Optimizing the trauma resuscitation bay during the covid-19 pandemic

Abstract

The covid-19 global pandemic due to the SARS-CoV2 (CoV2) virus has created the need to adapt hospital workspaces and staffing models, and trauma is no exception. While the optimal configuration of a trauma resuscitation area is debatable, the space needs to be large enough to accommodate the trauma team and ancillary staff. It also needs to have ready access to supplies and equipment to quickly and easily control hemorrhage, secure an airway and initiate fluid resuscitation. Lastly, stores of personal protective equipment in the form of fluid resistant gowns, head covering, face shield, and gloves (both sterile and non-sterile) should be readily available but under strict access. As CoV2 carriers increased in our population in New Jersey, we treated each incoming trauma patient as a potentially CoV2-positive case and sought to reconfigure out trauma resuscitation area to minimize exposure of our supplies to aerosolized virus.

Keywords: body fluids; disasters; emergency treatment.

Figure 1

Individual trauma bay after removing all supplies from shelves and equipment. Mayo stand with single patient supplies in lieu of standard nursing cart.

Figure 2

Trauma resuscitation area with clearly delineated hot (red tape), warm (yellow tape) and cold zones. Transfer table is present in the warm zone with all other easily accessible supplies in the cold area.

Figure 3

Close up of the supplies for stationed for each case. Individually bagged intravenous and phlebotomy tubes, extra masks for patient, underbody absorbent pad and disposable stethoscope.

Figure 4

Trauma team awaiting level 1 activations, multiple gunshot wounds. Due to potential severity of activation, team consists of chief and midlevel trauma residents, a senior emergency medicine resident and trauma nurse. Trauma attending staff is present in the cold zone as team leader and readily available but not gowned and gloved to conserve PPE. Equipment carts (A)) at each end of the trauma resuscitation area. The main supply (red arrow), PPE carts (purple P) and airway cart (not visualized) are kept centrally.

Figure 5

Dedicated airway cart.

Figure 6

Equipment cart with tube thoracotomy supplies, syringes, commonly used sutures, suction tubing and procedure tray (bottom shelf). These small portable carts allow easy access to resuscitations supplies to be passed into the hot zone.