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MULTISYSTEM TRAUMA: 13.0

All Providers

  • Focused history and physical exam
  • Cardiac monitor, ETCO2, pulse oximetry when available
  • Treatment Plan
    • Primary Survey
      • Hemorrhage control
        • Assess and stop severe hemorrhage
      • Airway
        • Assess airway patency, ask patient to talk, assess stridor, ease of air movement
        • Assess for injuries that could compromise airway including unstable facial fractures, expanding neck hematoma, blood or vomitus in the airway, facial burns/inhalation
        • Evaluate mental status for ability to protect airway (AVPU or GCS)
        • Establish a patent airway with cervical spine precautions
      • Breathing
        • Assess rate and pattern, symmetry of chest movement, breath sounds
        • If absent or diminished breath sounds in a hypotensive patient, consider tension pneumothorax
        • For open chest wound, place an occlusive dressing sealed on 3 sides
      • Circulation
        • Assess vital signs, check radial pulse
        • If pelvis is unstable, place pelvic binder
      • Disability
        • Assess pupils, motor movement of extremities, mental status (AVPU)
      • Exposure/Environment
        • Rapid evaluation of entire body, including back, to assess injuries
        • Prevent hypothermia
    • FIELD TRAUMA DECISION SCHEME AND TRAUMA TEAM ACTIVATION PROTOCOL
        • Key Considerations
        • Scene times should be as short as possible for severely injured patients, goal of 10 minutes
        • Perform required procedures enroute to the trauma center
        • Severely injured patients should be preferentially transported to a trauma center
        • Withhold resuscitative efforts for trauma patients with any of the following:
          • Decapitation
          • Hemicorpectomy
          • Rigor Mortis or dependent lividity
          • Blunt trauma patients who are apneic, pulseless, and have no organized activity on the cardiac monitor

ADULT

AEMT
  • IV/IO Access and Shock Protocol
  • Pain management Protocol
Paramedic
  • Suspected Tension Pneumothorax
    • Chest trauma with hypotension
    • Needle decompression of affected side
  • Traumatic arrest
    • Consider bilateral needle decompression based on mechanism of injury

Pediatric (not to exceed adult dose)

AEMT
  • IV/IO Access and Shock Protocol
  • Pain management Protocol
Paramedic
  • Suspected Tension Pneumothorax
    • Chest trauma with hypotension
    • Needle decompression of affected side
  • Traumatic arrest
    • Consider bilateral needle decompression based on mechanism of injury