3-1 INITIAL TRAUMA CARE

Any patient with injuries, which have the potential to cause hypotension/shock, must be treated aggressively regardless of what current vital signs may show.  Any patient who is injured and has a persistent resting tachycardia is assumed to be in compensated shock until proven otherwise.

Goal scene time less than 10 minutes for Major Trauma patients.

EMR - Emergency Medical Responder

Assess the scene to determine scene safety and need for additional resources such as Law Enforcement, HazMat, fire suppression, extrication, aeromedical evacuation, MCI trailer, etc.

Consider ALS Intercept, including possible activation of EAGLE III.

Perform an Initial assessment (Should require less than 2 minutes to complete)

1. AIRWAY:
   1. Assess, secure and maintain an adequate airway. Refer to the airway management protocol.
   2. Always suspect a neck injury and take cervical spine precautions if mechanism consistent with possible cervical spine injury.
2. BREATHING:
   1. Visually check the chest including chest rise and deformity.
   2. Check  and document breath sounds bilaterally
   3. Palpate for crepitus or deformity
   4. Administer supplemental oxygen with high flow oxygen
   5. Assist ventilations as necessary
   6. Stabilize flail segments manually
   7. Cover sucking chest wounds with occlusive dressing, taped on 3 sides
3. CIRCULATION:
   1. Assess pulse for presence and quality.  Check capillary refill, skin color, moisture and temperature.
   2. Assess for indications to withhold CPR, if none found, initiate CPR.  
   3. Control all significant bleeding with direct pressure.
   4. Wound packing with gauze should be considered when necessary to stop bleeding.  It is preferred to use gauze with commercially impregnated clotting agents.  If impregnated clotting gauze are not available, normal rolled gauze can be used.
4. C-SPINE / DISABILITY:
   1. If appropriate based on mechanism of injury, place a rigid cervical collar and perform appropriate immobilization, if not already done.
   2. Perform a brief neurological exam.  Check and document:
      1. Level of consciousness using the AVPU system.(Alert, Verbal stimuli, Painful stimuli, Unresponsive)
      2. Pupil size, shape, reaction to light
      3. Movement of extremities
5. EXPOSE the patient:
   1. Detailed secondary assessment.
   2. Do not remove impaled objects unless interfering with the airway.  Support and immobilize in place.
   3. Splint as indicated and time allows, prepare for load and go.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Initiate ALS Intercept if not already done.
2. Consult MEDICAL CONTROL for patients with no signs of life.
3. Initiate rapid transport
4. Perform thorough, detailed examination as indicated en route
5. Perform a blood glucose test on any patient with an altered level of consciousness (LOC) or seizure
6. Apply cardiac monitor if indicated and trained to do so and print rhythm strip.
7. Contact the hospital as soon as possible.  Include only pertinent information:
   1. ETA
   2. Number of victims
   3. Age(s)
   4. Mechanism of injury, including if patient was restrained.
   5. Brief patient history, including major injuries, and whether or not the patient was ever unconscious or hypotensive.
   6. Consider using the phrase “Trauma Alert.”
8. Perform and document a Glasgow Coma Scale
   1. Record the best response out of 15 points
   2. Coma = <9 and indicates need for airway management.  

Adult	Score	Pediatric
Eye opening:   4 pts
Spontaneous	4	Spontaneous
To voice	3	To voice
To pain	2	To pain
None	1	None
Verbal response: 5 pts
Oriented	5	Appropriate/babbles
Confused	4	Cries but consolable
Inappropriate words	3	Persistent crying/screaming
Incomprehensible words	2	Grunting/moaning with pain
None	1	None
Motor response: 6 pts
Follows commands	6	Follows/spontaneous
Localizes to pain	5	Localizes to pain
Withdraws to pain	4	Withdraws to pain
Flexion posturing	3	Flexion posturing
Extension posturing	2	Extension posturing
None	1	None

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Initiate ALS Intercept if not already done
2. Initiate transport
3. Establish 2 large bore IV’s en route, if possible.
   1. Avoid sites distal to deformities or on injured extremities.
   2. Administer a fluid bolus of NS at 20 mL/kg up to 500 mL if the patient has a systolic BP less than 90 mm Hg. Consult MEDICAL CONTROL for further fluid orders.

Intermediate - Perform/Confirm All Above Interventions

1. Contact MEDICAL CONTROL for consideration of:
   1. Needle decompression of tension pneumothorax if indicated (note if patient has lost pulses, decompression may be performed prior to contacting Medical Control).
   2. Administration of pain medications, if approved, manage via pain management protocol.
   3. Repeat Vital signs and if SBP < 90, repeat bolus of 500 mL NS, contact Medical Control for further fluid orders.

Paramedic - Perform/Confirm All Above Interventions