Cochairmen:
W.F. Dick
P.J.F. Baskett

Participants:
C. Grande (USA)
H. Delooz (Belgium)
W. Kloeck (South Africa)
C. Lackner (Germany)
M. Lipp (Germany)
W. Mauritz (Austria)
M. Nerlich (Germany)
J. Nicholl (UK)
J. Nolan (UK)
P. Oakley (UK)
M. Parr (UK/Australia)
Seekamp (Germany)
E. Soreide (Norway)
P.A. Steen (Norway)
Luc van Camp (Belgium)
B. Wolcke (Germany)
D. Yates (UK)

A similar situation has existed for other areas of emergency medicine, and resuscitation from cardiac arrest is a particularly important example. To address this particular problem, the European Resuscitation Council (ERC), the American Heart Association (AHA),the Australian Resuscitation Council, the Resuscitation Council of Southern Africa, and similar organisations in other continents, after intensive discussion and a series of consensus processes, have issued "Guidelines for Uniform Reporting of Data following Out-of-Hospital and In-Hospital Cardiac Arrest - the Utstein Style".^1,2 Since then, studies from different centers have been published that facilitate valid comparison of data and systems on the basis of this uniform terminology and template.

In 1995, Spaite and his colleagues³ in the United States published a report from the Uniform Prehospital Emergency Medical Services Data Conference that defined the principles of data collection, setting out, among others, proposals that data be stratified into "Core" (essential) and "Optional" (Supplemental) information in an effort to provide useful information for improvement of THE quality of both care and research specifically in the prehospital arena.

In 1994, at its 7th Annual Symposium in Paris, a working group from the International Trauma Anaesthesia and Critical Care Society (ITACCS) agreed to design a system, based on the Utstein concept and template, but specifically targeted at uniform reporting of data following trauma.⁴ The project was not to be confined to capture of data only in the prehospital phase, but also would attempt to include early in-hospital management and, significantly, would incorporate data from outcome studies.

In 1996,during the 9th ITACCS Symposium in London, the working group met again and agreed that there now was an urgent need for a common terminology and reporting template to be developed to facilitate the acquisition, processing, audit, and analysis of data that would be both compatible and comparable.

Such a system should have the following features:

In February 1998, the main ITACCS consensus project committee met in Mainz, Germany to produce a definitive draft of the document. Six initial small group( each with five members) meetings were followed by plenary debate. The six groups then prepared a component draft that was debated, developed, and refined within the group, following which the secretary of each group submitted their component draft to a small writing committee charged with the preparation of a pre-final composit draft document. This was finalised in May 1998,during the 11th ITACCS Annual Symposium in Vienna. Prior to and since that meeting, the document has received substantial input from additional researchers and clinicians from complementary disciplines and support from scientific organisations world wide.

Trauma Data Structure Development Using Object-Orientated Modelling

The data to be collected for trauma care inherently is complex. Different personnel who take part at different stages of trauma care, often have different requirements for data collection, yet there are inherent similarities that allow the development of a single unifying model. In the object-oriented approach, the patient can be regarded as an object with a unique identification number "travelling" through time (from the accident occurring) and space (location) with other generic object links such as attendants (personnel involved at different stages), observations (sensors), and interventions (effectors), as shown in the Figure 1. The advantage of this approach, used by software engineers, is that it may be employed analytically to develop the model. A flexible structure is developed not only for recording and analysing data, but also for shaping the way in which trauma care is conceptualised and the language used to describe it. Object-orientated concepts such as "object inheritance" can be incorporated to define and refine individual objects within the overall model.

