New TTA criteria help ensure optimal care for injured patients

In 2005, Minnesota instituted a statewide trauma system. The aim was to reduce trauma-associated morbidity and mortality through a variety of system-wide initiatives, including decreasing time to definitive care by ensuring that hospital resources matched the needs of injured patients. Now, almost a decade later, the Southern Minnesota Regional Trauma Advisory Committee (SMRTAC) is rolling out regional trauma team activation (TTA) criteria with the same goal: getting the right patient to the right resources in the right amount of time.

According to SMRTAC coordinator Debra E. Horsman, R.N., care for injured patients will now be consistent across a region that spans 22 counties with 20 hospitals and close to 80 Emergency Medical Services (EMS) agencies. "In the past, EMS providers would use their own guidelines and hospitals would use theirs. Now, we have criteria in common, and we're all talking the same language, from prehospital through acute care," she says.

To help develop the new criteria, SMRTAC looked at what other regional trauma advisory committees were doing, especially in San Antonio, Texas, which has successfully standardized trauma activation criteria for a service area the size of West Virginia.

SMRTAC modified the Texas guidelines, using a Red and Yellow system, in which vital signs-driven findings and clinically based assessments of injuries are used to provide the most accurate triage, while still allowing use of local criteria and EMS provider judgment.

"Red criteria patients have compromised airways or circulation and need immediate lifesaving treatment. The decision to transfer them to definitive care should be made within 20 minutes," Horsman explains. "Yellow criteria patients have less-threatening injuries that should be treated within two hours. With adults, we used to look at mechanism of injury but now we focus on the immediate needs of the patient."

Kids' criteria

In addition to adult criteria, SMRTAC created TTA guidelines for children younger than age 15 to account for physiological differences.

"Children have a wide variety of vital signs that are different from adults'," Horsman points out, "and the StO2 monitor, which is highly sensitive in indicating patients in shock and predicting the need for massive blood transfusion, isn't useful in children. SMRTAC has also used data from the Level I Pediatric Trauma Center in the region to validate including open and depressed skull fractures as Red criteria for children and adding a qualifier to the ejection criteria for motocross."

She says pediatric and adult Red criteria patients meet Rural Trauma Team Development Course recommendations for early transfer to definitive care. For their part, rural hospitals seem highly supportive of the new guidelines.

"We've been to every hospital in the SMRTAC region, and for the most part we've gotten a great response," she says. "Rural hospitals want to have a consistent, systematic approach to injured patients. We've been to some of the sites that are already using the criteria and we're seeing an improvement in time to transfer. In trauma care, time is life."

Horsman stresses that developing the criteria was a highly collaborative effort. "People from all walks of life throughout the region helped develop SMRTAC's trauma activation criteria. We've been working on this for four years, and we're the first regional organization in Minnesota to have done it," she says.

For more information

SMRTAC Adult Trauma Activation Criteria. Southern Minnesota Regional Trauma Advisory Committee.

SMRTAC Pediatric Trauma Activation Criteria. Southern Minnesota Regional Trauma Advisory Committee.