Trauma is any physical injury caused by violence or other forces. Serious trauma puts the patient at risk of death or loss of function.
Types of Trauma
There are three types of serious trauma: penetrating, blunt, or burns. Other categories, such as poisoning and drowning, are sometimes considered under the heading, "trauma." Persons with traumatic injuries may have a combination of injury types.
What Patients Go Where?
Good trauma care depends on getting the right patient to the right place at the right time. The right place is determined by matching the patient's needs with the availability of definitive trauma care, that is usually, surgery. A concept called "triage" (sorting) is used to determine which patients are seriously injured and should go to a trauma center. (See the Adult and Pediatric Trauma Triage Guidelines) Because it can provide definitive surgical care in the shortest amount of time, the trauma center is the most appropriate medical facility for seriously injured patients. Care is waiting for the trauma patient, instead of the patient having to wait for care.
What is a Trauma Center?
Trauma centers are specially equipped and organized hospitals, specializing in caring for seriously injured patients. Trauma center care guarantees the immediate availability of specialized personnel, equipment, and capabilities 24 hours a day. These centers work closely with each other and with local community hospitals to assure the best possible appropriate trauma care. Level I and Level II trauma centers are located on a population and geographic basis across New Jersey.
•AtlantiCare Regional Medical Center, Atlantic City
What's the Difference Between a Level I and a Level II Trauma Center?
Because of the large personnel and facility resources needed for patient care, education and research, most Level I trauma centers in the U.S. are university-affiliated teaching hospitals. This is the case in New Jersey, where all three Level I trauma centers are hospitals which are affiliated with the University of Medicine and Dentistry of New Jersey. A Level I trauma center is a regional resource facility and has the capability to provide total care for all aspects of trauma, from prevention through rehabilitation.
Level I trauma centers in New Jersey must treat a minimum of 600 patients per year. This is because data show there is a correlation between patient outcome and the number of procedures which a surgeon performs annually. Adequate experience with life-threatening or urgent cases is necessary for the trauma team to maintain its skills. Cost-effectiveness is also a consideration.
Level II trauma centers are also expected to provide definitive trauma care, regardless of the severity of injury. Level II trauma centers have most of the clinical capabilities of a Level I. Level II trauma centers are required to participate in trauma research conducted by the Level Is and to sponsor public and provider educational programs in cooperation with the Level I centers. Level II trauma centers must treat a minimum of 350 patients per year.
Adult Trauma Triage Guidelines
Statement of INTENT: The following trauma triage guidelines are provided to assist in determining the disposition of adult trauma patients. These guidelines are intended to be utilized in conjunction with clinical judgment. It is understood that these are guidelines only and are to be used whenever possible in communication with a base station physician.
Pedestrian, Motorcyclist or Pedalcyclist
Thrown or Run Over
To TRAUMA CENTER with ALS
TO LOCAL HOSPITAL
Pediatric Trauma Triage Guidelines
STATEMENT OF INTENT: The following pediatric trauma triage guidelines are provided to assist in determining the disposition of children 12 years of age or younger. Use the adult trauma triage guidelines for children older than 12 years of age. It is understood that these are guidelines only and are to be used, whenever possible, in communication with a base station physician. These guidelines are intended to be utilized in conjunction with clinical judgment.
STEP 1: PHYSIOLOGY (any one of the parameters listed below)
Pedestrian, motorcyclist or pedalcyclist thrown or run over
Front seat passenger with deployment of air bag (same side)
TRAUMA CENTER with ALS
TO LOCAL HOSPITAL
Fly or Drive Criteria
Making an Informed Decision
When someone is seriously injured, EMS personnel need to decide whether transportation by ambulance or helicopter will get the patient to the trauma center sooner. There are several considerations in making this decision:
•Ground travel time to the nearest trauma center (e.g., distance, traffic congestion)
•The helicopter's estimated time of arrival (ETA), the transfer time, and flight time to the trauma center
•Whether multiple patients are involved
Let's discuss each of these considerations separately. Generally, the factors which should be taken into account are:
•Ground transport should be used for an unentrapped patient who is within 20 minutes ground travel time from a trauma center.
•Entrapped patients are an exception to the 20-minute rule, if the helicopter can reach the scene while the patient is being rescued or extricated.
•The helicopter should generally be called to a scene which is more than 30 minutes by ground from a trauma center.
•Helicopter use when ground travel time is between 20 and 30 minutes is a gray area. There you need to consider factors such as the helicopter's estimated time of arrival, in-flight time, extrication time, etc.
•Keep in mind that, while a helicopter is fast once in the air, getting to the landing zone and loading the patient can easily add 5 to 10 minutes, or more, to onscene time.
•Consider requesting a helicopter for incidents involving more than three critical patients. Additional manpower, communication with medical control, and transport options can be obtained by using the air medical helicopter system.
Accessing NorthSTAR and SouthSTAR
Two dedicated, medically configured helicopters serve New Jersey (see related Background Information). To access the New Jersey air medical system
•In the 609 area code, call 1-800-544-4356 for SouthSTAR
•In all other New Jersey area codes, call 1-800-332-4356 for NorthSTAR
If the service you call is not available, the air medical helicopter dispatch center will arrange for another EMS helicopter to respond. Mutual aid agreements exist among the two instate air medical program sites and between the New Jersey EMS Helicopter Response Program and air medical programs in Pennsylvania and New York.
Helicopter Request Information
When you call the dispatch center for air medical helicopter assistance, please have the following information ready, if possible:
•Your name and agency with a call back number
•The county and municipality names and incident location with cross-streets (so the pilot can find the incident location on a map) and any nearby landmarks which are visible from the air (such as water towers)
•The nature of the incident, including number of patients (with approximate age and sex), number of entrapped patients (with approximate age and sex), and the types of injuries and their extent (with vital signs, if available).
•Location of proposed landing zone to incident and any overhead obstructions or other dangerous conditions (such as wires or fences), if known at the time of the call
•If known at the time of the call, the following information should also be supplied: the original requesting agency unit number and name, as well as the VHF radio frequency of the onscene landing zone coordinator and that person's operating number and name
•Remember to call the helicopter dispatch center early in a serious incident to minimize response time. If you are en route to what appears to be a serious situation and you are unsure whether the helicopter will actually be needed, ask for it to be notified to "stand by."
•You can call the helicopter no matter what time of day or night.
•Always assume a helicopter is available and in operation, regardless of weather conditions.
•Also call for a mobile intensive care (MICU) advanced life support unit as soon as you have activated the helicopter, if an MICU hasn't been called for previously.