Trauma information for providers

We are the referral center for the region's only Level II Trauma Center, Comprehensive Stroke Center and Level III Neonatal Intensive Care Unit (NICU). Additionally, Mission Children’s Hospital provides multiple pediatric subspecialists as the region’s only dedicated children’s hospital, complete with a pediatric emergency room.

We also serve as the busiest robotic surgery program across North Carolina and South Carolina. Further, Mission Hospital provides the only open-heart program and interventional cardiology in the region.

Mountain Area Healthcare Preparedness Coalition (MAHPC)

Mission Health Emergency Services is proud to partner with the Mountain Area Healthcare Preparedness Coalition.

Mountain Area Trauma Regional Advisory Council (MATRAC)

We also partner with the Mountain Area Trauma Regional Advisory Council (MATRAC) to:

• Commit the team of physicians and clinical specialists in Mission Hospital's designated Level II Trauma Center to offer the best possible trauma care, including injury prevention, education, as well as acute and rehabilitative care
• Collaborate between Mission Hospital's Level II Trauma Center and partnering agencies to promote excellence and quality outcomes in our trauma population
  
• Involve partners in performance improvement initiatives
• Increase regional awareness of the outcomes at our Level II Trauma Center at Mission Hospital through data analysis and case study presentations
• Provide educational opportunities related to injury prevention, treatment/management, disaster response guidance and evidence-based research findings

The majority of trauma patients can, and should, receive definitive care at the nearest regional hospital. A small percentage, five-to-eight percent, will require transfer to the Trauma Center. The triage decision is the responsibility of the emergency department attending at each facility. It is incumbent upon that physician to be familiar with the degree of definitive care capability at their facility. If the patient’s needs exceed that capability, then prompt movement through the trauma system is in the best interest of the patient. This may involve air medical directly to the scene, ground emergency medical services (EMS) bypass of the nearest facility directly to the Trauma Center, air medical or ground transport from the regional facility to the Trauma Center.

Note that it may be necessary to consider immediate trauma center diversion/transfer and the CDC 2011 Field Triage Guidelines for Injured Patients.

• Systolic blood pressure (SBP) greater than 90 mmHG in an adult or signs of shock in a pediatric patient
• HR greater than 90 or SBP greater than 110 mmHG should be considered in the case of geriatric blunt trauma
• Respiratory rate greater than 10 or greater than or equal to 29 bpm or need for ventilator support ( greater than 20 in infants)

• All penetrating injury to head, neck, torso and extremities proximal to elbow or knee
• Chest wall instability or deformity (e.g., flail chest)
• Two or more proximal long-bone fractures
• Crushed, degloved, mangled or pulseless extremity
• Amputation proximal to wrist or ankle
• Pelvic fractures
• Open or depressed skull fractures
• Paralysis

• Falls
  • Adults > 20 feet
  • Children > 10 feet or two to three times the height of the child
• High-risk auto crash
  • Intrusion including roof > 12 inches occupant side or 18 inches any side
  • Ejection (partial/complete) from automobile
  • Death in the same passenger compartment
  • Vehicle telemetry consistent with high-risk injury
• Auto vs. pedestrian/bicyclist thrown, run over or with significant (> 20 mph) impact\
  • Motorcycle crash > 20 mph

• Older Adults
  • Risk of injury/death increases after age 55
  • SBP < 110="" or="" hr="" /> 90 may represent shock after age 65
  • Low impact (falls level surface) may result in severe injury
• Children
  • Should preferably be triaged to a trauma center with pediatric capabilities
• Anticoagulants and bleeding disorders
  • Patient with head injury are at high risk for rapid deterioration
• Burns
  • Without other trauma mechanism: triage to Burn Center
  • With trauma mechanism: triage to Trauma Center
• Pregnancy > 20 weeks
• EMS provider judgement
• Other patients at the discretion of the regional emergency department attending

NOTE: All such decisions rest with the emergency medicine physician in regional hospitals. It is vital to remember and understand that major trauma victims must move through the trauma system quickly to realize maximum benefit from the system. Complete, definitive, time-consuming radiologic evaluation is neither necessary nor desirable prior to Trauma Center transfer. This is the standard of care established by MATRAC in 2000 and has not changed. The emergency medicine physician at Mission is authorized to accept any trauma patient in transfer from the region. This decision will be supported by the on-call trauma surgeon. It is necessary for the referring MD to speak only with the EM MD at Mission to initiate the transfer.

The Mission Health System Regional Referral Call Center is responsible for the coordination of all regional and direct admission patient placements through Mission Direct. Clinical judgement will be utilized to coordinate and expedite the transfer of patients within the region while simultaneously working with the receiving and sending physicians to resolve any issues that may arise.

The Transfer Center RN (TCRN) works collaboratively with the house supervisor to determine bed availability within the Mission Health system. The TCRN is responsible for the coordination of all Emergency Medical Treatment and Labor Act (EMTALA) forms from the organization ensuring all patients are transferred in and out of the Mission Health system with appropriate documentation.