Coordinator: Chris Wagner Designate: Judy Collier

TRAUMA CENTER HOSPITALS

-

Saint Louis University Hospital - Level I Trauma Center

BJC Hospital - Level I Trauma Center

Cardinal Glennon Children’s Medical Center Level I Pediatric Trauma Center

St. Louis Children’s Hospital - Level I Pediatric Trauma Center

Mercy Burn Center

Section 5. System Management

A. Process for Changing Plan and Conduct of Regional Trauma Committee Meetings

1. The Regional Trauma Advisory Committee may meet quarterly and amend the Trauma Region Plan at any meeting of the Regional Trauma Committee.

2. All meetings of the Regional Trauma Committee will be governed by Robert’s

Rule of Order and will be open meetings, subject to contrary provisions of the Trauma Region Plan. The Director of one of the Level I Trauma Center or his designee will chair the Regional Trauma Committee. The Director may appoint subcommittees from time to time to assist the full Committee. The chair will rotate every 2 years between the 4 Level I trauma Centers from Missouri.

3. Any amendment of the Trauma Region Plan shall comply with Emergency

Medical Services and Trauma Center Code.

4. Special Meetings. Special meetings of the Committee may be called by or at the request of the Chairman or any two (2) Committee members.

5. Place of Meeting. The Chairman may designate any place within Region 4 - as the place of the meeting.

6. Notice of Meeting: Written or printed notice, stating the place, time and hour of the meeting and, in the case of a special meeting, the purpose or purposes for which the meeting is called, shall be delivered not less than five (5) days before the date of the meeting, either by person- or by mail, or at the direction of the person or persons calling the meeting, to each without objecting to the form or notice of that meeting at the commencement of the meeting, shall be deemed to have waived any objections to the form of notice.

7. Each regular member shall have one vote. That individual shall vote in person or by written proxy executed prior to and in attendance of the meeting.

8. Quorum. Fifty-one percent (51%) (rounded to the highest whole number) of the Committee members present in person constitutes a quorum at any meeting of the Committee; provided that if less than a quorum are represented at any meeting, a majority of the members so present may adjourn the meeting.

9. Majority Control. The vote of a majority of the Committee members present at a meeting at which a quorum is present shall be necessary for the adoption of any matter voted upon by the Committee.

Section 6. Pre-Hospital Care

A. Field Triage

1. If there is sustained hypotension – BP 25 minutes from Trauma Center, transport to nearest participating trauma hospital

> 30 minutes from Trauma Center or participating trauma hospital, transport to nearest hospital

>45 minutes from Trauma Center or participating trauma hospital in a rural area where there is no comprehensive emergency department available, transport to nearest hospital

(Source: Amended at 24 Ill. Reg. 9006, effective June 15, 2000)

Appendix II REGION IV STANDARD OPERATING PROCEDURES (SOPs)

START TRIAGE PLAN

The START plan (Simple Triage & Rapid Treatment) was developed to be used in the event of a mass casualty incident (MCI). This plan allows Rescuers, EMTs & Paramedics to triage a patient at a MCI in 60 seconds or less. The plan is based on three observations of each patient:

1. Respiration

2. Circulation

3. Mental Status

START Principles:

The START plan calls for rescuers to correct the main threats to life, obstructed airways and severe arterial bleeding. The START plan utilizes the METTAG Triage Card which classifies patients into four different areas for treatment. It is a system that quickly and accurately categorizes victims into treatment groups. The plan is simple to learn and simple to retain. It is extremely useful in the MCI setting by maximizing the efficiency of the rescuers.

The Triage Team must evaluate and place the patients into one of four categories.

Deceased (BLACK) – No ventilations present even after attempting to reposition the airway.

Immediate (RED) – Ventilations present only after repositioning the airway. Also place into this category if respiratory rate is greater than 30 per minute. Delayed capillary refill (greater than 2 seconds) or the patient is unable to follow simple commands.

Delayed (YELLOW) – Any patient who does not fit into either the immediate or minor categories.

