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Trauma Protocols and Registry

Patient care protocols for trauma

Legacy Trauma Services uses a protocol-based system to ensure quality patient care. Protocols may be developed and written by team members, and frequently result from issues identified during the continuous quality improvement (CQI) process. Each protocol is based on current literature and identifies rationale and key personnel. The author distributes draft protocols to key personnel for approval, such as Trauma Management and the Trauma Executive Committee.

Direct to OR: Our facility’s unique floor plan allows patients to be admitted directly from the field to an operating room. Patients admitted directly to the OR include trauma codes, penetrating chest or abdominal injuries, crush injuries, proximal amputations. Pre-hospital personnel at their discretion can request direct to the OR activation. The trauma team maintains individual roles and responsibilities, and the OR staff functions in its assigned roles of circulating and scrub staff. Our service feels that because of this unique capability, there is a direct impact on patient survival.

The Massive Transfusion Protocol (MTP) was developed in 1984 to facilitate the rapid restoration of circulating blood volume for patients in hemorrhagic shock. This protocol is initiated by the trauma surgeon and is the responsibility of the Trauma Resuscitation Nurses to implement. Continuous monitoring of vital signs, hemodynamic pressures, and laboratory parameters direct the administration of blood and coagulation factors. The success of the MTP is the result of protocolized collaboration between surgeons, anesthesiologists, critical care nurses, pathologist, and the blood bank.

Geriatric: This protocol was developed due to the increasing number of geriatric patients admitted to the trauma system and the increased risk of morbidity and mortality for this population. Elderly patients have constitutional impairments of cardiac, pulmonary, renal, and immunologic function. In addition, most also exhibit or are acutely afflicted with diseases that further impair organ function, limit organ functional reserve or reduce the capacity to respond to injury. Elderly trauma patients (>65 years old) have three to five times the mortality rate when compared to younger patients. The leading causes of mortality (following acute death) are severe closed head injury, cardiac complications, pulmonary failure and sepsis. Very little is written on the subject from the perspective of patient management. The protocol embodies an approach based on experience, applied physiology and published findings. Of great importance is the need to stabilize the patients as soon as possible after admission to the emergency department.

The Trauma Collaborative Practice Protocol (TCPP) originated in 1994 to expedite the decision-making process throughout the trauma patient's hospital course. The protocol allows for increased nursing and therapist initiation of clinical interventions such as standard treatment, setting of clinical parameters, and obtaining therapy consults as the patient progresses. TCPP allows for a smoother and timely transition of the patient from resuscitation to home.

Spleen and liver management: These protocols outline surgical vs. nonoperative management for spleen and liver injuries. Both of these protocols include patient teaching for discharge and the application of medical alert bracelets advising the risk of bleeding or hemorrhage.

Legacy Trauma Registry

Legacy collects data from trauma cases to improve our care. In addition, doctors and researchers use these data in Legacy Trauma Registry, and we work with other Level I and II trauma centers in research activities, exchanging data from our registry.

State governments and regulators also use registry data to measure the performance of the Oregon Trauma System. Trauma Registry data are submitted to the Oregon Health Division for incorporation into the Oregon Trauma Registry and review by state trauma system administrators.