The ideal location for a trauma operating room (OR) is adjacent or in close proximity to the trauma resuscitation unit. Ideally, it is always better to take the patient to the operating room as opposed to bringing the operating room to the patient. However, these principles are contingent upon hospital-specific geography, resources, and the scenario faced by the resuscitation team. Optimal situations dictate that the trauma operating room should be located in the main operating room suite to allow more flexibility of equipment and personnel. The so-called hybrid rooms with a diverse collection of equipment allow a multidisciplinary approach including full vascular/imaging and interventional technology. Elevator standby and priority transport protocols must be in place. All OR rooms should be stocked with the necessary tools to allow direct OR transport from the scene (in extremis) for continued resuscitation or procedural intervention. These scenarios may dictate bypass of the emergency department.

A trauma OR should have adequate space, 400 to 600 sq ft. Safety of the staff with properly configured ORs free of wires, equipment cords, and bulky items in walkways is a priority to avoid personnel injury. The following equipment and drugs should be available:

The critically injured patient must be accompanied by the resuscitation team to the OR. Notification of the OR charge nurse should be done immediately upon patient arrival to clear the way for potential OR utilization. A point of care analyzer (INR, hemoglobin, and lactate parameters) is essential to continued resuscitation. Immediate and concise discussion between the operating surgeon, OR circulating/scrub teams, and most importantly, anesthesia personnel should ensue. This “hand-off” communication helps to ensure the availability of blood products and equipment. It also serves to outline key factors that relate to the patient’s medical history, mechanism of injury, and treatment(s) rendered in the ED. Patient safety initiatives using aviation crew resource management and TeamSTEPPS principles are recommended. Adequate lifting help must be on hand to move the patient from the stretcher and provide transfer of the patient to the OR table. All equipment such as pelvic binders or backboard equipment should be removed prior to the start of the case.