The components of this model are incorporated into the various sections of the guidelines as listed:

1) Factors Relating to the Circumstances of Trauma;
2) System Factors;
3) Patient Factors;
4) Treatment and Outcome;
5) Ethical Issues; and
6) Documentation/Methodology

The document is structured along the lines essentially similar to the original Utstein Style Guidelines publication on "prehospital cardiac arrest".¹ It includes a glossary of terms used in the prehospital and early hospital phase, and definitions, time points, and intervals. The document uses an almost identical scheme (Figure 2) for illustrating the different, overlapping time clocks - one for the patient, one for the dispatch centre, one for the ambulance, and finally, one for the hospital. Guidelines and where appropriate, definitions, are provided for clinical inputs, interventions, and outcomes that should be included in reports, and recommendations made for the description of emergency medical services systems, together with the variables for input, process, and outcome. These variables may be stratified into core (essential ) (prefixed with a "c"), or optional (supplemental) data (prefixed with an "o").

Definitions such as bystander, emergency personnel, etc., used in the document are identical to those used in the original Utstein template for cardiac arrest documents, and may be referred to in those publications.^1,2

In trauma, the terminology corresponding to Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) should have been Basic Trauma Life Support (BTLS) and Advanced Trauma Life Support (ATLS). However, ATLS® is a trade mark held by the American College of Surgeons; therefore, the working group elected to use the more generic terms Basic Care (BC) and Advanced Care (AC).

As in the previous Utstein style documents, the term interval (event-to-event interval) replaces the term "time" or "down-time". Thus, the "call-to-response interval" denotes the period from receipt of the call by the emergency dispatcher to the moment the emergency response vehicle stops moving at the scene; however, in this document, the "call-to-patient-arrival" interval is utilised because it includes the period from "vehicle stops moving at the scene" until arrival of the crew "at patient side", a period which is not available for intervention, but which may prove to be time-critical.

In the section on outcome, particular attention has been paid to data on morbidity and disability. They are developed to provide greater detail than do the corresponding cardiac arrest documents. Proposals are made for scalar indices that investigators may use to quantify disability, quality of life, and other relevant parameters.

The structural and operational components of the Emergency Medical Services (EMS) are described in accordance with the original Utstein documents, i.e., the dispatch system and the first, second, and third tiers.

In contrast to the Utstein Templates used for pre- or in-hospital cardiac arrest, the working group decided for the present time, to use a semantic rather than a graphic approach to the protocol for actually recording data. In the future, however, when the document has been promulgated and discussed widely, the group may come forward with a graphical report form for trauma patients that may facilitate collection or processing of data.

1. Type of injury;
2. Severity of the injury(ies);
3. Mechanism of the injury; and
4. The location of the injury

To allow meaningful interpretation and comparison, both anatomical and physiological assessments must be documented. The most commonly used scoring systems in current use are the Abbreviated Injury Scale (AIS),^25,28,from which the Injury Severity Score (ISS)^26,27 is derived, and the Revised Trauma Score (RTS)²⁹ that is composed of the Glasgow Coma Scale,^29,30 the systolic blood pressure, and the respiratory rate. The ISS and RTS allow TRISS methodology³¹ and comparison with the Major Trauma Outcome Study (MTOS).^32,33

Available studies have produced conflicting results.^6,7,34-41 Some studies have suggested that Advanced Life Support procedures improve physiological variables but not outcome.⁴⁰

Of greater concern would be if prehospital ALS procedures actually may be detrimental.^42,43 As a result, the traditional concept of trauma management in the prehospital setting is increasingly questioned.⁴⁴ These uncertainties underline the importance of accurate documentation of treatment and outcome. This will provide evidence for or against the efficacy of management systems and treatment interventions and regimes.^{3. 45}

In trauma research it particularly is important to depersonalise all data as it generally is easier to connect a specific person to a trauma incident than to a disease process, especially in case reports.

All studies should follow the Declaration of Helsinki, and must not be initiated until approved by the appropriate ethics committee. This usually implies that informed consent must be obtained from the patient if possible. This is problematic and presents a unique ethical challenge in trauma research.

Some patients will be unconscious, and so cannot consent at the time needed for inclusion in many studies. Surrogate permission from family members or legal guardian, is unacceptable in some countries,^46,47 and rarely is available in the acute care situation in countries in which it is accepted.

