Trauma

June 21, 2025

When someone experiences blunt or penetrating trauma, it plants the seeds for a trauma activation.

When trauma happens in Southeast Minnesota, Mayo Clinic Ambulance emergency medical services (EMS) personnel respond and follow specific steps, starting with observation of the patient's presentation and vital signs.

Identifying trauma

When EMS personnel arrive at a trauma scene, they perform an investigative role, says Alexander C. Catevenis, a Mayo Clinic community paramedic and acting executive director for Ground Ambulance Rochester and Southeastern Minnesota Emergency Medical Services.

"Our role begins with recognition, or acknowledgement, of a patient's potential underlying trauma," he says. "For example, symptomatically, a patient may present with hypovolemic shock, but actually this individual's having a heart attack, which causes the traumatic event."

EMS personnel may encounter patients in medical or traumatic circumstances, yet a blend of the two is common, says Catevenis. He notes that when patients experience trauma in Southern Minnesota, Northern Iowa or Western Wisconsin, the injuries often vary significantly from those found in the Twin Cities.

"We see a different type of trauma," he says. "We see more farming and vehicle incidents."

During training, trauma recognition can be clear-cut, such as a person falling off a roof, says Catevenis. Yet, in practice, healthcare professionals encounter more nuance and complexity.

"In real life, whether an individual has experienced trauma is gray," says Catevenis. "We treat patients as if they've undergone trauma till it's ruled out."

Catevenis and colleagues report to the Mayo Clinic Hospital, Saint Marys Campus, trauma resource nurse (TRN) about the patient in transport. This includes an alphanumeric patient injury category, such as R3 for no radial pulse. Leveling, or trauma patient triage, is not a primary EMS role, however.

"We try not to level patients," says Catevenis. "Formal leveling requires further information and a good patient report to the TRN. We may tell dispatch we have two yellows or five reds and one green. However, this is a notification and not a trauma activation. We speak to the TRN, who defines and activates a trauma along with emergency medicine physicians. EMS paints the picture for TRNs so they can leverage patient care resources and conduct a formal trauma activation."

During patient leveling, a TRN has authority to adjust and use discretion for each patient.

Following the in-transit report, the trauma resource nurse determines necessary resources, says Mike L. Diekmann, R.N., TCRN, CCRN, an emergency medicine TRN at Mayo Clinic Hospital, Saint Marys Campus.

Patient preparation for trauma activation

Patients Mayo Clinic Ambulance transports to the trauma bay often do not know what to expect. The injury, emergency services contact and ambulance arrival can affect them emotionally, says Catevenis.

"We brief the patient on what'll happen in the trauma bay," he says. "This is necessary, as patients' anxiety reflects in their vitals, called white coat syndrome."

Calming and expectation setting for patients transported to the trauma bay also promote accurate patient leveling, says Catevenis. For instance, older adult patients may be upset after a fall, contributing to a heart rate of greater than 110, automatically categorizing their conditions as red-level trauma. In such situations, he conveys the patient's nervousness to the TRN during the report.

Quality time with patients in transport to the trauma bay is a priority for Catevenis, outranking patient-related paperwork. Traumatic events potentially are a life-changing experience, he notes, and one that many people will never experience. Catevenis wants to ensure patients understand and receive appropriate care.

"I'm not starting the written report till I drop off the patient," he says. "One-on-one time with patients in transport is huge."

Catevenis says he explains what's going to happen when the patient arrives at the trauma bay, including many professionals moving fast, working to ensure thorough evaluation and treatment.

"Medical transport and being in a trauma bay can make patients think they're dying if they aren't given an explanation," Catevenis says. "There's significant drama with riding in an ambulance and then seeing 40 people in a little room."

When medical transport arrives at the hospital, the EMS personnel hand off the patient to an activation team member and briefly remain outside the trauma bay in case there are questions. The physician leading the trauma activation asks EMS personnel about symptoms and if family members are present, says Catevenis. Then the EMS team leaves the patient in the trauma team's care.

Triage and trauma activation

When a patient arrives at the emergency department — by ground or air ambulance, internal physician referral or through the front door — the TRN determines the care level needed. This decision is based on the trauma team activation criteria using green, yellow or red colors to triage patients' needs, says Diekmann.

While a standard emergency workup is appropriate for patients designated green, designation as yellow or red activates a trauma.

These color categories signify:

Green. Patients are injured but in stable, not critical, condition.

Yellow. Mechanism of injury assigns patients to this triage color, such as high-speed motor vehicle crashes or falls from height. Details of patient injuries may be unknown, but it is evident they need extra support.

Red. These patients have known injuries, altered vital signs or both.

The TRN and emergency medicine physician also incorporate other patient leveling criteria. For example, if EMS personnel applied a tourniquet, the patient is designated level red.

Diekmann says triage status can be ambiguous for some injured patients.

"Not all patients fit well into the triage color categories," he says.

In these cases, the TRN and the emergency medicine physician discuss appropriate triage.

In a trauma activation, healthcare professionals gather in the trauma bay. This includes emergency medicine physicians, trauma surgeons, nurses, phlebotomists, social workers and respiratory therapists, and consulting services such as neurosurgeons or orthopedic surgeons.

The TRN pages all groups for the activation, indicating report time, triage color status and number of injured patients. The trauma bay is larger than other exam rooms to accommodate necessary personnel and hold all potential supplies and equipment. Each allied health professional refers to a trauma bay map indicating where to stand and responsibilities. Typically, three nurses participate in an activation: one at each side of the patient and another managing clinical documentation. Physicians also have guidelines for activation roles.

Diekmann notes that patients needing the trauma bay's resources are "the sickest of the sick." Hospital personnel also use trauma bays for stroke or cardiac arrest.

Simulations, done twice a quarter, help staff involved in trauma activations practice anticipating injuries, gathering resources, readying staff and prioritizing injured patients, says Diekmann. Each simulation features a unique scenario conducted in a simulation center with smart manikins.

Benefits of trauma activation

Diekmann says trauma activation exemplifies Mayo Clinic's values of putting patients first and anticipating necessary resources, planning care and achieving best outcomes.

Catevenis says trauma activation helps patients and healthcare professionals in these ways:

• Healthcare professional mental alert. When emergency medical services personnel tell the TRN they are transporting a patient who may need the trauma bay, the TRN alerts hospital staff it will face leveraged resources shortly.
• Healthcare professional resource alert. Hospital staff can appropriately dispense response resources, including staff and supplies, after leveling a patient's condition and activating a trauma.

"Trauma leveling and activation benefit every patient experiencing a traumatic injury," says Catevenis. "They help the hospital prepare to provide a patient with everything needed simultaneously."

For more information

Southeastern Minnesota Emergency Medical Services.