Skip to content

Pre-Arrival

Principles

Trauma resuscitation begins before patient arrival.
The objective is a safe, organized, and fully prepared environment that allows immediate lifesaving intervention.
Preparation saves lives — ensure that equipment, personnel, and the environment are ready before starting the primary survey.
Do not delay critical actions once the patient enters the room.

Team Organization and Leadership

  • Identify the team leader before arrival.
  • Assign and confirm roles:
  • Airway: prepare for intubation.
  • Breathing: chest access, oxygen setup, thoracostomy readiness.
  • Circulation: IV access, blood draw, MTP setup.
  • Monitor: ECG, SpO₂, BP, temperature.
  • Recorder: document vitals, interventions, and times.
  • Runner: manage supplies, coordinate x-ray, labs, and blood products.
  • Establish closed-loop communication and confirm understanding (“copy” / “understood”).
  • Reinforce teamwork and safety: “If anyone identifies a safety issue, speak up.”

Safety and Environment

  • All team members must wear PPE (gloves, gown, mask, face protection).
  • Maintain room temperature ≥26 °C to prevent hypothermia.
  • Ensure adequate lighting and a clear workspace.
  • Verify sharps containers and spill management availability.
  • Prepare warm blankets and active warming devices.
  • Maintain a safe environment for staff and patient at all times.

Equipment and Supply Readiness

Airway

  • Confirm suction is functional and canister empty.
  • Ensure oxygen source >1000 psi and flowmeter operational.
  • Prepare bag-valve-mask with reservoir and tubing.
  • Check laryngoscope light, and prepare ETTs (7.0–8.0 mm) with stylet and CO₂ detector.
  • Keep cricothyroidotomy set open and visible.
  • Draw up RSI medications (sedative, paralytic, flushes).

Breathing

  • Open chest-tube tray (36–40 Fr) and attach drainage system.
  • Prepare 14 G needle for decompression at 5th ICS AAL.
  • Place occlusive dressings and scissors nearby.
  • Confirm ventilator or O₂ circuit readiness.

Circulation

  • Insert two large-bore (14–16 G) IVs or have ready.
  • Ensure rapid infuser, pressure bags, and fluid warmers functional.
  • Prime and hang warmed Ringer’s lactate.
  • Place pelvic binder and tourniquets at bedside.
  • Confirm IO access kit and MTP cooler available.
  • Warm all fluids and blood to avoid hypothermia/coagulopathy.

Monitoring and Adjuncts

  • Attach ECG, SpO₂, BP cuff, temperature probe.
  • Power on FAST ultrasound.
  • Prepare Foley and NG/OG tubes.
  • Ensure portable x-ray and lead aprons ready.
  • Set up point-of-care testing (ABG, glucose, lactate).

Pre-Arrival Brief (Team Huddle)

  • Conduct 2–3 minutes before arrival.
  • Team leader summarizes:
  • Mechanism and expected injuries.
  • Anticipated interventions (airway, MTP, thoracostomy).
  • Individual task assignments and sequence.
  • Confirm readiness verbally:

    “Suction on, oxygen on, IV fluids warmed, chest tray open.”

  • Reinforce communication:

    “I will call out ABCDE — speak up with critical findings.”
    A brief, structured huddle ensures a shared mental model and readiness for high-risk interventions.

Final Cross-Checks Before Entry

  • Suction functional and within reach.
  • Oxygen flowing and visible.
  • Bag-valve-mask assembled and tested.
  • Chest-tube tray open with sterile gloves available.
  • Warmed fluids running through warmer.
  • Pelvic binder at bedside.
  • Ultrasound probe clean with gel ready.
  • Defibrillator powered and charged.

Medications and Blood Products

  • RSI agents:
  • Etomidate 0.3 mg/kg or Ketamine 1.5 mg/kg.
  • Succinylcholine 1.5 mg/kg or Rocuronium 1 mg/kg.
  • Vasopressors available (norepinephrine / epinephrine).
  • TXA 1 g IV in 100 mL NS over 10 min (if < 3 hr from injury).
  • Tetanus prophylaxis drawn and labeled.
  • Analgesics (morphine, fentanyl) ready post-stabilization.

Handoff Reception (MIST)

  • Assign one person to receive the prehospital report.
  • Use MIST format:
  • M: Mechanism of injury
  • I: Injuries found or suspected
  • S: Signs (vital parameters)
  • T: Treatment provided and time of injury
  • Confirm time of injury and fluids given.
  • Direct transfer to bed and begin primary survey.

Leader statement:

“Thank you. Team ready, patient to bed.
Beginning primary survey — Airway and cervical spine protection.”

Quality and Safety

  • Remove backboard promptly once spine precautions are secured.
  • Keep the patient and room warm.
  • Maintain clear equipment access and staff pathways.
  • Document arrival time, first vitals, interventions immediately.
  • Dispose of sharps safely after use.

Transition to Primary Survey

Leader confirmation:

“Monitors on, suction and oxygen functional, team in PPE, MIST received.
Beginning primary survey — Airway and cervical spine protection.”

References

  • Advanced Trauma Life Support (ATLS®) 10th Edition, American College of Surgeons Committee on Trauma.
  • Vanderbilt University Medical Center Trauma PMG Format.