BCoFD Medical Director Notification Re: July 1, 2013 MIEMSS Protocol Changes (TRAUMA ARREST)

On June 10, 2013 the Baltimore County Fire Department EMS leadership staff convened for its bimonthly meeting.  The EMS staff felt that it was very important to clarify some of the contents contained in the 'Trauma Arrest' protocol update:


o Trauma arrest:
• EMS providers can terminate without medical consult when there are no signs of life and the patient is in asystole
• EMS providers can terminate with medical consult
     • Blunt trauma-- when there are no signs of life and the patient is in a rhythm other than asystole with no ROSC despite 15 minutes of EMS CPR and other appropriate treatment
     • Penetrating trauma-- when there are no signs of life and the patient is in a rhythm other than asystole and there is no ROSC
          o If less than 15 minutes from a trauma center, patient should be transported
          o If greater than 15 minutes from a trauma center, provider should consult for orders to terminate

• With both blunt and penetrating trauma when the patient is in a rhythm other than asystole and there are no obvious signs of death, priority should focus on MINIMAL ON-SCENE TIME and RAPID TRANSPORTATION to the receiving trauma center.
• Unless transport is delayed (i.e. an appropriate aviation request with prolonged MSP trooper ETA, heavily entrapped patient), on-scene time should always be kept to a minimum.  On-scene time goal should be always be less than 10 minutes.  Even after extrication (regardless of time required to extricate the patient), the patient should be transported immediately, without delay, and emergency care provided while enroute to the receiving trauma center.
• Blunt and penetrating trauma patients in cardiac arrest without obvious signs of death should be treated and transported rapidly to a trauma center.  Providers should not remain on-scene to perform CPR or any other resuscitative measures for 15 minutes prior to transportation - the patient should be transported immediately and resuscitated enroute to the trauma center.
• Even if 'great than 15 minutes from a trauma center', transport immediately, and resuscitate enroute. 
• Once treatment and transportation is initiated for patients in traumatic cardiac arrest, treatment should be continued to the receiving hospital and care should be transferred to the receiving facility.  Termination of resuscitative efforts during transport should never occur.
• And a reminder: patients with isolated penetrating trauma do NOT require spinal immobilization - they DO require immediate and rapid transportation to the receiving trauma center.
• And finally: when in doubt, obtain a trauma consult.