Minor (GREEN) – Separate from the general group at the beginning of the triage operation. Also known as the “walking wounded”. Direct patients away from the scene to a designated safe area. Use these patients to control bleeding and assist in airway maintenance of immediate patients.

Implemented/Revised: 8/25/2003, reviewed: 8/19/2014

REGION IV STANDARD OPERATING PROCEDURES (SOPs) cont.

START Procedures:

RESPIRATORY

Every patient will be assessed for ventilatory rate & adequacy.

If a patient is not breathing, check for foreign objects causing obstruction in the mouth. Remove loose dentures.

Reposition the head, using cervical spine precautions if this does not delay assessment.

If the above efforts do not initiate respiratory efforts, TAG THE PATIENT RED

Victims who have respirations less than 30 per minutes are NOT TO BE TAGGED AT THIS TIME. ASSESS THESE PATIENTS FOR PERFUSION.

PERFUSION

The best method to assess perfusion is capillary nail bed refill.

Press nail beds or lips, then release. Color should return to the area within two seconds.

If it takes more than two seconds, the patient is showing signs of inadequate perfusion and MUST BE TAGGED RED.

If the color returns within two seconds, the patient is NOT TAGGED UNTIL THE MENTAL STATUS IS ASSESSED.

If capillary refill cannot be assessed, palpate the radial pulse. In most cases, if the radial pulse cannot be felt, the systolic blood pressure will be below 80 mmHg.

Hemorrhage control techniques will be incorporated into this section. Control significant bleeding by direct pressure and elevate the lower extremities.

Utilize the “walking wounded” to assist the hemorrhage control on himself or another patient.

Implemented/Revised: 8/25/2003, reviewed 8/19/2014

REGION IV STANDARD OPERATING PROCEDURES (SOPs) cont.

MENTAL STATUS

The mental status evaluation is used for patient whose respirations and perfusion are adequate. To test mental status, the rescuer should ask the victim to follow a simple command such as, “open and close your eyes”, or “squeeze my hands”.

If the patient cannot follow these commands, then TAG THE PATIENT RED.

If the patient can follow these commands, TAG THE PATIENT GREEN.

Only after all patients have been triaged can patients be treated. The above procedures should take no more than 60 seconds per patient.

TRIAGE TAGS

Triage tags are completed during transportation to the hospital or in the treatment area if there is time. To fill out the tag properly, follow these instructions:

• enter time of triage

• enter date

• enter other important information (history, treatment, etc…)

• enter vital signs and the time taken in indicated areas

• enter injuries on the diagram

• enter name (if able to obtain)

• enter address with city and state (if able to obtain)

• EMT’s rendering treatment will enter IV’s drugs, and other treatments

• tear off all colored areas below the determined priority and retain

• attach tag SECURELY and in a CLEARLY VISIBLE area

The corner of the tag marked with a cross is removed in the treatment section prior to moving to a medical facility. These should be given to the Sector Officer in that area.

The corner marked with an ambulance is to be removed prior to the actual removal of the patient from the treatment area to a medical facility. It is to be retained by the crew until the end of the MCI. These are then given to the Sector Officer in charge of Transportation.

Implemented/Revised: 8/25/2003, reviewed: 8/19/2014

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Appendix III ILLINOIS REGION 4 & 5 TRAUMA QI

Audit Filter: Category I/II Trauma transfers that were in the ER > 2 hours

No issues to report this quarter

Institutional 7 digit number:_________________________________

(Month and year should be first 4 digits, e.g.: January 2004 – 0104; remaining 3 digits institutional choice, blinded to committee)

Patient Information:

Age:____ Sex:_____ Mechanism of Injury: MVC  MCC ATV

GSW _____ SGW _____ SW___

Assault Fall (___ ft) Other_______

ED Information:

ED LOS _____________

ED Management: Radiology/CT scans Labs Other_______

Chest Tube IV’s

Suturing Lacerations ( ) Blood products (_____________)

Transfer Diagnosis: _______________________________________________________________________________

