Who responds to a pediatric trauma/resuscitation

[cdufer13]

I work at a Level 1 Pediatric (stand alone-no adults) Trauma Emergency Room. We're still a baby (no pun intended) in our program, it's 2.5 years old, and we're constantly striving to improve. I am wondering what nurses from outside the ER respond to a Level 1 trauma, a Level 2 trauma and resuscitations in the ER. For example, does a med/surg RN come down to record? Does a PICU nurse come to the unit to help? Do transport/resource/fly/circulating RN's respond? If you do respond and you're not from the ER, what is your role during that response time? Do you help with the pt at hand, or do you help the unit out while the trauma resuscitation is happening?

If your hospital has any evidence based research for your practice, or where you adopted that practice from, please share! It would be greatly appreciated!

[nmsumurse]

Unless your staff is really strained in the ED due to in being on the smaller side outside assistance isn't ideal having outsiders come in can do more harm than good. If there is a surgeon, an ER doc or two, blood bank, xray, plus nursing staff there should be enough hands to get a job done. Is your hospital a teaching facility or is it private? Having 1 trauma surgeon establish control and going through atls protocol with people having a defined role is the best way to get things done quickly and not miss anything. In private hospitals that are trauma things can get tricky when multiple procedures are going on say the surgeon is performing a thoracotomy, he is no longer in a position to run the trauma. The Er doc must step up. Or both of them may be placing lines, chest tubes ect, and there are no hands left for medical procedures this is really the only time when you want outsiders coming in like anesthesia or picu attending. In traumas at my shop ed doc resident at head of bed with ed attending intubating, surgical residents placing alines, sublavians, chest tubes, senior resident running code with attending waiting to fill if things start to go haywire or needs to step in and dictate things. I've worked ed and ICU. The only tasks on me as the icu RN coming downstairs was to alert the nursing sup of bed situation upstairs, unless there was multiple trauma victims then you asked where you were needed.

[ZooMommyRN, ADN, RN]

PICU attending or their fellow, trauma surgeons, anesthesia if they aren't already tubed in case they are a difficult airway, and if needed neuro attending or fellow. Our attending runs the show, one of our techs and usually 2-3 of our nurses for a level 1 or 2

[NickiLaughs, ADN, BSN, RN]

When I worked at a level 1 the following would respond:

trauma surgeon and all their minions

eR doc is in charge of airway and FAST and input orders

Radiology

RT

it wasn't shocking with staffing to be the only RN in the trauma, it could be brutal

at my level 2:

trauma surgeon directs the flow

ER doc airway/fast

RN outs in orders

tech hooks patient to leads after getting manual palp pressure

lab draws lab, second nurse starts primary or additional lines if EMS initiated one.

RT is present with a vent in case

radiology is ready to shoot a pelvis and chest stat

OR staff - they only help if you ask them. They know how to run Belmont better than anyone usually.

if patient needs to go straight to OR then OR team and primary nurse roll out

if stable, they go to CT and then X-ray for additional scans

now this is an adult only level 2, so thinks may go somewhat different with peds.

[JVoEDrn]

Recorder must be a PALS certified nurse, Responders must be PALs certified as well.

Respiratory, ICU nurse and ED nurses. In our hospital ED only responds to the first floor code Bc that's the floor we are on , one ICU nurse is always apart of the code. 2nd floor and on its ICUs territory and we send up one PALS ED nurse.