Trauma roon in your ED... who gets it?

[A&OxNone]

So, I feel like my job is kind of screwy about who gets trauma and how the room assignments are split, so I wanted some advice on how you devided your trauma rooms up!

As it stands now, whoever has trauma usually has 2 or 3 other rooms (depending on the charge nurse), but it always screws a nurse either way. (which requires a long explaination that probably doesn't matter)

So, I have heard of the charge nurse taking a trauma if it comes in, or whoever float is having trauma (if your ED has a float), or you being assigned blocks of time when you would be the trauma nurse... Tell me what your system is and what works best for you!

I will say that we have only one true trauma room that is kept open for the seriously sick. (like cardiac arrests, ect). STEMI's dont even get put in the trauma room usually, so honestly anybody can get a sick patient, but you have to have a rhythm of dead or vitals of almost dead to go in trauma.

[PMFB-RN, RN]

I have heard of this happening, but never seen it. And I have travelled in over 100 ER's across the US. The idea of the ICU nurse "coming down" for a trauma is a good idea to be a second nurse in the trauma, but I think it is a poor idea to assign an ICU nurse as the primary trauma nurse. I worked ICU, and I know what is done in ICU. An ICU nurse is an awesome asset in a controlled code, but I think is an entirely poor asset for an uncontrolled traumatic condition in a department that is not their home department (such as the ED).

*** We specialize in the uncontrolled traumatic conditions :) It's similar to the situation with the physicians. The ER physician has no roll on the trauma team. The trauma team physicians are trauma suregons and their residents and mid levels.

Our ER nurses are great and skilled nurses. They back us up. Our situation is unique in that we are a large hospital (by the standards of this state), a trauma center, and a teritary care center in a very small town. While the hospital serves a huge geographic area, the ER serves a small town and is tiny relitive to the rest of the hospital. It is common to only have one ER physician and two or three RNs on duty in the ER and yet we regularly accept level I & II traumas. There may be 12-18 SICU nurses on any given shift.

It also happens that there is a LOT of overlap between the SICU staff and the ER staff with many nurses working both units. About the only time there are ER only RNs working the ER is on weekdays on day shift. Any other sift and all the nurses in the ER might well be SICU nurses

[murphyle, BSN, RN]

A bit about our department: We have 45 acute-care rooms, of which 3 are the Trauma/Resuscitation bays. The other 42 are split up into "teams" of 10-11 rooms staffed by three RNs, one tech (ECT) and one unit secretary; each RN is responsible for 3-4 rooms and enough hallway pulls to make up 5 patients. We see about 71K a year. We're not a trauma center yet, but we're pursuing Level II status down the road.

Resus is staffed on an on-call basis by at least one attending MD, whatever residents and/or MS we might have laying around, two RNs (one scribe, one bedside), an ECT and a US in four-hour blocks. For example, if you are assigned Resus for your first four, you take care of your usual patient assignment, but if a Priority 1 case comes in, it'll be paged overhead and you drop what you're doing and go to the bay to await the incoming patient. While you're gone, the other staff on your team will cover your assignment. For this reason, if we have float RN coverage, those people will be put on Resus first to avoid pulling staff from busy teams. If two cases come in simultaneously, the charge nurse will staff the second case, along with whatever other staff he/she can scrounge up.

The key to our system is that patients don't stay in Resus, and the resus nurses don't stay assigned to that patient (i.e. the resus case isn't tacked onto your existing five - however, it sometimes happens that one of the nurses who was on Resus will be the next nurse with an open bed to put the post-resus patient in). The resus team does the initial assessment and stabilizing treatment, and then move them to a team bed, admit them direct to one of the critical-care units (MICU, CCU, SICU), transfer them to another hospital, or they've expired. Once the patient is out of Resus, if they're going to a team the resus nurse will report off to whichever team nurse is picking up that patient.

The system works pretty well for us. We get occasional "Night of the Living Dead" runs where we have four or five cases back-to-back and you never see your team for that four-hour block, but in general it spreads the load out evenly and ensures that the bays are always covered.

[freki, ADN, RN]

In our 30-bed ER we have 5 major rooms. The nurse assignments are split so a nurse has a major room plus 3-4 other rooms. Then, depending on the time of day, there are 1-2 float nurses that typically get assigned to a level 1 or arrest. We also have trauma teams so for a level 1/2 we get an ICU nurse, house supervisor, social services nurse, xray, CT, and lab. So there's usually plenty of people to help out.

[Christy1019, ASN, RN]

My ED is a level 1 trauma center w/120 beds divided into triage, CDU (24hr observation unit) & tx areas by acuity i.e. cat 3/4 is peds and fast track, cat 2 is abd pain, & non-emergent DIB/CP w/a separate closed area for psych & flight risk pts, cat 1 is for emergent/critical care & holds for ICU admits where u usually only have 2-3 pts, then we have a separate area w/2 resuscitation rooms, room 1 is set up for traumas, room 2 for medicals. Pts that come in unstable, unconscious, acute MI/stroke or meeting level 1 or 2 trauma criteria go directly to these rooms. All of our nurses rotate thru these assigned areas each shift & 2 RNs are assigned to the resus rooms (one scribes one circulating). The charge RN always responds as well as any available floats or cat 1 nurses when necessary. If both rooms are full & another resus pt comes in they go to cat 1 and the resus protocol is done there by floats/cat 1 nurses & in extreme cases like when we had 5 gsw pts drive up to the ambulance bay, any available nurses from triage, cat 2 or cat 3/4 respond. The cat 1 physicians and pharmacy respond to all resus rooms, & for traumas the CC activates the trauma team (MDs) & they respond in addition to everyone else stated and are in charge of the trauma pts, although the cat 1 ER physicians are still responsible for the pts airway and doing primary & secondary surveys. Resus pts will either go to cat 1 when stabilized and assigned to a cat 1 nurse or transferred directly to cath lab or OR by a resus nurse and cardiology or trauma MDs.

