The document provides guidance on trauma assessment and management for EMS personnel. It outlines performing an initial assessment of airway, breathing, circulation and mental status followed by a rapid trauma survey. For patients with significant injuries, EMS should load and transport immediately. Others receive a focused exam based on chief complaints and mechanism of injury. The document details assessing each body region from head to toe and providing ongoing reassessment of the patient.
The document provides guidance on trauma assessment and management for EMS personnel. It outlines performing an initial assessment of airway, breathing, circulation and mental status followed by a rapid trauma survey. For patients with significant injuries, EMS should load and transport immediately. Others receive a focused exam based on chief complaints and mechanism of injury. The document details assessing each body region from head to toe and providing ongoing reassessment of the patient.
The document provides guidance on trauma assessment and management for EMS personnel. It outlines performing an initial assessment of airway, breathing, circulation and mental status followed by a rapid trauma survey. For patients with significant injuries, EMS should load and transport immediately. Others receive a focused exam based on chief complaints and mechanism of injury. The document details assessing each body region from head to toe and providing ongoing reassessment of the patient.
The document provides guidance on trauma assessment and management for EMS personnel. It outlines performing an initial assessment of airway, breathing, circulation and mental status followed by a rapid trauma survey. For patients with significant injuries, EMS should load and transport immediately. Others receive a focused exam based on chief complaints and mechanism of injury. The document details assessing each body region from head to toe and providing ongoing reassessment of the patient.
Purwoko Sugeng H Introduction • Golden Hour – Time to reach operating room (or other definitive treatment) – NOT time for transport to ED – NOT time in Emergency Department • EMS does NOT have a Golden Hour • EMS has a Platinum Ten Minutes
Home Introduction • Patients in their Golden Hour must: – Be recognized quickly – Have only immediate life threats managed – Be transported to an APPROPRIATE facility • Survival depends on assessment skills • Good assessment results from – An organized approach – Clearly defined priorities – Understanding available resources
Home Trauma Assessment Scene Size Up
Initial Assessment
Load and Go Situation ?
Rapid Focus Trauma Assessment Survey
Load and Go Situation ? HOSP
Detailed Assessment Ongoing Assessment
Scene Size-Up • Safety • Body Substance Isolation (BSI) • Number of Patients • Additional Resources • Mechanism of Injury(MOI) Safety • Traffic • Smoke • Electricity • Haz-Mat • Hostile Persons • Weapons • Drugs • Silence BODY SURFACE ISOLATION
• Gloves for minimal
fluids • Goggles for eye protection if there’s any chance of splatter • Mask and Gown for gross contamination Number of Patients
Call for additional resources
ASAP Additional resources
• Extrication • Traffic control • Utilities Significant Mechanism of Injury Ejection from vehicle High-speed vehicle collision Death in same passenger Vehicle-pedestrian compartment collision Fall of greater than Motorcycle crash 15 feet or Unresponsive or altered 3 times the patient’s mental status height Penetrating injury of head, Rollover of vehicle chest, or abdomen Home Bent Steering Wheel Broken Mirror
Spider-Webbed Windshield
Deformed Distorted Pedals Dashboard
Home Initial Assessment • General Impression • Mental Status • Airway • Breathing • Circulation General Impression • Age, Weight, Gender • Position (relative to posture and surroundings) • Activity • Obvious Injuries/Bleeding Assess Mental Status • Take C-Spine control • A – Alert and immediately responsive • V – Responsive to verbal stimuli • P – Responsive to painful stimuli • U – Unresponsive Assess Airway • Open if necessary using jaw-thrust maneuver • Consider oro- or naso-pharyngeal airway • Note unusual sounds and correct cause – Snoring – oro-/naso-pharyngeal airway – Gurgling – suction – Stridor – consider intubation – Silence Correcting silence • Attempt ventilation • Reposition • Heimlich • Visualize and remove • Intubate • Trans-laryngeal jet insuflation Assess Breathing
and corotid – Regular • Rate – Irregular – Normal • Quality – Fast – Weak – Slow – Thready – Bounding Assess Circulation - Skin • Color • Temperature • Moisture Assess Circulation - Bleeding • Direct pressure • Pressure dressing Determine priority
Load and Go Situation ?
– Poor general impression
– Mental status changes – Difficulty breathing – Shock – Chest pain – Severe bleeding – Severe pain Rapid Trauma Survey • Head to toe • Rapid sweep to identify major injuries which could prove life threatening • DCAP-BTLS Rapid Trauma Survey Inspect and Palpate for DCAP-BTLS D = Deformities B = Burns C = Contusions T = Tenderness A = Abrasions L = Lacerations P = Punctures/ S = Swelling Penetrations Deformities Contusions
Breath Sounds (Presence and Equality) Listen to both sides of the chest. Is air entry present? Absent? Equal on both sides? Compare left side to right side.
Mid-clavicular Mid-axillary Abdomen: DCAP-BTLS + Firmness and Distention
Pelvis: DCAP-BTLS (Compress gently)
Extremities: DCAP-BTLS + Distal Pulse, Sensation, Motor Function
Posterior: DCAP-BTLS Package and begin transport • Immediate – immobilize, load, go • Delayed – immobilize, treat as necessary, transport If No Significant Mechanism of Injury Reconsider mechanism of injury Determine chief complaint Perform focused physical exam based on: Chief complaint Mechanism of injury Use DCAP-BTLS on focused area of assessment Assess baseline vital signs Obtain SAMPLE history Focused History and Physical
• Baseline vital signs
• SAMPLE History • Focus on and treat injuries found during initial assessment and rapid trauma assessment as appropriate considering priority SAMPLE History S = Signs and symptoms A = Allergies M = Medications P = Pertinent past history L = Last oral intake E = Events leading to injury or illness • Vital Signs Respirations Pulse Skin color, temperature, condition Pupils Blood Pressure
Home Detailed Physical Exam • As appropriate, considering priority • History and vital signs, neurological • Repeat initial assessment • Complete critical interventions • Careful head to toe survey (DCAP/BTLS) Detailed Physical Exam Head to Toe • Head – DCAP/BTLS and creptiation • Ears – DCAP/BTLS and blood/fluid • Face – DCAP/BTLS and blood/fluid • Eyes – DCAP/BTLS and discoloration, pupils, foreign bodies, blood • Nose – DCAP/BTLS and blood/fluid • Mouth – DCAP/BTLS and teeth, foreign bodies, swelling, lacerations, odor Head to Toe Detailed Physical Exam Head to Toe • Neck – DCAP/BTLS and JVD, crepitation • Chest – DCAP/BTLS and palpate for paradoxical motion, symmetry, crepitation, and auscultate breath sounds • Abdomen – DCAP/BTLS and tenderness, rigidity, distention • Pelvis – DCAP/BTLS and pain, tenderness, motion, crepitation • Upper extremities – DCAP/BTLS and PMS • Lower extremities – DCAP/BTLS and PMS • Posterior – DCAP/BTLS On-Going Assessment • Subjective changes • Reassess vital signs:neurological,ABC • Reassess injuries • Reassess interventions Home
