All posts by TheTraumaPro

Do you have any videos or wisdom to share of how a trauma call should run, from arrival to disposition to OR/ICU? Trauma team roles, positions, responsibilities, etc.

This is something that has to be individualized for every hospital. The team composition, positions, responsibilities is designed with the hospital size, type and trauma center level in mind. I have a few videos available about are team. Start with this one: https://www.youtube.com/watch?v=J8estsbxEWI

How Big Should Your Trauma Bay Be?

Last week I asked for your assistance in determining how big a trauma resuscitation room should be. Thanks to everyone who replied! As you might suspect, these rooms can range from the very spacious…

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to very tight…

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Most respondents indicated that their trauma bays were somewhere between 225 and 300 square feet (21-28 sq meters), although some were quite large (Rashid Hospital in Dubai at nearly 50 sq meters!).

Interestingly, I did manage to find a set of published guidelines on this topic. The Facility Guidelines Institute (FGI) develops detailed recommendations for the design of a variety of healthcare facilities. Here are their guidelines for adult trauma bays:

  • Single patient room: The clear floor area should be 250 sq ft (23 sq m), with a minimum clearance of 5 feet on all sides of the patient stretcher. 
  • Multiple patient room: The clear floor area should be 200 sq ft (18.5 sq m) with curtains separating patient areas. Minimum clearance of 5 feet on all sides of the patient stretcher should be maintained.

The FGI “clear floor area” corresponds to my “Trauma Bay Working Area”, which is the area that excludes all the carts, cabinets, and countertops scattered about the usual trauma room. California’s guideline of 280 sq feet seems pretty reasonable as the “Trauma Bay Total Area”, if you can keep your wasted space down to about 30 sq feet.

Bottom line: Once again, don’t try to figure out everything from scratch. Somebody has probably already done it (designed a trauma bay, developed a practice guideline, etc). But remember, a generic guideline or even one developed for a specific institution may not completely fit your situation. In this case, the FGI guidelines say nothing about the trauma team size, which is a critical factor in space planning. Use the work of others as a springboard to jump start your own efforts at solving the problem.

Related posts:

Hare Traction: The Orthopaedic Surgeon’s Perspective

Here’s a curbside consult from Peter Cole MD, Chief of Orthopaedics at Regions Hospital. This is very interesting information for prehospital and ED providers. Length is 5:23.

This video was presented at Trauma Education: The Next Generation last September. Be sure to check out the upcoming 2014 conference materials at www.TETNG.org. Be sure to register now if you want to get continuing education credit for it!

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The “Dang!” Factor

This tip is for all trauma professionals: prehospital, doctors, nurses, etc. Anyone who touches a trauma patient. You’ve probably seen this phenomenon in action. A patient sustains a very disfiguring injury. It could be a mangled extremity, a shotgun blast to the torso, or some really severe facial trauma. People cluster around the injured part and say “Dang! That looks really bad!”

It’s just human nature. We are drawn to extremes, and that goes for trauma care as well. And it doesn’t matter what your level of training or expertise, we are all susceptible to it. The problem is that we get so engrossed (!) in the disfiguring injury that we ignore the fact that the patient is turning blue. Or bleeding to death from a small puncture wound somewhere else. We forget to focus on the other life threatening things that may be going on.

How do we avoid this common pitfall? It takes a little forethought and mental preparation. Here’s what to do:

  • If you know in advance that one of these injuries is present, prepare your crew or team. Tell them what to expect so they can guard against this phenomenon.
  • Quickly assess to see if it is life threatening. If it bleeds or sucks, it needs immediate attention. Take care of it immediately.
  • If it’s not life threatening, cover it and focus on the usual priorities (a la ATLS, for example).
  • When it’s time to address the injury in the usual order of things, uncover, assess and treat.

Don’t get caught off guard! Just being aware of this common pitfall can save you and your patient!