Pothiawala S, Bhagvan S, MacCormick A. Incorporating red blanket protocol within code crimson: Streamlining definitive trauma care amid the chaos. World J Crit Care Med 2025; 14(1): 98487 [DOI: 10.5492/wjccm.v14.i1.98487]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sohil Pothiawala, Savitha Bhagvan, Trauma and Emergency Services, Auckland City Hospital, Auckland 1023, New Zealand
Andrew MacCormick, Department of General Surgery, Middlemore Hospital, Auckland 2025, New Zealand
Author contributions: Pothiawala S conceptualized and drafted the initial version of the manuscript; Bhagvan S and MacCormick A reviewed and edited the manuscript. All authors accept the final version of the manuscript
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: June 27, 2024 Revised: October 30, 2024 Accepted: November 19, 2024 Published online: March 9, 2025 Processing time: 167 Days and 4.2 Hours
Abstract
The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control, and it requires co-ordinated multidisciplinary care. During initial resuscitation of a patient in the emergency department (ED), Code Crimson activation facilitates rapid decision-making by multi-disciplinary specialists for definitive haemorrhage control in operating theatre (OT) and/or interventional radiology (IR) suite. Once this decision has been made, there may still be various factors that lead to delay in transporting the patient from ED to OT/IR. Red Blanket protocol identifies and addresses these factors and processes which cause delay, and aims to facilitate rapid and safe transport of the haemodynamically unstable patient from ED to OT, while minimizing delay in resuscitation during the transfer. The two processes, Code Crimson and Red Blanket, complement each other. It would be ideal to merge the two processes into a single protocol rather than having two separate workflows. Introducing these quality improvement strategies and coordinated processes within the trauma framework of the hospitals/healthcare systems will help in further improving the multi-disciplinary care for the complex trauma patients requiring rapid and definitive haemorrhage control.
Core Tip: Code Crimson is aimed at rapid decision-making for definitive haemorrhage control, while Red Blanket addresses the factors and processes causing delay and aims to get the patient rapidly to operating theatre/ interventional radiology for definitive haemorrhage control. Both these processes complement each other. Hence, unifying these processes into a single workflow would ensure combined benefits of both these protocols, aimed at reducing the time from emergency department to definitive haemorrhage control in a patient with exsanguinating trauma. This will eventually aim to improve the care for the complex trauma patients requiring multi-disciplinary care and definitive haemorrhage control.
