Prehospital activation of a coordinated multidisciplinary hospital response in preparation for patients with severe hemorrhage: A statewide data linkage study of the New South Wales “Code Crimson” pathway

Abstract

Prehospital medical teams accurately alert trauma teams of the impending arrival of severely injured patients requiring massive blood transfusion and interventional hemorrhage control using “Code Crimson” activations.

The Use of Prehospital Intensive Care Units in Emergencies—A Scoping Review

“…For air-type PICUs, HEMS is the most common type that was reported in nine studies from Australia, Germany, Denmark, France, and Japan. Some articles reported HEMS alone [29,30,33,34,38], while four articles mentioned HEMS operating in combination with GEMS [26][27][28]36].…”

“…Moreover, providers were trained to provide basic or intermediate care to trauma patients, such as oxygen administration, vascular access, and defibrillation [33,39]. The most reported advanced skill training includes advanced airway management, cricothyroidotomy, and advanced life support training [27,29,30,37,39]. In addition, some ICFPs had additional qualifications or skills to perform advanced care such as intubation or blood transfusion [30,33,34,39].…”

Catchy code names in trauma care cannot replace surgical decision‐making

“…Red Blanket, pre‐hospital Code Crimson, in‐hospital Code Crimson and OPSTAT are all protocols that are used for the management of the exsanguinating patient 1–6 . In Australasia they have been heavily communicated but varyingly adopted by providers of trauma care.…”

“…Partyka et al . in their data linkage paper describing the pre‐hospital Code Crimson guideline implemented in NSW very appropriately highlighted many of the limitations of these types of studies; they clearly identified the inability to make an obvious clinical benefit from pre‐hospital Code Crimson and acknowledged the need for prospective clinical trials 2 . Similarly, Tovmassian and colleagues were unable to demonstrate improved outcomes, also recognizing the need for larger RCT; however, they were able to show decreased time to operating room for their in‐hospital Code Crimson 4 .…”

“…Red Blanket, pre-hospital Code Crimson, in-hospital Code Crimson and OPSTAT are all protocols that are used for the management of the exsanguinating patient. [1][2][3][4][5][6] In Australasia they have been heavily communicated but varyingly adopted by providers of trauma care. Single-institutional 'pre and post' papers have demonstrated a consistent reduction in time from the emergency department to the operating room since implementation of the protocols, but their impact on patient outcomes is harder to extrapolate.…”