Regionalized trauma systems have been developed to ensure access to care for injured patients who require time-sensitive life-saving interventions and advanced critical care to support recovery. The current worldwide COVID-19 pandemic threatens to overwhelm the health care system and thus impact the ability to care for critically injured patients and other surgical emergencies. The intent of this document is to advise trauma medical directors and trauma program managers on factors to consider as the public health and health care sectors prepare for an anticipated surge of critically ill patients related to COVID-19 infection. This document is not meant to be all inclusive for the planning and preparation required by hospitals and health care systems, but to raise awareness of the importance of preserving capacity to respond to traumatic injuries that routinely occur in our communities.
Engaging in the Planning Process
Trauma Medical Directors (TMD) and Trauma Program Managers (TPM) should be actively engaged in regional and hospital planning for this epidemic.
At the regional level, the TMD and TPM should engage with health care coalitions and local health departments to establish policies for regional distribution of patients and engage in ongoing discussion of regional ICU triage, regional resource allocation, and development of crisis standards of care, commensurate with the resources of the community.
The TMD and TPM should ensure that the impact on the triage and transport of injured patients is considered in the planning process and discuss the importance of preserving capacity at regional Level I and II trauma centers to receive and manage these patients.
The TMD and TPM should be involved in discussions regarding the management of injured patients, as it relates to adaptation of standards of care, and be involved in ongoing regional discussions as the situation evolves. The TMD should serve as a subject matter expert in establishing criteria for early triage to palliative care for injured patients not likely to survive.
d. The TMD and TPM should be aware of the potential impact on trauma patients across the continuum of care including transport limitations by the EMS and aeromedical
services, potential disruptions in the transfer process for injured patients
needing a higher level of care, and limitations in discharge disposition for COVID
Specific items to consider:
incident command structure and ensure hospital leadership is aware of
the expected needs to support trauma care during this timeframe.
from non-COVID patients, however optimal injury care should be a
for ICU admission, ventilator allocation, and resource-limited interventions. This process should be independent of the direct care providers.
appropriate sources for training in use of PPE; and remaining current in emerging
guidance from the CDC and regional health agencies.
hand washing, avoiding handshakes, covering mouth when coughing, and staying home when ill.
c. Educate staff on community, regional, and state disaster plans and resources. d. Support social distancing practices and allow providers not on service and non-
clinical staff to work from home.
e. Transition from in-person to virtual meetings for administrative and educational
f. When possible, restructure trauma teams and stagger cohorts to reduce the
number of trauma/ICU providers in the hospital simultaneously to decrease
exposure risk and preserve staff.
g. Develop redundancy in backup schedules for providers who may be ill or
h. Develop a mechanism to monitor the well-being of team members who have had
potential COVID-19 exposure or who are on quarantine.
i. Ensure that each trauma team member has an individual plan to support
childcare and family/pet needs.
j. Ensure regular scheduled communication for team providers as hospital policies
and procedures evolve, provide situational awareness on the patient load, and support development of a centralized, online resource for the health care system to disseminate information and policies and procedures.
k. Allow personnel with specific critical skills to concentrate on those skills. For example, surgical intensivists may need to help overwhelmed medical intensivists with ventilator management of critical COVID-19 patients, while general surgeons could assist with trauma alerts, emergency general surgery procedures, and floor rounds.
l. Support schedules and team culture that optimize wellness and maintain resilience for team members.
IV. Strategies at Point of Care
a. Trauma Bay
face mask on the patient.
exposure history, travel history to history and take appropriate isolation
for direct patient care.
COVID patients requiring emergent intubation.
See CDC references below
V. Strategies for Managing Scarce Resources
Shortages of PPE and blood products may develop. The TMD and TPM should support hospital policies and procedures to preserve these resources.
b. Blood Products
Due to community social distancing policies and public fear of donation and disease transmission, we are already seeing a decrease in the regional blood supply in parts of the country.
CDC COVID testing and PPE recommendations
Crisis Standards of Care
Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, NASEM. Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement: Triage