Royal Brisbane and Womens Hospital

PROCEDURE
Effective from: September 2010 Review due: September 2014
Title: Purpose: Outcome:
01618/Proc : Rapid Transfer (Red Blanket) of the Trauma Patient from the Department of Emergency Medicine to the Operating Room To promote swift transfer of non-responding, hypotensive trauma patients from Department of Emergency Medicine to the Operating Room. The non-responding, hypotensive trauma patient will be swiftly transferred from Department of Emergency Medicine to the Operating Room for immediate surgery. Department of Emergency Medicine Trauma Team Staff and Perioperative Services Staff

Target Audience:

Background
The patient requiring emergency surgery will always take priority over other prioritised patients in accordance with 01203/CPP: Bookings - Emergency / Urgent Operating Room Cases. Urgent health care is defined as health care needed urgently to meet imminent risk to life or health or health care needed urgently to prevent significant pain or distress. If a patient lacks the capacity to consent because of their unconscious state and it is not reasonably practicable to get consent from a substitute decision maker as above then the health care can be carried out under Section 63 of the Guardianship & Administration Act 2000 with the appropriate recording of the facts in the patient record in accordance with 74100/CPP: Documentation - Patient Record. If a medical officer is in doubt in any aspect then they should discuss this with the Executive Director Medical Services or representative. Refer 76005/Proc: Patient Consent, Public and Private Patients.

Mandatory Requirement
There must be agreement between the Department of Emergency Medicine Consultant and the Surgical Consultant for this procedure to be activated.

Process
Situation
In the event of a hypotensive trauma patient not responsive to fluid or other therapy and requiring emergency life saving operative intervention a Red Blanket activation should be initiated as follows: DEM Nurse co-ordinator will contact OT on 65954 to inform potential Red Blanket case The Department of Emergency Medicine (DEM) Consultant or Senior DEM Registrar to contact the Consultant Surgeon regarding patient condition and the need for a Red Blanket activation. All reasonable attempts will be made to contact the Next of Kin prior to surgery. The Consultant Surgeon, following notification from the DEM Consultant or Registrar (in person or via phone), will accept responsibility for the patient requiring immediate surgery and consent to the immediate activation of the Red Blanket procedure. The most senior Emergency Doctor will accept full resuscitation responsibility until safe to hand over to a full anaesthetic team. This process does NOT replace the process of Category 1 emergency surgical booking of cases which is relevant for cases requiring surgical intervention with anaesthetic support immediately. It is mandatory that a Consultant Surgeon is present during the procedure. Based on pre-hospital clinical information, the patient may proceed directly from the helipad to the OT.

NB: This activation implies theatre consent and negates property check lists.

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Royal Brisbane and Womens Hospital 01618/Proc :Rapid Transfer (Red Blanket) of the Trauma Patient from the Department of Emergency Medicine to the Operating Room

Procedure
Once the trauma Red Blanket is activated by the Consultant Surgeon, the DEM nursing shift coordinator activates the Red Blanket paging call through the desk top paging system by typing (MMZZ) and notify OT staff on 65954. On receipt of the Red Blanket page, the Operating Room (OR) shift coordinator will phone 64629 to alert the DEM nursing shift coordinator of Operating Room number and readiness, outline gender, approximate age of patient and body region of injury. On notification of Operating Room readiness the DEM nursing shift co-ordinator will arrange transport of patient to the Operating Room. The DEM trauma team will escort the patient directly to OR via the southern theatre entrance. The trauma patient moves directly into the Operating Room and is transferred to the operating table under the direction of the DEM trauma team leader and identification of patient is confirmed by DEM consultant. The DEM trauma team continues resuscitation and the Emergency Physician maintains overall responsibility of the patient until safe handover to both surgical and anaesthetic teams can occur. The Anaesthetist(s) will arrive when possible after ensuring the safety of their existing cases (if any), until that time resuscitation remains with the DEM Doctors. Once the patient care has been handed over to theatre personnel the DEM trauma team maybe stood down, following anaesthetist agreement.

Post Urgent Surgery

Post Operative Care will be given to the patient in the Post Anaesthetic Care Unit or the patient will be immediately transferred to the Department of Intensive Care Medicine. Verify patients identification and follow processes for either: 74252/ALL: Patient Identity Unknown, Management of; 80502/ALL : Patient - Identification of and Queensland Health Policy Ensuring Correct Patient, Correct Site and Side, Correct Procedure ( 3Cs). Document all care given and reasoning for Red Blanket case in accordance with 74100/CPP: Documentation - Patient Record. Notify or relatives / significant others of the urgent medical care that has been given to the patient and advise them of support services available ie Social Work Services.

References
Queensland Health Policy, Ensuring Correct Patient Correct Site and Side, Correct Procedure ( 3Cs) QLD Health, Informed Consent for Invasive Procedure, QHEPS 14025, 1/3/2004 Guardianship & Administration Act 2000 Civil Liability Act 2003 Civil Liability (Good Samaritan) Amendment Bill 2007 Law Reform Act 1995 Morozumi, J., H. Homma, et al. (2010). "Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability." J Trauma 68(1): 90-95. Wurmb, T. E., P. Fruhwald, et al. (2008). "Application of standard operating procedures accelerates the process of trauma care in patients with multiple injuries." Eur J Emerg Med 15(6): 311-317. Bernhard, M., T. K. Becker, et al. (2007). "Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room." Resuscitation 73(3): 362-373. Cirocchi, R., I. Abraha, et al. "Damage control surgery for abdominal trauma." Cochrane Database of Systematic Reviews(1).

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Royal Brisbane and Womens Hospital 01618/Proc :Rapid Transfer (Red Blanket) of the Trauma Patient from the Department of Emergency Medicine to the Operating Room

Document History
Custodian Risk Compliance Methods / Evaluation
Trauma Services
Low

There is a review by a multidisciplinary team of each patient event. Incidents will be PRIMED.

Replaces Document / History Previous Version Key Stakeholders

New
Nil

Trauma Services, Surgical and Perioperative Services Perioperative Services, Surgical and Perioperative Services Director of Anaesthetics Department of Emergency Medicine, Critical Care and Clinical Support Services Surgical and Perioperative Services Executive Director Medical Services Deputy Executive Director Medical Services Safety and Quality Unit Legal Services

Related Documents

01203/CPP: Bookings - Emergency / Urgent Operating Room Cases 01129/SPR : Helicopter - Aeromedical Transfers 74252/ALL: Patient Identity Unknown, Management of 80502/ALL : Patient - Identification 74100/CPP: Documentation - Patient Record 18002/Proc: Patient Escort - Intra-hospital (Adult & Neonate) 76005/Proc: Patient Consent, Public and Private Patients

Search Information

01618/Proc;01618;Rapid Transfer;Red Blanket;Trauma;Trauma Patient;emergency surgery

AUTHORISATION
Signature.. Date. Director Safety & Quality Unit

AUTHORISATION
Signature.. Date. Executive Director Medical Services

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