Time Critical Guidelines

Question 1

The concept of the Time Critical patient allows…?

Answer 1

The recognition of the severity of a patients condition or the likelihood of deterioration.

Question 2

What are the 5 points covered within the time critical guidelines that inform clinical decision making?

Answer 2

1. Triage decisions for pts with major trauma
2. Triage decisions for pts with significant medical conditions
3. Requests for additional resources including MICA/HEMS
4. Judicious scene time management
5. Appropriate receiving hospital and early notification

Question 3

How long should the scene time be for a non-trapped major trauma patient?

Answer 3

Max. 20mins

Question 4

Time criticality does not infer _________ but rather the concept implies there be a _____________.

Answer 4

Directive for speed of transport

Time consciousness

Question 5

Define Actual Time Critical.

Answer 5

At time of VSS, pt is in APD.

Question 6

Define Emergent Time Critical.

Answer 6

At time of VSS, pt is not APD but has a POI or medical condition with a high probability of deteriorating.

Question 7

Define Potential Time Critical.

Answer 7

At time of VSS, pt is not physiologically distressed with no significant POI or medical condition but has an MOI with the potential to deteriorate to APD.

Question 8

Patients meeting major trauma criteria should be triaged to…?

Answer 8

The highest level of trauma care available within 45 minutes transport time.

Question 9

a. Which specific patients under this guideline should be transported to the RMH if within 45 minutes?
b. If >45min travel time, transport to..?

Answer 9

1. All maternity patients who meet time critical criteria
2. Any pt >24wks gestation with any trauma or potential harm to the unborn child

b. Nearest alternative highest level of trauma service.

Question 10

List the examples of “significant illness limiting normal activity/constant threat to life” constituting a co-morbidity under the major trauma guidelines (7).

Answer 10

1. Poorly controlled HTN
2. Obesity
3. Controlled/uncontrolled CCF
4. Symptomatic COPD
5. Ischaemic heart disease
6. Chronic renal failure
7. Chronic liver disease

Question 11

What are the co-morbidities listed under the Major Trauma guidelines?

Answer 11

1. > 55
2. <12
3. Pregnancy
4. Significant illness limiting activity/threat to life

Question 12

Medically critical pregnant patients should not be transported past _________ or _______ to a primary obstetric facility.

Answer 12

A Level 1 or Level 2 ED.

Question 13

a. Medically time critical maternity patients should be transported to…
b. Even if…

Answer 13

a. Nearest major ED capable of accepting a critically unwell adult with some obstetric support associated.
b. Even if it is believed that the criticality is caused by a maternity condition eg. ectopic pregnancy.

Question 14

List the Pre-Hospital Vital Signs Major Trauma Criteria.

Answer 14

HR <60 or >120
RR <10 or >30
SBP <90mmHg
SPO2 <90%
GCS <13 (if  ≥16 y.o)
GCS <15 (if ≤15 y.o)

Question 15

What is the specific indication listed to transport a patient to the nearest Metropolitan Neurosurgical Facility?

Answer 15

If the abnormal vital sign identified is an isolated reduction in GCS of a patient >65 who suffered a fall of <1m in the metropolitan region.

Question 16

List the Major Trauma Criteria for penetrating injuries.

Answer 16

All penetrating injuries except isolated superficial limb injuries.

Question 17

List the Major Trauma Criteria for blunt injuries.

Answer 17

1. Serious injury to a single body region such that specialised care or intervention may be required or such that life, limb or long-term quality of life may be at risk.
2. Significant injuries involving more than one body region.

Question 18

List the 9 Specific Injuries that meet Major Trauma Criteria.

Answer 18

1. Limb amputation or limb threatening injury
2. Suspected SCI or spinal fracture
3. Burns >20% TBSA or >10% if ≤15 y.o.
4. Suspected respiratory tract burns
5. High voltage (>1000 volts) burn injury
6. Serious crush injury
7. Major compound fracture or open dislocation
8. Fracture to ≥2 of femur/tibia/humerus
9. Fractured pelvis

Question 19

List the 8 MOI associated with High Risk Criteria for Major Trauma.

Answer 19

1. Motor/cyclist impact >30kph
2. High speed MCA >60kph
3. Pedestrian impact
4. Ejection from vehicle
5. Prolonged extrication
6. Fall from height >3m
7. Struck on head by object falling >3m
8. Explosion

Question 20

At what age are Major Trauma patients transported to a paediatric MTS?

Answer 20

≤15

Question 21

Where should trauma patients who don’t meet any of these criteria be transported to?

Answer 21

Nearest appropriate emergency care facility.