Trauma 'Code Crimson' Pathway

‘Code Crimson’ is a term that is commonly used by hospital-based teams managing patients with life-threatening haemorrhage that is refractory to resuscitation. The purpose of a ‘Code Crimson’ activation is to streamline patient access to definitive intervention, including an operating theatre or interventional radiology suite.

The ITIM Clinical Review Committee has led the development of a clinical practice guideline to enhance the current management of a patient with life-threatening traumatic haemorrhage by recommending that pre-hospital medical retrieval teams initiate a ‘Code Crimson’ activation, thereby further reducing the time to definitive intervention in these patients.

This clinical guideline therefore aims to standardise the:

• pre-hospital identification of a trauma ‘Code Crimson’
• activation of a Trauma ‘Code Crimson’ Pathway by pre-hospital medical retrieval teams and the subsequent notification to a receiving trauma centre
• procedures instituted by trauma centres following activation of a trauma ‘Code Crimson’ pathway.

Clinical Guideline

Trauma 'Code Crimson' Pathway - Streamlining access to definitive intervention for patients with life-threatening haemorrhage.

Implementation resources

A number of resources are currently being developed to assist with the local implementation of the Trauma 'Code Crimson' Pathway including:

• implementation guide
• frequently asked questions
• trauma 'Code Crimson' ED flowchart – for adaptation to your Local Health District (LHD)
• educational PowerPoint – for adaptation to your LHD
• suggested clinical review tool
• data collection.

Literature

• Grabs, AJ., May, AN., Fulde, GW., et al. "Code Crimson: a life-saving measure to treat exsanguinating emergencies in trauma." ANZ J Surg. 2008;78(7): 523-525.
• Reed, M., Glover, A., Byrne L., et al."Experience of implementing a National pre-hospital Code Red bleeding protocol in Scotland." Injury. 2017; 48(1): 41-46.
• Tinkoff, G. and R. O'Connor. "Validation of new trauma triage rules for trauma attending response to the emergency department." J Trauma. 2002;52(6): 1153-1158; discussion 1158-1159.
• Weaver, AE., Hunter-Dunn, C, Lyon RM, et al. "The effectiveness of Code Red transfusion request policy activated by pre-hospital physicians." Injury. 2016;47(1): 3-6

Contact

For more information please contact:

Ms Kelly Dee
Clinical Review Officer
NSW Institute of Trauma and Injury Management
kelly.dee@health.nsw.gov.au