Even in conscious patients, informed consent is problematic in the acute care setting.^47,48 Informed consent implies that a competent patient must, to the best of a competent researcher's knowledge, have received and understood all the appropriate information. As the treatment of the patient has first priority, there frequently is not sufficient time to ensure quality informed consent in the management of patients with severe trauma.

All studies must comply with ethical principles. These can vary between nations, states, or local communities. In the United States, as an example, Federal regulations concerning informed consent resulted in a virtual halt in resuscitation research in the early 1990s. In response, the 1995 Coalition Conference of Acute Resuscitation and Critical Care researchers stated that research can and should be done in clinical circumstances where it was not feasible to obtain informed, prospective, or proxy consent for enrolment in a study protocol.⁴⁹ The Coalition endorsed a new term - "appropriate incremental risk", which is defined as any potential risk specifically associated with participation in the research compared with risk of the natural consequences of the medical condition itself. Although patients indeed are vulnerable to research risks, they also are at risk of being denied potential beneficial therapy when no effective therapy currently exists. Therefore, recently the U.S. Food and Drug Administration has published a "final rule" allowing research to be performed in certain emergency situations without informed consent. It is not one of the requirements that the patient has to be unconscious, but that it is not feasible to obtain informed consent from the patient or a legal representative.

There are certain studies in which the act of asking for informed consent causes a bias in itself. This is covered in the Helsinki Declaration Section 11.5; thus if the physician thinks it is essential not to obtain informed consent, the specific reasons for this should be stated in the experimental protocol submission to the independent ethical committee.

There is no commonly accepted definition of medical futility. Hidden value judgments may be made by clinicians who declare futility. Some cases such as decapitation, incineration, drowning with bloating, hemicorporectomy, or rigor mortis will be considered futile by all. Other situations, such as prolonged submersion or exsanguination with asystole will require a statement of the time element required for defining futility in the specific study.

Qualitative futility is a term being used by some researchers implying survival with a quality of life well below the threshold considered minimal by general professional judgment. This is problematic without obtaining the wish of the patient, as it recently has been reported that there is relatively poor correlation between the evaluation of quality of life between physicians and the patients.^50,53 Seckler et al⁵⁴ and Suhl et al⁵⁵ also have found poor or no correlation between patients and physicians or family members/surrogates concerning their wish for resuscitation.

The term DNAR/DNR is more difficult to apply in the trauma patient than in victims of cardiac arrest of cardiac origin. Resuscitation can involve more factors in trauma management such as fluid resuscitation,etc. In studies of trauma in which these terms are applied, it therefore is essential that they are defined, together with other possible codes for withholding or withdrawing treatment.

In studies involving patients, the information must be depersonalised and informed consent must be obtained. If the patient also refuses standard treatment, that should be noted. The rules for declaring the patient incompetent, and so allowing treatment, vary between countries, and also should be noted. This does not automatically permit the inclusion of the patient in a study without consent.

The provision of patient information to police is mainly a patient management problem, but also can pertain to study data. Informed consent generally is required, but national or state rules for divulging information to the police without consent can apply. In some countries, the duty to protect the public from potential further damage weighs more heavily than does the patient's right to privacy, with national variations in the degree of damage potential required. In other circumstances, the police may acquire information by legal enforcement.

Information such as alcohol or drug blood levels obtained strictly as part of a study, should not be divulged to the treatment team without informed consent. If reported in a study, the process for obtaining such information should be described, as the routine testing in all motor vehicle accident patients in some countries in itself may give a different result from that taken for a specific indication.

This is an important patient management problem, with no specific research aspects. It should be noted that in some countries the media are being used actively by researchers to inform the public that a certain acute care study is going on, in an attempt to pre-inform patients as part of the informed consent procedure.

