Anesthesia "Go Team" for trauma patients: field based anesthesia.

AANA Journal/April 2007/Vol. 75, No. 2 107 among critically ill and injured trauma patients throughout the state of Maryland. The trauma center recognizes the fact that prolonged accident victim entrapment will delay transport to definitive care and can potentially have an adverse impact on both patient morbidity and mortality. As a result, the center has the ability to send a team of medical personnel that can deliver advanced surgical and anesthesia services in the field as an adjunct to the prehospital providers on the scene. Prehospital providers at the scene of an accident can request this team, known as the “Shock Trauma Go Team.” The Go Team is indicated for dispatch in 3 general scenarios: (1) Priority 1 or 2 patients who are expected to exceed 1 hour total scene time, (2) hemodynamically unstable patients with an undetermined extrication time, and (3) mass casualty incidents with multiple patients of varying acuity. The Go Team consists of an attending physician (typically an orthopedic surgeon) and a Certified Registered Nurse Anesthetist (CRNA). The members of the Go Team all possess the following basic training: hazardous material awareness, vehicle extrication, incident command system, and helicopter safety. The attending physician is certified in advanced trauma life support. The physician and the CRNA are involved in ongoing field operations training conducted on an annual or semiannual basis. The CRNA is available 24 hours a day and 7 days a week from the in-house location at the trauma center. The attending physician is available from either in-house or from a location outside of the trauma center. The mode of response, be it by helicopter or ground ambulance, is determined by well-defined protocol guidelines and based on the specific needs of the incident. Once a Go Team request has been received by the trauma center, the attending physician and CRNA are mobilized. The providers take the folSedation, and even general anesthesia, is sometimes