National scoping review and survey of trauma team activation criteria and team membership across Canada

Introduction: Optimized trauma team activation (TTA) improves mortality and reduces over-triage and burnout. There is no universal consensus on TTA criteria or trauma team membership (TTM). Limited published evidence exists on optimal TTA or TTM in Canada. This study describes current variations in TTA and TTM across Canadian trauma centers. Methods: A scoping review of Ovid MEDLINE and Embase identified published descriptions of Canadian TTA and TTM for adults (1946–2023). A 26-question survey was distributed to trauma leaders at major Canadian trauma centers, exploring TTA and TTM. Data were analyzed by thematic exploration, descriptive statistics, and analysis of variance ( P = 0.05). Results: The scoping review identified 509 articles, with 13 undergoing full review. Three articles focused on TTA, and three on TTM. The survey was completed by 16 individuals from 12 major trauma centers in Canada representing 70% of Canadian provinces. TTA criteria varied from 4 to more than 18. Physiologic and anatomic factors were universally included. Mechanism of injury (67%), Glasgow coma scale (87%), and blood pressure were frequently included in the TTA. TTM varied from 4 to 12 individuals, the most common being 7–9. TTM most often included trauma fellowship-trained general surgeons (83%) and Royal College certified emergency physicians (75%). TTA and TTM protocols were typically based on local trauma leaders’ consensus (56% and 69%, respectively), rather than literature reviews (31% and 19%, respectively. Conclusion: Published Canadian data on TTA and TTM are limited. Standardizing and increasing the accessibility of these protocols are essential for improving trauma care nationally.