4. Activate code
• Trauma 4 code • Non-trauma 4 code
• Code A • Stroke Fast Tract
• Code B • birth before
• Code C admit(BBA)
• Code M • CPR
• MI Fast Tract
7. Code A
•
• Open air way , Suction ,Clear air way
• Assess ABCDE Provide O2
sat Stabilize
• Establish IV Access and obtain Blood samples
• ER Trauma 02 – 5347143 – 45
CODE A
8. Code B
• CODE B
• Tension pneumothorax , Massive hemothorax
• Open sucking chest wound
• Fail chest
9. Code B
•
• Open sucking wound
One valve dressing
, O2
• Assess ABCDE Provide O2
sat
• Establish IV Access ( RLS ) and obtain Blood
samples
• ER Trauma 02 – 5347143 – 45
CODE B
10. Code C
• CODE C
Shock
Blood supply
(inadequate tissue perfusion )
Hypotension , impairment of
consciousness , Cyanosis , Oliguria
11. Code C
• Stop External Bleeding O2
• Assess ABCDE Provide O2 sat
Stabilize
• Establish IV Access ( RLS x 2 line ) and obtain
Blood samples and G/M
• ER Trauma 02 – 5347143 – 45
CODE C
12. Code M
• CODE M 2
• Stop External Bleeding O2
• Assess ABCDs Provide O2 sat
Stabilize
• Establish IV Access ( RLS x 2 line ) and obtain
Blood samples and G/M
• ER Trauma 02 – 5347143 – 45
CODE M
13. The Efficacy of A Trauma Code
Activation System by
The Pre-hospital Care Team at
Bhumibol Adulyadej Hospital
Nickjaree Songsungvorn, MD.,
Sutasinee Jiampresert,MD
Emergency department, Bhumibol Adulyadej Hospital
14. Background
-199 patients who were transferred to
the Emergency Room of Bhumibol
Adulyadej Hospital by the Khumklao
pre-hospital team
- October 1, 2010 –September 30, 2011
14
15. Objective
• To evaluate the efficacy of triage
and code activation on trauma
patients by the pre-hospital care
team.
• To identify trauma patient
characteristics.
• To examine the impact of
activation and non activation of
the trauma code.
15
16. Methods
• Design : Retrospective, descriptive study
• Setting : Trauma center, Bhumibol
Adulyadej Hospital
Identified
correct code
Pre-hospital Accuracy in
data percentage
Actually
activated code
17. Table 1 : Personnel responsibility
for code activation
CODE M CODE A B and C
(Activate trauma team)
Staff trauma surgeon Emergency medicine staff
Trauma surgical fellowship Emergency medicine resident
Trauma surgical chief resident and resident Trauma surgical resident
Emergency medicine staff Emergency department nursing staff
Emergency medicine resident Emergency department nurses
Neuro-surgical chief resident
Orthopaedic chief resident
Emergency department nursing staff
Emergency department nurses
Operating room nurse
Blood bank technician
Diagnostic imaging technician 17
18. Results
• During the study period, there
were 199 included patients.
• The mean of age was 38.6 years.
• Male 144 (72%) Female 55
(28%)
18
19. Results
Study
population 199
48 required
the code
activation
Activated Non activated
27 21
Figure 2 : Study population 19
20. Results
Stabbing Body assaultHanging Other
1% 4% 1% 3%
GSW
fall from 1%
heigh
8%
fall on same
level
13%
MCA
Pedal cyclist
53%
1%
MVA
Pedestrian
11%
4%
Figure 1 : Mechanism of injur
20
21. Results
Table 2 : Activated group
CODE Activated Correct Under
triage triage
A 2 1 1
B 2 1 1
C 1 1 0
M 22 22 0
TOTAL 27 25 2 21
22. Results
Table 3 : Non-activated group
CODE NON ACTIVATION
A 1
B 0
C 3
M 17
TOTAL 21
22
23. Results
Table 4 : A comparison of activated group with
non-activated group in code M patients
Activated Non-activated Statistic
(n = 22) (n = 17) (95%CI)
Age mean ± SD 34.6 ± 13.4 35.8 ± 16.4 T-Test
P = 0.807
Sex, Male 18(82%) 13(76%) Chi- square
P = 0.682
Pre-hospital 17(77%) 15(88) Chi- square
GCS ≤ 8 P = 0.376
Pre-hospital 12(55%) 5(29%) Chi- square
SBP < 90 P = 0.117 23
24. Results
Table 4 : A comparison of activated group with
non-activated group in code M patients
Activate d Non-activated Statistic
(n = 22) (n = 17) (95%CI)
Hospital LOS for 3.4 ± 4.9 2.3 ± 1.6 T-Test
dead patients P = 0.584
Hospital LOS for 25.6 ± 21.7 29 ± 21 T-Test
survive patients P = 0.805
24
25. Results
Table 4 : A comparison of activated group with
non-activated group in code M patients
Activated Non-activated Statistic
(n = 22) (n = 17) (95%CI)
Transferred OR 10(45%) 3(18%) Chi- square
from ER P = 0.068
LOS in ER for 139.5 ± 83.2 208 ± 27.5 T-Test
transferred OR P = 0.048
from ER (minutes)
mean ± SD
25
26. Results
Table 4 : A comparison of activated group with
non-activated group in code M patients
Activated Non-activated Statistic (95%CI)
(n = 22) (n = 17)
Died in hospital 8 (36%) 12 (71%) Chi- square
P = 0.034
ODD Ratio = 4.2
Totally died 15 (68%) 13 (76%) Chi- square
P = 0.568
26
27. Code M activated patients (n=22)
7 Died in ER • 6 Pre-hospital CPR
• 1 died in OR
10 Emergency • 6 died in hospital
OR • 3 survived
• 4 OR later 4 survived
5 admit • 1 no operating died in hospital
27
28. Code M non-activated patients
(n=17)
1 Died in ER • 1 Pre-hospital CPR
3 Emergency • 3 died in hospital
OR
• 2 OR later 1 survived, 1died in
hospital
13 admit • 11 no operating 3survived, 8 died
in hospital
28
29. Non-trauma 4 code
• Stroke Fast Tract
• birth before admit(BBA)
• CPR
• MI Fast Tract
30. Stroke Fast Tract
• Stroke Warning Signs
• Sudden weakness or numbness of the face,
arm, or leg, especially on one side of the body
• Sudden confusion
• Trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
balance or coordination
• Sudden severe headache with no known cause.
31. Goal
• Rapid recognition and reaction to stroke
warning signs
• Rapid emergency medical services (EMS)
dispatch
• Rapid EMS system transport and hospital pre-
notification
• Rapid diagnosis and treatment in the hospital
32. Edward C. Jauch, et al ; Part 11: Adult Stroke; 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
33. The “D’s of Stroke Care”
Key points at which delays can occur
• Detection • Data
• Dispatch • Decision
• Delivery • Drug
• Door • Disposition
Edward C. Jauch, et al ; Part 11: Adult Stroke; 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
34. 1.Detection
• Rapid recognition of stroke symptoms
•
•
• Stroke Fast Tract
The Cincinnati Phehospital Stroke Scale
4.5
– Facial Drop
– Arm Drift
– Abnormal Speech