Planning for data collection
Plans for collecting data on trauma patients should be drawn up prospectively. Full co-operation between prehospital and in-hospital personnel will minimise the possibility of omitting or duplicating relevant data. If the pre-hospital and in-hospital data can be linked with police, EMS, or population studies, they may provide a means for data verification and validation.

Data collection
Data collection can be done manually or it can be automated. Some manual techniques are partly automated by using some form of hand-held computer with which to record data. In the future, physiological telemetry is likely to become more widely available, and will allow continuous, automated collection of data in both the pre-hospital and in-hospital areas.

Manual collection
Real-time data collection is the ideal, but this will require the continual presence of a dedicated data collector. With the exception of well-funded research studies, this is unlikely to be practical in the prehospital phase.

A single data collection form for both pre-hospital and in-hospital phases may be seen as ideal, but most trauma systems will utilise two ore more forms. These need to be linked by a unique identifier, preferably a number. This will be supported by secondary identifiers, comprised of the name and time. Links are required between the pre-hospital, in-hospital forms, audit forms, and forms at any secondary or tertiary hospital to which the patient has been transferred.

Data may be abstracted from audio and/or video tape, but this often will be too labour intensive to use for routine audit. This technique, however, may be a valuable research tool.

Personnel in the control/dispatch centre may well be able to collect and record some of the relevant pre-hospital data.

Guided by previous consensus processes evolved by the ERC, the AHA, and other International Organisations represented in ILCOR - on Uniform Reporting of Data following Out-of-hospital and In-hospital Cardiac Arrest - the Utstein Style, an international working group of ITACCS has drafted a document, Recommendations for Uniform Reporting of Data following Major Trauma - the Utstein Style. The reporting system is based on the following considerations:

1) A structured reporting system based on an "Utstein style template" that would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance, and quality of care (and enable groups to challenge performance statistics that did not take account of all relevant information);

2) The recommendations and template should encompass both out-of-hospital and in-hospital trauma care;

3) The recommendations and template should permit further intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives; and

4) The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example, such studies might focus on the factors that determine survival.

The document is structured along the lines of the original Utstein Style Guidelines publication on "prehospital cardiac arrest". It includes a glossary of terms used in the prehospital and early hospital phase as definitions, time points, and time intervals. The document uses an almost identical scheme for illustrating the different process time clocks - one for the patient, one for the dispatch centre, one for the ambulance, and, finally, one for the hospital.

For clarity, data should be reported as core data (i.e., always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present Template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form.

The document includes the following sections:

I. Introduction and Background;

II. Trauma Data Structure Development -a general outline of the development of structured data using object-orientated modelling(which will be discussed in due course) and includes a set of explanatory illustrations;

III. Terms and Definitions - outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma);

IV. Factors Relating to the Circumstances of the Injury - describes the following items:

a) Cause of injury (e.g.type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc;

b) Severity of Injury - e.g., prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1 = head to 9 = external; the physiological disability scale ranges ordinally from "0" to "unsurvivable";

c) Mechanism of injury - recording for transportation incidents etc; e.g., the type of impact, possible restraining devices,and deliberate self-harm; and

d) Demographics of injury - e.g., presentation of data concerning the location and other social information pertaining to the injury.

V. System Factors - defines the factors that may be structured, subdivided into pre-hospital, inter-hospital transfer, and trauma centre/receiving hospital factors or temporal consisting of dates, time points, and time intervals that are defined in accordance with the previous Utstein template on cardiac arrest. Trauma centre details focus on the trauma team, its composition, and its respective experience, the facilities available during the 24-hour period, and arrival data at different transit/treatment locations such as the operating room, PACU, ICU, discharge, etc;

VI. Patient factors - defines demographics such as age, gender, dimensions, and co-morbidity factors that may be most important for survival. Co-morbidity is graded ordinally from 1 = Healthy to 4 = Systemic illness: constant threat to life. Scores and scales for consistent quality assessment of trauma then are addressed, concentrating in particular on respiratory and cardiovascular function, temperature, blood gases, the anatomic assessment of injury and treatment modalities and details. The section concludes with a look at the present situation where conflicting results either confirm or refute not only the efficacy and effectiveness of prehospital ALS procedures but also any influence that such measures may exhibit as a rationale for evidence based medicine. These latter phenomena require further scientific evaluation in randomized, controlled studies, where possible.

