Code crimson (CC) was implemented at Auckland City Hospital (ACH) in 2015 and is defined as an activation of additional staff for critically ill trauma patients who are highly likely to require urgent surgery, interventional radiology (IR) and/or a massive haemorrhage protocol. CC aims to improve access to definitive care and treatment for these patients.
CC will be called if the patient meets criteria for a standard trauma call PLUS an assessment of blood consumption (ABC) score of 2 (one point for each of the following: penetrating mechanism, SBP <90mmHg, HR >120bpm, or +ve E-FAST).
A prior study at ACH (N Day & S Bhagvan) analysed the key characteristics of CC patients, aiming to develop a better understanding of injury patterns and therefore better predictions of their intervention requirements. 248 patients were included with 64.1% requiring intervention ( IR or surgery within 6 hours of admission). Median time to intervention was 64 minutes, with a median time to thoracotomy of 20 minutes, and a median time to laparotomy of 42.5 minutes. Overall mortality was 53 patients. Of these, 14 patients (26.4%) died in ED, and 11 (20.8%) died in surgery within 3 hours of arrival. Causes of death included haemorrhagic shock (n=16), traumatic brain injury (n=31) and other (n=6).
Following this research, our retrospective cohort study aims to investigate outcomes including blood product consumption, time to arrive at the operating theatre and mortality for CC patients, and compare them to major trauma patients before CC implementation.