RECORDS AND LEGAL CONSIDERATIONS 17developed, reevaluated, and
rehearsed frequently to en hance the possibility of saving the
maximum number of in jured patients. ATLS providers should
understand their role in disaster management within their
health-care institu tions and remember the principles of l\TLS
relevant (0 pa tien t care.Records and legalConsiderationsSpecific
legal considerations, including records, consent fortreatment, and
forensic evidence, are relevant to ATLSproviders.Definitive Care13
Which patients do I level of care? When occur?Interhospital triage
criteria will help determine the level, pace, and intensity of
initial treatment of the multiply inthe patient's physiologic
status, obvious anatomic injury, mechanisms of injury, concurrent
diseases, and other fac tors that can alter the patient's
prognosis. ED and surgical personnel should use these criteria to
determine whether the patien t requ ires transfer to a trauma cen
tel' or closest appropriate hospi taJ capable of providing more
specialized care. The closest appropriate locaJ facility should be
cho sen based on its overall capabilities to care [or the injured
patient. JI Sec Chapter 13: Transfer to Definitive Care and Figure
1-1.DisasterDisasters frequently overwhelm local and regional
resources. Plans for management of such conditions must be
RECORDSMeticulous record keeping, including documenting the time
for all events, is very important. Of len more than one doctor
cares for an individual patient, Precise records are essential to
evaluate the patient's needs a.nd clinical status. Accurate record
keeping during resuscitation ca.n be facili tated by a member of
the nursing staff whose primary re sponsibility is to record and
collate alJ patient care in formation.Med icolegal problems arise
frequcn tly, and preciserecords are helpful for all individuals
concerned. Chrono logie reporting with flowsheets helps both the
attending doc lor and the consulting doctor to assess changes in
the patienr's condition quickly. JI See Appendix D: Sample Trauma
Flow Sheet, Chapter 13: Transfer to Definitive Care, and Pigure
13.1: Sample Transfer Form.CONSENT FOR TREATMENTConsent is sought
before treatment, if possible. in life threatening emergencies, it
is often not possible to obtain such consent. In these cases,
treatment should be provided first, with formal consent obtained
later.FORENSIC EVIDENCEIf criminal activity is suspected in
conjunction with a pa tient's injury, the personnel caring for the
patien t must pre serve the evidence. AlL items, such as clothing
and bullets, must be saved for law enforcement personnel.
Laboratory determinations of blood alcohol concentrations and other
drugs DlaY be particularly pertinent and have substantial legal
implications. JI See Appendix B: Biomechanics of In-.Jury.
transfertoa highershouldthetransfer
jured
patient.JI See ACS COT, Resources Jor Optima!
CareoJtheInjuredPatient, 2006. These criteria take into account