VII. Outcome - addresses mortality (time, date, location of death, place, confirmation, cause of death, and adverse factors) and morbidity, defined as all non-fatal problems leading from impairment to disability and reversible and irreversible disability. A number of widely used outcome scales are discussed;

VIII. Ethical issues - dedicates special emphasis on patient consent to trauma research, on medical futility, DNAR and DNR directives, deliberate self-inflicted harm, care of relatives, and advanced directives; and

IX. Documentation - addresses methodology and technology, underlining the need for data collection to be planned. Details such as manual, automatic, and electronic data collection and entry, and data collection forms are outlined. It is emphasised that particularly all data collectors and enterers should receive appropriate training before being involved in the data collection process. It further is pointed out that the standardisation of data collection will allow downloading into a valid common database.

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TERMS TO BE AVOIDED:
Isolated Trauma
Pattern of Injury
Single System Trauma
Triage

The comparative assessment of the individual patient, i.e., their needs and priorities in relation to:

1) Vital functions
2) Concomitant injuries
3) Age + comorbidity
4) Circumstances of the event

B1. TYPE OF INJURY (check ALL that apply)
co B1.1 Blunt
co B1.2 Penetrating

oo B1.3 Burn
oo B1.4 Cold
oo B1.5 Asphyxia
oo B1.6 Other (specify)_____________________________________
oo B1.7 Other (specify)_____________________________________
oo B1.8 Other (specify)_____________________________________
oo B1.9 Crush
oo B1.10 Laceration
oo B1.11 Amputation
oo B1.12 Radiation
oo B1.13 Multiple
oo B1.14 Other (specify)_____________________________________
oo B1.15 Other (specify)_____________________________________
oo B1.16 Other (specify)_____________________________________

B3. MECHANISM OF INJURY
cB3.1 TRANSPORT
o o B3.1 Motor Vehicle (car or truck)
o o B3.2 Motor cycle
o o B3.3 Cycle
o o B3.4 Train
o o B3.5 Airplane
o o B3.6 Boat
o o B3.7 Other (specify) ______________________________
o o B3.10 Occupant or Rider
o o B3.11 Pedestrian

o POSITION IN VEHICLE (select ONE most appropriate)
o o B3.12 Passenger
o o B3.13 Front
o o B3.14 Rear
o o B3.15 Driver/Pilot
o o B3.16 Position in Train/Plane/Boat
o o B3.17 ____________Seat Number
o o B3.20 Other (specify) ______________________________

o TYPE OF IMPACT (select ALL appropriate)
o o B3.30 Head-on
o o B3.31 Rear-end
o o B3.32 Side
o o B3.33 Roll-over
o o B3.34 Ejection
o o B3.35 Entrapment
o o B3.40 Other (specify) ______________________________

o VEHICLE DEFORMITY (select ALL appropriate)
o o B3.50 Front
o o B3.51 Rear
o o B3.52 Side
o o B3.53 Roof
o o B3.60 Other (specify) ______________________________

o RESTRAINING DEVICES (select ALL appropriate)
o o B3.70 Seat Belt
o o B3.71 Air Bags
o o B3.72 Helmet
o o B3.80 Other (specify) ______________________________

cB3.2 FALL (fill-in blanks)
oo B3.100 Height ______________metres
oo B3.101 Landing Surface __________________________

cB3.3 INTERPERSONNAL VIOLENCE (select MOST appropriate)
oo B3.110 Blunt
oo B3.111 Stab
oo B3.112 Bullet
oo B3.113 Spike
oo B3.119 Other (specify) ______________________________

