Emergency medical services responding to the scene will notify the receiving hospital that a trauma patient is on their way. This may be a major, metropolitan, or regional trauma service or sometimes an urgent care service, depending on distance, facilities available and the patient’s condition. Notification information is crucial to managing a severely injured patient and can allow for communication to vital members of the response team as well as time to prepare the department for the patient’s arrival. On certain occasions a notification to ARV might occur before the patient reaches the first medical facility, this can be initiated by the medical facility or the incoming emergency medical service.

The following sequence of actions should take place upon initial notification:

1. Gather vital information from the notifier using the IMIST mnemonic:^{(4, 5)}
   I   Identification: Who and what is your role? Patient identifiers – name, age, sex.M   Mechanism: Presenting problem, how it happened.I   Injuries: specific injuries that have been found or potential to exist.S   Signs: vital signs, such as HR, RR, BP, Temp, BGL, GCS, etc.T   Treatment and Trends: treatment administered and patient’s response to treatment, trends in vital signs.
2. Set up the trauma bay to receive the patient, including equipment checks, documentation, medications, and resuscitation equipment.
3. Activate the trauma team and available support departments (medical imaging, pathology, blood bank). In small health service settings, the available staff will be limited. Additional staff may be gathered from wards or on call. It may be necessary to utilise the skills of all available resources including emergency response personnel in the initial trauma management.
4. If the patient is hypotensive the massive transfusion protocol should be activated. Hypotension should be considered due to blood loss or tension pneumothorax until proven otherwise. Large-volume blood loss is best managed with blood component resuscitation, and early definitive control of bleeding.
5. Designation of roles and specific tasks to staff can help to maintain a structured approach based on teamwork. Ensure clear communication between all parties involved in managing the trauma. Use closed-loop communication, which ensures accuracy in information shared between response staff. Repeat instructions, make eye contact, and provide feedback. Misinterpreted information may lead to adverse events.

If there is no prior notification of the patient, then rapid activation of the trauma team request must take place and any additional resources notified. If it is anticipated that transfer to a major trauma service will be required, early retrieval activation is essential (phone ARV on 1300 368 661).

• Early retrieval activation ensures access to critical care advice and a more effective retrieval response which leads to improved clinical outcomes for the patient ⁽⁶⁾.

If you are undecided, call the ARV coordinator, who can provide expert guidance and advice over the phone or via teleconference, and link to MTS as required.

Ambulance handover

On arrival at the emergency department, a structured handover is provided by the paramedics to the treating team, using the IMIST-AMBO format ^{(4, 5)}. The timing of the handover will be dependent on patient clinical stability and requirements. If the patient is stable, it may be best to perform the handover before placing the patient on a trolley. If the patient is unstable or critically unwell, it may be necessary for the patient to be transferred to the trolley so the team can continue management and intervention, while the team leader receives the handover.

Reception and resuscitation

Ensure the patient is correctly identified and appropriate patient identification labels applied.

The reception and resuscitation of major trauma patients involves simultaneous assessment and management, with multiple activities occurring in parallel. Resuscitation follows the standard <C> ABCDE approach, with some modifications based on recognising and treating immediate life threats that are unique to trauma patients and preventing secondary complications.

The response to resuscitation will vary depending on the injuries sustained, the treatment administered or omitted as well as other factors such as the patient’s age and medical comorbidities. Ongoing resuscitation is guided by the response to treatment and the need for definitive management.

Assessment must also be made of medical conditions and comorbidities that may have preceded or contributed to the patient sustaining an injury, especially in in elderly patients. Cardiac or neurological events leading to syncope or falls are common events that predispose to injury in older patients.