A recent study indicates a lower risk of death when care of traumatized patient is provided in a trauma centre compared to non-trauma centre . Different standardized protocols and procedures on trauma care are characteristic routines in a dedicated trauma centre. Pre-notification of an arriving trauma patient is needed for giving an ED some minutes to get ready for the patient before the patient actually arrives.
In the preparing process for an arriving trauma patient at ED, two levels can be identified; basic and special level. In basic level, all the basic preparing procedures, such as trauma team activation, are carried out. This is normally enough for vast majority of arriving trauma patients. However, in some cases EMS meets physiological or anatomical conditions, such as lack of patent airway, which has to be taken care of immediately upon arrival. These pre-notified conditions launch special level of preparations, and are of crucial importance in executing emergency operations promptly after an arrival. However, the pre-notified information should be kept simple and focused only in relevant issues, since only parts of verbal information can be recalled when taking care of arriving trauma patients .
The median EET from the time of pre-notification phone call was observed to be 15 minutes in the present study. Our experience in Töölö hospital ED is that 15 minutes is an optimal period of time, since it allows individual trauma team members to work in different parts of hospital still being able to reach trauma bay well before the arriving patient. On the other hand, if pre-notification takes place too much in advance, there is always a risk that individual team members may end up doing something else before entering trauma bay, and thus meeting a risk of being late. It might even be favorable to ask peripherial EMS, the ones bringing patients from outside of the downtown, to give their pre-notifications little later en route in terms of decreasing inappropriate long EETs. On the other hand, future technology, such as global positioning based real-time tracking systems and digital data transmission between EMS and hospitals, could provide us with more accurate and precise pre-notifications in the future.
There were two or more simultaneous patients arriving from the same injury site almost once a week. In addition to that, there might be simultaneous trauma patients arriving from different injury sites resulting in multiple patient scenarios. In such cases, it is obligatory for ED to get pre-notification in terms of recruiting enough personnel to accommodate the needed number of trauma teams. That becomes of crucial importance in scenarios when the number of ED personnel is not enough, and more personnel has to be recruited from the other parts of hospital.
It has been stated that unnecessary trauma team activations should be balanced in terms of gaining optimal initial trauma care to all severely injured patients . That is, trauma teams involving several specialties and personnel are considered expensive and limited resource, which should be utilized in reasonable manner. Also, the efficient use of hospital resources utilized in TTAs, should be addressed in economical points of view. In addition to the disturbance for normal hospital work the team activation results, through its personnel leaving the routine daily tasks and gathering to the trauma bay, the unnecessary utilization of teams may result in decrease of the team morale.
Normally trauma admitting hospitals, including our, base their trauma team activation criteria on three categories including observed physiological signs, anatomical symptoms, and mechanism of injury. In recent rapport from Denmark, a level 1 trauma centre using ACS-COT criteria, the sensitivity (zero undertriage) of that triage protocol was 92%, the specificity (zero overtriage) being 76% . There are studies showing that MOI criteria alone are inadequate to identify those in need of trauma team activation [10, 11]. In recent paper from level 1 hospital in Norway, the MOI as a trauma team activation criterion had a sensitivity of 14% and positive predictive value (the probability of serious injury conditional on team activation) of 7% resulting in a 93% overtriage .
Coded RTS-methodology is not routinely used by the Finnish prehospital personnel. Thus, it was not a surprise that all the needed parameters for RTS-scoring were present only in 6% of the studied pre-notifications. Our experience is that numerical coded RTS values are not necessarily needed in every day practice but clinical categories, such as "normal or decreased", may serve as appropriate substitutes.