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Time is of the essence in caring for patients with multiple injuries. To emphasize the time-
sensitive nature of this care, the critical period immediately following injury was historically
termed the golden hour. The golden hour is no longer sacred, as we know that patient
outcome is directly related to the time from injury to definitive care.1
In order to save time, the initial assessment and management should follow a systematic
approach that can be easily learned and practiced. This approach is the foundation for the
Advanced Trauma Life Support (ATLS) course. Lack of a systematic approach to the initial
assessment can result in errors from which the resuscitation team, and ultimately the patient, do
not recover.2
When specific criteria suggesting a possible serious injury are met, the trauma team is activated
through a trauma alert system. The entire team responds immediately. In addition, the triage
officer may activate the trauma alert system at his/her own discretion for any reason.3
- Ideally, the team arrives before the patient. The trauma surgery attending physician is the team
leader. Each team member must understand their role. Communication is essential, and
discussion of potential scenarios prior to the arrival of the patient can be very useful.
- The operating room should be notified and made aware of a possible emergent case.
- The radiology team should be ready and waiting for patients arrival.
Protecting the Trauma Team
- Needlesticks and splashes are endemic in acute trauma management.
- Universal precautions are probably more important here than in any other part of the hospital,
given the patient population, use of sharp instruments and needles, number of staff, and
accelerated pace of trauma assessment.
- Be careful of unexpected sharps such as broken ribs and retained missiles or foreign bodies.
The team leader is responsible for keeping the resuscitation smooth and calm.
Airway
Maintenance of the airway is the most important priority in caring for the trauma patient.
Inadequate ventilation leads to hypoxia and inadequate oxygen delivery to tissues.1