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Full/Modified Trauma Activation Orders

R*PO0001*rPO0001 Full/Modified TraumaActivation OrdersRev. 3-09 Form 0819 Page 1 of 1 Full/Modified Trauma Activation Orders full Trauma Activation Shock (Hypotension) - Systolic BP <90 (Age 15-Adult) - Systolic BP <80 (Age 0-14) GSW (Head, Neck, Torso, or Groin) Compromised airway or ventilation Traumatic cardiac arrest Traumatic Amputation (Arm/Leg) Page Trauma Surgeon: Time paged_____Called Back_____ Page Trauma Team: Time paged_____ modified Trauma Activation Significant CNS injury (GCS <10 or paralysis) Stab wound to the torso Flail chest Multiple long bone fractures Crush injury to pelvis Ejection from vehicle Auto vs. Pedestrian >10mph or thrown > 10 feet Any patient not meeting the criteria who decompensates in the ED Page Trauma Team: Time paged_____ Page Trauma Surgeon: Time paged_____Called Back_____Scene Information:Radio___ Telephone ___ AgencyCalling_____ Date: _____ Time of Call _____Location _____ETA: _____Procedures: = Mandatory = Optional 2 16 gauge or larger IV s with LR (if possible) Oximetry ECG Vital signs every 15 minutes Foley catheter (if no blood at meatus) NG tube (OG if Facial fractures)Patient Information:Male____ Female____ Age___BP____ / ____ Puls

YAKIMA VALLEY TRAUMA SERVICES REHABILITATION CONSULTATION FOR TRAUMA The Trauma Rehab Coordinator is notified BY FAX, for EACH Trauma Team activation AND any head injury, spinal cord injury, significant peripheral nerve injury and major …

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