The Emergency Medicine Trauma Handbook

Описание

threats, and prompt transport to the appropriate level trauma center (see CDC guidelines
chart, Figure 1.1) by EMS personnel.3
EMS professionals perform an abridged version of the hospital team’s primary and
secondary surveys. Many EMS systems rely on basic-level Emergency Medical Technicians
(EMTs) to respond to calls for traumatic injuries. Modern EMT-staffed Basic Life Support
ambulances carry equipment more advanced than simple standard first aid, such as
tourniquets and hemostatic dressings for severe hemorrhage, and supraglottic airway
devices. Paramedics, the highest trained pre-hospital providers, are capable of intubation,
Measure vital signs and level of consciousness
Glasgow Coma Scale
Systolic Blood Pressure (mmHg)
Respiratory rate
Step One
Step Two§
Step Three§
Step Four
<90mmHg
<10 or >29 breaths per minute*
(<20 in infant aged <1 year),
or need for ventilatory support
Transport to a trauma
center.* Steps One and Two
attempt to identify the
most seriously injured
patients. These patients
should be transported
preferentially to the
highest level of care within
the defined trauma system.
When in doubt, transport to a trauma center
Transport according
to protocol***
Assess special patient or
system considerations
Assess mechanism of
injury and evidence of
high-energy impact
All penetrating injuries to head, neck, torso and extremities proximal to elbow
or knee
Chest wall instability or deformity (e.g, flait chest)
Two or more proximal long-bone fractures
Crushed, degloved, mangled, or pulseless extremity
Amputation proximal to wrist or ankle
Pelvic fractures
Open or depressed skull fracture
Paralysis
Falls
High-risk auto crash
Motorcycle crash >20 mph
Risk of injury/death increases after age 55 years
SBP <110 might represent shock after age 65 years
Low impact mechanisms (e.g. ground level falls) might result in severe injury
Should be triaged preferentially to pediatric capable trauma centers
Patients with head injury are at high risk for rapid deterioration
Without other trauma mechanism: triage to burn facility***
With trauma mechanism: triage to trauma center***
Older adults44
Children
Burns
Pregnancy >20 weeks
EMS provider judgment
Anticoagulants and bleeding disorders
Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph)
impact44
Adults: >20 feet (one story is equal to 10 feet)
Children: >10 feet or two or three times the height of the child
Intrusion,** including roof: >12 inches occupant site;>18 inches any site
Ejection (partial or complete) from automobile
Death in same passenger compartment
Vehicle telemetry data consistent with a high risk of injury
Assess anatomy
of injury
Transport to a trauma
center, which, depending
upon the defined trauma
sysytem, need not be the
highest level trauma
center.**
Transport to a trauma
center or hospital capable
of timely and thorough
evaluation and initial
management of potentially
serious injuries. Consider
consulation with medical
control.
Figure 1.1 CDC guidelines for field triage of injured victims3 (courtesy of the Centers for Disease Control, USA)
Ryan O’Halloran and Kaushal Shah

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