Incorporating red blanket protocol within code crimson: Streamlining definitive trauma care amid the chaos

Table 1 Table comparing the key features, benefits and limitations of code crimson, red blanket and unified protocol respectively

Protocol	Key features	Benefits	Limitations
Code crimson	(1) Second-tier of response in addition to the standard trauma team activation for trauma patients with exsanguinating haemorrhage; and (2) Effective step-up strategy to reduce morbidity and mortality in major trauma patients with severe haemorrhage	(1) Mobilization of additional personnel and resources specifically required for decision-making; (2) Expedites time for rapid diagnosis of major haemorrhage; (3) Initiation of haemostatic resuscitation using MTP; and (4) Rapid operative or radiological intervention for definitive haemorrhage control	(1) Does not address the factors leading to delays in transporting patient from ED to OT/IR after decision for haemorrhage control; and (2) Multiple phone calls amongst various stakeholders regarding OT location and timing of surgery, anaesthetist availability, consent-taking, pre-operative checklists, mobilizing staff for transfer
Red blanket	(1) Address the various factors that lead to delay once the decision has been made to transfer patient from ED to OT/IR; and (2) A communication process intended to facilitate rapid and safe transport of a haemodynamically unstable patients	(1) Significant reduction in time for transferring the patient from ED to OT/IR once a decision has been made for definitive haemorrhage control; (2) Ensure minimal delay in resuscitation during the transfer; and (3) Reduced length of stay in ICU and improved clinical outcomes	(1) Relies on assumption that hospital has an existing Code Crimson workflow; and (2) Does not address the need for early activation of key personnel for rapid decision-making for definitive haemorrhage control in patients with exsanguinating haemorrhage
Unified protocol	(1) Effective in ensuring early decision-making for definitive haemorrhage control as well; (2) Addresses the issues which lead to a delay in transferring the patient from ED to OT/IR; and (3) Benefits are not physician or time dependent	(1) Combines benefits of both Code Crimson and Red Blanket protocols. Reduces time from ED to definitive haemorrhage control in a patient with exsanguinating trauma; (2) Communication between various multi-disciplinary coordinators occurs rapidly and seamlessly; (3) Minimizes the number of calls that need to be made by the ED and trauma teams to various stakeholders and focus on resuscitation; and (4) Effective resource allocation and utilization	(1) Hesitancy of staff to adopt new workflow; (2) Logistical challenges of integrating the new unified workflow in the existing trauma system; and (3) Training requires time and resources that can impact work schedules and budget

ED: Emergency department; OT: Operating theatre; IR: Interventional radiology; ICU: Intensive care unit.