cB3.4 o B3.120 DELIBERATE SELF-HARM (select MOST appropriate)
oo B3.121 Blunt
oo B3.122 Stab
oo B3.123 Bullet
oo B3.124 Spike
oo B3.125 Fall
oo B3.126 Laceration
oo B3.127 Substance abuse
oo B3.129 Other (specify) ______________________________

cB3.5 o B3.130 ASPHYXIA (select ALL appropriate)
oo B3.131 Physical
oo B3.132 Hanging
oo B3.133 Strangulation
oo B3.134 Explosion
oo B3.135 Thermal
oo B3.136 Chemical
oo B3.137 Radiation
oo B3.138 Near-Drowning
oo B3.139 Foreign Body
oo B3.140 Other (specify) ______________________________

B3.6 OTHER
oo B3.150 Electrocution

oB4. LOCATION OF INCIDENT (select ONE most appropriate)
oo B4.1 Home
oo B4.2 Work
oo B4.3 Public Area
oo B4.4 Street/Road
oo B4.5 School
oo B4.6 Sports
oo B4.7 Industrial
oo B4.8 Farming
oo B4.9 Other (specify) ______________________________

(select ONE MOST appropriate)
oo B4.10 Urban
oo B4.11 Rural
oo B4.12 Remote
oo B4.19 Other (specify) ______________________________

C1. PREHOSPITAL FACTORS
C1.1. INCIDENT (fill-in blanks)
co C1.1 Date (day/month/year)______________________
co C1.2 Time of occurrence _________________________hours
co C1.3 Time of discovery __________________________hours
co C1.4 Discovery by:_______________________________

BYSTANDER CARE (Check ALL applicable)
co C1.5 Lay person
co C1.6 Physician/Doctor
co C1.7 Nurse
co C1.8 Technician
co C1.9 Other (specify)_______________________________________________

C1.2. CALL FOR ASSISTANCE
EMERGENCY TELEPHONE NUMBERS (Check ALL applicable)
co C1.10 National
co C1.11 Regional
co C1.12 Local
co C1.13 Dedicated to EMS
co C1.14 Other (specify)_____________________________________________

DISPATCHER (Check ALL applicable)
co C1.15 Protocols used
co C1.16 National
co C1.17 Specific trauma training
co C1.18 Authority in Decision-making
co C1.19 Pre-arrival instructions given
co C1.20 Call handed/transmitted to (specify)______________________________

C1.3. EMS RESPONSE
CREW (check ALL appropriate)
TECHNICIAN
co C1.21 Basic life support
co C1.22 Advance life support
co C1.23 Nurse trained in trauma care
co C1.24 Nurse NOT trained in trauma care
co C1.25 Physician trained in trauma care
co C1.26 Physician NOT trained in trauma care

VEHICLE (Check MOST applicable)
co C1.27 Ground
co C1.28 Air
co C1.29 Sea

TYPE OF CARE (select ONE)
co C1.30 Basic (non-invasive)
co C1.31 Advanced (invasive)

DISTANCES (fill-in blanks)
oo C1.40 _________km to base hospital
oo C1.41 _________km hospital 1 to hospital 2

C2. DATE/TIME-POINTS/TIME INTERVALS
C2.1 Incident (Fill in time using 24 hour clock)
c o C2.1_________h: Time of Occurrence
c o C2.2_________h: Time of Recognition
c o C2.3_________h: Time bystander care initiated
c o C2.4_________h: Time of EMS care initiated
c o C2.5_________h: Time Call for Assistance received
c o C2.6_________h: Time Call for Assistance processed
c o C2.7_________h: Time of Dispatch
c o C2.8_________h: Time Vehicle moves
c o C2.9_________h: Time Vehicle Arrives on Scene
c o C2.10 ________h: Time Arrival at Patient
c o C2.11 ________h: Time Scene interval (assessment/treatment)
c o C2.12 ________h: Time Vehicle departs from Scene
c o C2.13 ________h: Time Vehicle Arrival at trauma (emergency treatment) facility
oo C2.14 ________h: Time of Diversion from destination hospital

