ACS Sepsis Stroke Trauma GI bleed DKA Anaphylaxis Pregnancy trauma Child sepsis Status epilepticus APO HyperK

Major trauma

Start this sheet when: Trauma team call: SBP below 90, GCS 13 or less, RR below 10 or above 29, penetrating injury to head, neck, torso or proximal limb, flail chest, two or more long-bone fractures, amputation, or a high-energy mechanism.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time of injury (clock time)

Time since door

TXA window (3 h): enter time of injury

Team

Write who holds each role and stamp when they arrive. In a small ED one person may hold two roles; write the name in both.

Team leader · senior ED doctor

Directs from the foot end; makes the calls

Airway · anaesthetist

Airway, C-spine hold, RSI, ventilation

Procedures · surgeon / 2nd doctor

Chest, eFAST, drains, binder, bleeding control

Circulation nurse · staff nurse 1

IV/IO x2, bloods, blood products, TXA, drugs

Monitor & scribe · staff nurse 2

Vitals every 5 min; times on this sheet

Runner · MPW / attendant

Blood bank, samples, CT, porter, family

Radiographer · technician

Portable chest and pelvis X-ray; CT ready

Targets met --Breaches 0

1.Trauma team leader at the bedside
≤ 5 min from door · Local target: team waiting at the door
Enter door time
2.Primary survey (cABCDE) completed
≤ 15 min from door · Local target (ATLS sequence)
Enter door time
3.eFAST done
≤ 15 min from door · Local target: during the primary survey
Enter door time
4.First blood product running (MTP activated)(Shocked or bleeding)
≤ 15 min from door · Local target: O-negative / uncrossmatched in shock
N/AEnter door time
5.Tranexamic acid 1 g given(Bleeding or at risk of bleeding)
≤ 3 h from time of injury · CRASH-2: within 3 h of injury; every 15 min counts
N/AEnter door time
6.CT started (head / whole body)(Stable enough for CT)
≤ 1 h from door · Local target; NICE NG39: report within 1 h of the scan
N/AEnter door time
7.In OT / IR for haemorrhage control(Ongoing haemorrhage)
≤ 1 h from door · Local target: shocked patient not waiting for CT
N/AEnter door time
8.MLC registered and police intimated
Record · Record only: never delay care for police (Parmanand Katara, SC 1989)
Enter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Catastrophic bleeding first: pressure, tourniquet, pelvic binder
☐Permissive BP: SBP 80-90 until bleeding stops; MAP 80+ if severe head injury
☐Blood in 1:1:1 (RBC : FFP : platelets); calcium with every 4 units
☐Warm the patient and the fluids; hypothermia worsens bleeding
☐TXA after 3 h from injury is harmful: don't give it
☐Glucose check in every drop of GCS
☐Log-roll and C-spine protection until cleared by NEXUS / Canadian rule
☐Transfer decision in the first hour; don't wait for CT to call

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Team

Write who holds each role and stamp when they arrive. In a small ED one person may hold two roles; write the name in both.

Team leader · senior ED doctor

Directs from the foot end; makes the calls

Airway · anaesthetist

Airway, C-spine hold, RSI, ventilation

Procedures · surgeon / 2nd doctor

Chest, eFAST, drains, binder, bleeding control

Circulation nurse · staff nurse 1

IV/IO x2, bloods, blood products, TXA, drugs

Monitor & scribe · staff nurse 2

Vitals every 5 min; times on this sheet

Runner · MPW / attendant

Blood bank, samples, CT, porter, family

Radiographer · technician

Portable chest and pelvis X-ray; CT ready

Bedside checklist

☐Catastrophic bleeding first: pressure, tourniquet, pelvic binder

☐Permissive BP: SBP 80-90 until bleeding stops; MAP 80+ if severe head injury

☐Blood in 1:1:1 (RBC : FFP : platelets); calcium with every 4 units

☐Warm the patient and the fluids; hypothermia worsens bleeding

☐TXA after 3 h from injury is harmful: don't give it

☐Glucose check in every drop of GCS

☐Log-roll and C-spine protection until cleared by NEXUS / Canadian rule

☐Transfer decision in the first hour; don't wait for CT to call