The Code Red Decision Study
Research type
Research Study
Full title
Critical decision analysis of prehospital major haemorrhage protocol activation: the Code Red Decision Study
IRAS ID
304475
Contact name
Jared Wohlgemut
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
0 years, 5 months, 27 days
Research summary
Injury is the most frequent cause of death in people under the age of 40. Common incidents which lead to injury include road traffic collisions, high level falls, or assaults. Injured patients are at risk of life-threatening bleeding. This severe bleeding from injury is called major trauma haemorrhage. At the scene of a trauma incident (known as ‘prehospital’), doctors or paramedics can declare a ‘major haemorrhage protocol activation’ (MHPA) for patients with known or suspected major trauma haemorrhage. Also known as ‘code red’, MHPA is one of the most important prehospital decisions to consider for bleeding trauma patients. MHPA represents not only the recognition of a bleeding trauma patient, but also sets an entire organisational system in motion. This includes giving the patient blood transfusions at the scene of the incident, alerting the receiving hospital to assemble a team of trauma experts, ensuring more blood transfusions are ready if required, and preparing surgical teams and the operating theatre for the patient.
The decision to activate a MHPA can be difficult, even for expert doctors. For these experts, it is unlikely that a lack of knowledge affects their decision making, however other, uncontrollable factors may contribute. For example, a lack of awareness of the environment and the events surrounding the incident may impact on decision making. A prehospital scene can be chaotic, with large numbers of people and noise. It may be difficult to comprehend the situation and make clear plans for what should happen to the patient next. These factors are known as situational awareness, and a lack of this in high stress situations such as medicine, aviation and military settings has been shown to adversely affect decision making. It may be that by improving situational awareness at a prehospital scene with a clinical decision support system, this will also assist MHPA decision making.
This study aims to investigate which factors influence doctors in their decisions to activate prehospital major haemorrhage protocols (MHPA). Doctors working at one air ambulance service in England will be invited to participate in the study, to answer questions about their decision making processes regarding MHPA. The study will not include patients.
REC name
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REC reference
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