C3. INTERHOSPITAL TRANSFER FACTORS
C3.1. INDICATIONS (select one)
c o C3.1 Usual Facilities NOT Available
c o C3.2 Special Facilities NOT Available
c o C3.3 Others (specify) ________________________________________________

C3.2. DATE/TIME-POINTS/TIME INTERVALS (Fill in time using 24 hour clock)
c o C3.4 _________h: Time Referral Call received
c o C3.5 _________h: Time Transfer Accepted
c o C3.6 _________h: Time Departed from fixed-monitoring-environment bed> stretcher
c o C3.7 _________h: Initiation of transfer (vehicle moves)
c o C3.8 _________h: Time Arrival at Fixed-monitoring-environment (stretcherà bed)

C3.3. c o C3.9 Emergency (check ONLY if "yes")

C3.4 EMS RESPONSE (check ALL appropriate)
CREW
co C3.10 Basic life support
co C3.11 Advance life support
co C3.12 Nurse trained in trauma care
co C3.13 Nurse NOT trained in trauma care
co C3.14 Physician trained in trauma care
co C3.15 Physician NOT trained in trauma care

VEHICLE
co C3.16 Ground
co C3.17 Air
co C3.18 Sea

TYPE OF CARE
co C3.19 Basic (non-invasive)
co C3.20 Advanced (invasive)

DISTANCES
oo C3.21 _________km to base hospital
oo C3.22 _________km hospital 1 to hospital 2

C4. TRAUMA CENTER/RECEIVING HOSPITAL (IN-HOSPITAL) FACTORS
C4.1. TRAUMA TEAM (check ALL appropriate)
c o C4.1 Designated Trauma Team
c o C4.2 Designated Trauma Protocol
c o C4.3 Advance warning
c o C4.4 Trauma alert - one tier (whole team responded)
c o C4.5 Multiple tier (only certain members respond)

oTRAUMA TEAM MEMBERS (enter number of personnel available in each category and check all applicable boxes for each positive response)

 
C4.2 FACILITIES AVAILABLE (24 HOURS/DAY) (check ALL applicable)
oo C4.40 Blood bank
oo C4.41 CT scan
oo C4.42 Cardiothoracic surgery
oo C4.43 Neurosurgery
oo C4.44 Laboratory
oo C4.45 Designated Audit System

C4.3. DATE/TIME-POINTS/TIME INTERVALS (enter TIMES using 24 hour clock)
co C4.50_________h: Arrival at Facility
co C4.51_________h: Arrival of 1^st (responsible) Physician
oo C4.52_________h: 1^st x-rays (initiation)
oo C4.53_________h: 1^st Ultrasound (initiation)
oo C4.54_________h: 1^st CT (initiation)
oo C4.55_________h: Specify________________________________
oo C4.56_________h: Left Emergency Department
co C4.56_________h: Arrival Operating Room
oo C4.57_________h: Skin incision
oo C4.58_________h: Skin closure
oo C4.59_________h: Arrival Post-Anaesthesia Care Unit
co C4.60_________h: Arrival ICU
co C4.61_________Date of Discharge ICU (day/month/year)
oo C4.62_________Date of Discharge from Hospital (day/month/year)
oo C4.63_________Date Discharge from in-hospital Rehabilitation (day/month/year)
oo C4.64_________Date Return to Work (day/month/year)

D1.3. TIME INTERVALS (as a minimum) (enter times in hours or fractions thereof)
co D1.3_________h: Scene
co D1.4_________h: Emergency room
co D1.5_________h: Operating room
co D1.6_________h: Intensive Care Unit
co D1.7_________h: Ward

