Major Trauma Pre-Alert ASHICE / ATMIST

Capital Health Service — clinician quick-reference for calling a pre-alert to the receiving Major Trauma Centre / ED.

⚠️ Roleplay reference only. Capital Roleplay / Capital Health Service in-character resource. Not for real clinical use.

▸ When to send a Pre-Alert

Pre-alert if ANY of:

Major trauma / mechanism suggesting serious injury
Catastrophic haemorrhage or shock CRIT
Airway compromise or threatened airway
GCS ≤ 8 or rapidly falling GCS
SpO₂ < 90% / respiratory compromise
Suspected tension pneumothorax
Time-critical transfer / blue-light conveyance

How & who

Call Control / ED switchboard as early as possible — ideally on scene or en route.
Keep it under 30–60 seconds. Read in order, don't improvise.
Give a clear ETA so the trauma team can stand up.
State plainly: "This is a Major Trauma pre-alert."

▸ ASHICE — Standard Pre-Alert Structure

Age

Patient's age (or best estimate) and sex.

Sex

Male / Female (state if unknown).

History

Mechanism / what happened & presenting complaint. Keep it one line.

Injuries / Illness

Key injuries found, head-to-toe, most serious first.

Condition / Vitals

Obs & trend: GCS, RR, SpO₂, HR, BP, Temp. Plus treatment given.

ETA

Estimated time of arrival + any special requirements (trauma team, blood, theatre).

▸ ATMIST — Trauma Handover (preferred for Major Trauma)

Age & sex

e.g. "32-year-old male".

Time of incident

When it happened (important for TXA window & trauma timing).

Mechanism

RTC, fall >2x height, stabbing, crush, etc. Include forces / entrapment.

Injuries

Injuries found / suspected, top-to-toe.

Signs (vitals)

GCS, RR, SpO₂, HR, BP, Temp — and the trend.

Treatment & ETA

Interventions given (TXA, splint, decompression, fluids) + ETA + needs on arrival.

▸ The Pre-Alert Script (read this out)

Replace the highlighted parts. Speak slowly and clearly; confirm they're ready to copy before you start.

"[Receiving Hospital] ED, this is [Callsign] — Capital Health Service. I have a MAJOR TRAUMA pre-alert. Are you ready to copy?" — wait for "go ahead" — "Using ATMIST: AGE / SEX: [age]-year-old [male / female]. TIME: Incident at approximately [time]. MECHANISM: [e.g. high-speed RTC, ejected, prolonged entrapment]. INJURIES: [most serious first — e.g. open # femur, ? pelvic injury, head injury]. SIGNS: GCS [x/15], RR [x], SpO2 [x%] on [O2 device], HR [x], BP [x/x], Temp [x]. TREATMENT: [O2, IV access, TXA given at xx:xx, pelvic binder, splinting, analgesia]. ETA is [x] minutes. Requesting: trauma team on standby [+ blood / theatre / imaging as needed]. Anything further? — [Callsign] out."

▸ Major Trauma Management — <C>ABCDE

Scene time < 20 minutes if possible. Treat life threats as you find them.

<C> — Catastrophic Haemorrhage. Control life-threatening external bleeding.
Direct pressure → wound packing → tourniquet. Apply pelvic binder for suspected pelvic injury.
A — Airway (with C-spine control). Open & maintain airway.
Jaw thrust, suction, adjuncts. Manual in-line stabilisation of the cervical spine.
B — Breathing. Assess breathing, give high-flow O₂, treat tension pneumothorax.
O₂ 15 L/min via non-rebreather. Consider chest decompression if tension pneumothorax.
C — Circulation. IV/IO access, fluid resuscitation, TXA.
Gain access; permissive hypotension; give TXA 1g IV if major haemorrhage (within 3 hrs of injury).
D — Disability. Assess GCS, pupils, blood glucose.
Record GCS, check BM. Falling GCS = time-critical.
E — Exposure. Expose & examine, prevent hypothermia.
Log roll, keep the patient warm — the lethal triad: hypothermia, acidosis, coagulopathy.

▸ Key Trauma Drugs (from LAS Drug Matrix)

Drug	Dose	Route	Indication / Notes
Tranexamic Acid (TXA)	1g	IV	Major trauma with haemorrhage — give within 3 hrs of injury.
Morphine Sulphate	2.5–5mg	IV	Moderate–severe pain. Titrate to effect, max 20mg.
Morphine Sulphate	5–10mg	IM	Where IV access delayed.
Entonox (50% N₂O/O₂)	Self-admin	Inhaled	Mild–moderate pain. Avoid: ? pneumothorax, head injury.
Oxygen	15 L/min	NRB mask	Critical illness / trauma — target SpO₂ per protocol.
Hartmann's Solution	250ml bolus	IV	Trauma / burns fluid resuscitation.
Sodium Chloride 0.9%	250ml bolus	IV	Fluid resuscitation (titrate to radial pulse / mentation).
Ondansetron	4mg	IV	Nausea / vomiting (e.g. post-opioid).
Paracetamol	1g	IV / PO	Adjunct analgesia.

Always check contraindications, allergies and current obs before administration. Document time of every drug — especially TXA.