We never have ICU nurses respond to anything in the ER w/the exception of neuro ICU nurses that bring down equipment and help set up for ventriculostomy insertions, then they go back to ICU. I personally like our setup b/c you'll never be responsible for an intubated pt in one room and abd/toe painers in another, u can be focused on your critical pts if you're in cat 1.

Hope that helps!

[bartender514, ADN, BSN]

I work in a level 1 trauma center as well. To touch upon the ICU nurse thing. We used to have a position for what we called a TEDI nurse. We no longer have this but this is how it worked....out trauma bay has 7 rooms. 2 designated trauma rooms and the rest are for ICU/really sick people. The TEDI nurse was someone who was hired to only work in the trauma bay with the idea being that the ED trauma nurses would take the trauma patients that came in while the TEDI nurse took the ICU/CCU pts that came in. Granted, actual level 1 and level 2 traumas aren't always streaming through the door so you just divide the patients amongst yourselves or everyone just kind of works as a team.

Typical staffing in our trauma bay is 1 nurse from mid-noon and hopefully 2-3 for the noon-midnight business. Charge is always available to help and is good to pull other nurses in if it hits the fan. During an actual level 1 or 2 trauma we typically have 1 bedside nurse while the other documents. If the other is busy someone from peds ED is usually available to chart.

[Jennifer, RN]

We have 2 trauma rooms. At the beginning of each shift, a trauma nurse is assigned to one of the 2 rooms. She also has 4-5 other rooms assigned. We work on teams though. A team consists of 2 nurses and 1 tech. When a trauma comes in, the other team nurse and tech take over taking care of the trauma nurse's patients. Which means, the other nurse ends up 8-10 patients to care for. Not the ideal situation. But, it's better than no one looking after your patients while your in the trauma room.

[360jRN]

We're a rural hospital with a 8 total beds counting 2 trauma beds. We have two RN's on staff from 7-7 a and p, an ER clerk from 12p-12a (this is new, so pretty pumped lol) and a "House Sup" at night. If we have a trauma come in it's usually all hands on deck for us until pt is stabilized and then one of us will assume further care while the other goes and runs the floor. Its not too terribly bad because the EMT's usually hang around if it's a hairy situation so that gives us more hands.

[Lunah, MSN, RN]

Our EMS folks were always willing to lend a hand, too. Sometimes that makes all the difference in the world, like one evening where we had two working codes come in to our small-ish and already full ED at the same time. The ED that I just left was freestanding, though -- no hospital or other resources anywhere in sight!

[AlmostJesus]

I work as a paramedic in a small town ED, we have 5 beds 2 which are in a trauma bay. Generally we staff one RN in the ED and the paramedic is available to help, generally, when it hits the fan, we have the floor charge come up and assist us, especially if the paramedic (me) gets sent out on a call. If it is a trauma that come in by POV, the nurse and paramedic will share the patient. We are unique here in that we are allowed to take patient assignments in the ED, so the paramedic might take lead on the patient, especially if they are going to be transferred out for continuity of care.

The other smaller hospital hospital I work at has 3 rooms 1 which is a trauma bay. The floor charge is the ER nurse and when we get something more serious in, nursing administration will help during the day or on call at night, many times the floor nurse will go to assist while the ward clerk watches the floor. (Our normal staffing is 2 nurses, 1 ward clerk, and 1 on call nurse... I'd like to see that changed to add a medic)

[ErinBSN]

We are supposed to rotate, but generally the same nurses get the "crit" rooms and the triage assignment. If I'm not in triage, I'm in a "crit" room.

We have added monitors to all rooms except fast track but it still falls to the "front end" We are not trauma certified, so we get walk in's stabilize and transfer out to the level II or sometimes they go the 30 min ride to the level I depending.

People assume because we don't take ambulances we don't get anything. Last week alone we had 2 shooting walk in. Crazy world.. (I got one of them, another nurse got another)

[TiggerBelly]

Generally whoever has the trauma room also has two other rooms. If that nurse gets a trauma, then we try to not put any patients in her other two rooms, or if we do then they are very minor care patients (med refills, coughs etc). We all try to pitch in and help and keep an eye on her other rooms. After all, if we were in her shoes, we would want someone to help us as well. Gotta work together!

[mybrowneyedgirl, BSN, RN]

We have six beds in "RED" as we call it. It's for critical patients. 3 of those beds are set up for trauma. The RED nurse has one partner and one tech. So you have 3 patients each but of course the partner will take over if one nurse is pulled into a trauma. If we have a good charge, she will help but will not "take" the trauma. If we have more than 3 traumas we pull people from lesser acquity areas and they will have their patients covered by their partner.