D1.4. TIMES AND VALUES OF 1ST RECORDING OF: (fill in blanks as appropriate; use 24 hour clock for times; insert first values obtained for each variable)
co D1.8_________h: Glasgow Coma Scale Score (assessed prior to administration of drugs)
co D1.9_________Eye movement
co D1.10________Ventilation
co D1.11________Movement

co D1.12________h: Respiratory Function
co D1.13 Assisted
co D1.14_________Rate/minute
oo D1.15_________End-tidal CO₂

co D1.16_________h: Heart Rate
co D1.17_________Rate/minute
oo D1.18_________h: ECG
oo D1.19 (interpretation)___________________________________________
____________________________________________________________

co D1.20_____________h Blood pressure
co D1.21 Method___________________________________________
co D1.22 _________Systolic
co D1.23 _________Diastolic
co D1.24 Unable to obtain)

co D1.25_________h: Pulse oximetry
co D1.26 _________SaO₂
co D1.27 Unable to obtain

co D1.28_________h: Temperature
co D1.29 _________ºC
co D1.30 Method_______________________________________________

oo D1.31 _________h: Blood Gases
oo D1.32 _________pH (units)
oo D1.33 _________pCO₂
oo D1.34 _________pO₂
oo D1.35 _________Base Deficit

oo D1.36_________h: Electrolytes
oo D1.37 _________Sodium
oo D1.38 _________Potassium
oo D1.39 _________Chloride
oo D1.40 _________CO₂

co D1.41_________h: Hemoglobin/Hematocrit
co D1.42 _________Hemoglobin (g/dL)
co D1.43 _________Hematocrit (%)

oo D1.44_________h: Blood Sugar
oo D1.45 _________ (g/dL)

(Enter name of measure used)
oo D1.46_________h: Other
oo D1.47 _________Measure
oo D1.48 _________Value
oo D1.49_________h: Other
oo D1.50 _________Measure
oo D1.51 _________Value
oo D1.52_________h: Other
oo D1.53 _________Measure
oo D1.54 _________Value
oo D1.56_________h: Other
oo D1.57 _________Measure
oo D1.58 _________Value
oo D1.59_________h: Other
oo D1.60 _________Measure
oo D1.61 _________Value

(Enter times of occurrence as applicable)
co D1.80_________h: Cardiac Arrest (Prehospital)
co D1.81_____________h: Cardiac Arrest (In-hospital)
co D1.82_________h: Respiratory Arrest (Prehospital)
c o D1.83_________h: Respiratory Arrest (In-hospital)

oo D1.90 Autopsy findings:_______________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________

cD2. TREATMENT (Check as applicable AND times when possible)

cDRUG INFORMATION (Insert drug name in appropriate box)

D3. COMPLICATIONS (specific when possible)

D3.100: Specify from above: __________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c E1.1. LOCATION OF DEATH (check MOST appropriate)
o E1.4 Found dead
o E1.5 Died at scene
o E1.6 Dead on arrival at hospital
o E1.7 Died in hospital
o E1.8 Died after discharge from hospital

c E1.2. TIME OF DEATH
c o E1.9 _________ Date of clinical death (day/month/year)
c o E1.10_________h Time of clinical death
c o E1.11 _________ Date of declaration of death (day/month/year)
c o E1.12_________h Time of declaration death

E1.3. CPR
c o E1.13 CPR Withheld
c o E1.14 CPR Withdrawn
c o E1.15 Treatment Withdrawn
c o E1.16 Cause of Death_____________________________________________

c o E1.17 AUTOPSY
c o E1.18 Details ____________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________

c E1.4. ADVERSE FACTORS (possibly responsible for Fatal Outcome)

c E1.5. OTHER MEASURES OF OUTCOME
c o E1.50_________days in ICU
c o E1.51_________days in Hospital
c o E1.52_________Cost

c FUNCTIONAL STATUS (check ALL that apply)
o E2.50 Back to work
o E2.51__________________(day/month/year)
o E2.52 Old job
o E2.53 Reduced capacity
o E2.54 ________% reduction
o E2.55 Patient's Opinion________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________