Trauma: 10 Things You Need to Know to Save Lives

EDITOR'S NOTE: Special thanks to our guest blogger, Bob Sullivan. Bob Sullivan, MS, NRP, is a paramedic instructor at Delaware Technical Community College. He has been in EMS since 1999, and has worked as a paramedic in private, fire-based, volunteer, and municipal EMS services, and is an ally to Pulsara. Contact info for Bob can be found on his blog, The EMS Patient Perspective.
Enjoy!

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Trauma is a leading cause of death for all age groups. EMS plays a pivotal role in trauma systems of care through assessment, treatment, and transport to the most appropriate trauma-care facility. Here are the top 10 things you need to know about multi-system trauma to save lives:

1. Only a few things can be fixed on scene, the rest need a trauma center.

Definitive care for multi-system trauma patients is surgery at a trauma center, and time to surgery is critical for those with serious injuries. Interventions on scene should be limited to a rapid head-to-toe exam that identifies severe injuries and the need to control of severe external bleeding, manage the airway, and ventilate or oxygenate the patient. Unless a patient is trapped, most other interventions are done during transport.

2. Know your trauma centers.

EMS transport of severely injured patients to Level I and Level II trauma centers, which have specialists and emergency surgery available, has proven to be lifesaving. Not every trauma patient requires transport to a Level I or II trauma center, though, and over-triage can overwhelm the finite resources at those hospitals. Use the CDC field triage guidelines to determine which patients can be safely taken to Level III and IV trauma centers to better distribute patient load. However, err on the side of over triage and transport to the higher-level center if there is any concern about the severity of the patient’s injuries.[1]

3. Apply pressure, then tourniquets to stop external bleeding.

External hemorrhage control begins by applying pressure to the wound with a dressing. Hold the dressing tightly on the wound, directly on the injured blood vessel. If that does not quickly control bleeding, apply a tourniquet ‘high and tight’ proximal to the wound. Adjust the pressure of a commercial device or inflate a blood pressure cuff until the bleeding stops. If bleeding continues after the maximum amount of pressure is reached, a second tourniquet may be applied proximal to the first. There is no nerve damage or risk of limb loss from tourniquets for at least two hours after application.[2]

4. Decompress a tension pneumothorax with a large and long needle.

Traumatic injury to the lung can cause a tension pneumothorax, in which air leaks into the space between the lung and chest wall and compresses the lung, heart, and blood vessels. This compromises both ventilation and cardiac output and can quickly lead to death.

Auscultate for silent or decreased breath sounds on one side, tachycardia, altered mental status, and hypotension during the primary assessment, and treat a tension pneumothorax as soon as it is recognized. This is done through placement of a needle into the second intercostal space at the mid-clavicular line of the chest, which relieves pressure in the chest and increases the size of the lung. The needle should be large bore (14 gauge or higher), and at least two inches long to ensure penetration of the chest wall. Assess for a rush of air and change in vital signs after needle placement.

5. Use capnography to detect shock.