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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