Receiving Facility: ______________________________________________________________

Mode of Transfer: Ground Air Private

Reason for Transfer: Patient Request Specialized Care Primary Care Physician Request

Reason for > 2 hour delay in transfer: Stabilization

Accepting Physician

Availability of beds at receiving hospital

EMS Response Ground Air

Weather

Other:_____________________________

Key: MVC: Motor Vehicle Collision GSW: Gunshot Wound

MCC: Motorcycle Collision SGW: Shotgun Wound

ATV: All Terrain Vehicle SW: Stab Wound

Fax to: Chris Green 314-268-6441 Developed: 9/97

Revised: 1/00, 06/04, 6/3/2014

Appendix IV

TRANSFER TO TRAUMA CENTER

Please complete this form and forward with patient to receiving trauma center

Date _____/_____/_____ Condition: □ Stable □ Fair □ Critical

|Accepting Physician:________________________ Patient Information |Referral Information |

|Name_____________________________ Age_____ M/F |Physician___________________________________ |

|Next of Kin_____________________ Family Notified___ |Hospital___________________________________ |

|Contact Information:___________________________ |Phone #___________________________________ |

| Mechanism of Injury |Symptoms/Signs |Injuries Found/Suspected |Treatment Initiated |

|Assault |

|ATV/4-wheeler |

|Bicycle |

|Fall/Jump ___ feet |

|GSW |

|Motorcycle |

|Motor Vehicle |

|Pedestrian |

|Stab/Cut |

|Other: |

Checklist

Airway: ___Endotracheal tube ___Spine protection

Breathing: ___Oxygen ___SaO2 ___EtCO2 ___Chest tubes

Circulation: ____ ml IV Fluids ____ ml Blood ___ Drugs Output: ___ ml Urine ___ ml Chest Tube

Diagnostic: ___ Radiographs [ ___Copies ___Electronically sent] ___Labs Contrast given: ___Yes ___No

Equipment: ___ED record ___EMS scene trip sheet ___IV ___Foley ___Splints ___Gastric tube

| Adult Level 1 Trauma Centers |

|Barnes Jewish Hospital: Referral Line: 800-252-3627 |SLU Hospital: Referral Line: 866-491-0858 |

|ED Fax: 314-747-3338 |ED Fax-314-577-8775 |

|Pediatric Level 1 Trauma Centers |

|Cardinal Glennon: Referral Line: 888-229-2424 |St. Louis Children’s: Referral Line: 800-678-HELP |

|ED Fax: 314-268-6417 |ED Fax: 314-544-2110 |

Completed by______________________________

Print Name

FOR HAND OFF COMMUNICATION ONLY. NOT PART OF MEDICAL RECORD PAG: 09/14

-----------------------

* Sustained Hypotension – BP < 90 Systolic

(Peds < 80 Systolic) on two consecutive measurements five minutes apart

Mandatory notification of the trauma surgeon from the field

Yes

Category I

Blunt or Penetrating Trauma with Unstable Vital Signs and/or:

*Hemodynamic Compromise as Evidenced By:

-BP < 90 systolic

-(Peds – BP < systolic)

*Respiratory Compromise as Evidenced By:

-Respiratory rate 29

*Altered Mentation as Evidenced By:

-Glasgow Coma Scale < 10

Anatomical Injury

*Penetrating injury of head, neck, torso, groin

*Two or more body regions with potential life or

limb treat

*Combination trauma with > 20% TBSA Burn

*Amputation above wrist or ankle

*Limb paralysis and/or sensory deficit above the

wrist or ankle

*Flail chest

Two or more proximal long bone fractures

Yes

*Initiate Field Trauma Treatment Protocols

*Rapid Transport to Trauma Center (1)

No

No

Category II

Mechanism of Injury

*Ejection from motor vehicle

*Death in same passenger compartment

*Falls > 20 feet

(Peds – falls > three time body length of child)

*Pregnancy > 24 weeks

No

*Initiate Field Trauma Treatment Protocols And

Transport to Closet Hospital

Yes

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