2013 Trauma Basics:

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2013 Trauma Basics:

“Blood, Heat & Gears”

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Your SCRTAC EMS Staff…

Chris Hammes Dan Williams Chris Carbon

State Trauma System…

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• DHS 118• DHS• S.T.A.C.• Trauma Registry

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What Is The EMS Role In The State Trauma System?

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START Triage...

START Triage...

Simple

Triage

And

Rapid

Treatment

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START Algorithm...

MUCC?

Model Uniform Core Criteria

24 Criteria that a triage system should contain

Based on science (data), and Based on best practice (what works

well)

SALT Triage meets ALL 24 criteria (START meets about 19 criteria)

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SALT Triage: Step 1: Sort

Sort:

Walk? Casualty Collection Point Last to be individually assessed

Wave? Assess those that do not wave 1st

They are most likely to need life-saving interventions

Assess those that wave next10

Your Turn.... SALT Triage Patient

11(www.skatermom.com)

Your Turn.... SALT Triage Patient

12(www.skatermom.com)

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WI Trauma Field Triage Guideline...

Approved by EMS and STAC fall of 2012 Adapted from the CDC / ACS Guidelines

Wisconsin has added an additional AIRWAY step

Guideline vs. Protocol Intent is for every EMS agency in the state to adopt

the guideline as their protocol for triage and transport of the traumatically injured patient

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How is the 2012 version different?

Most changes involve wording, making it more clear ‘Defined Trauma Region’ ‘Chest wall instability or deformity’

Had been ‘flail chest’

‘Pulseless extremity’ Adds vehicle ‘roof intrusion’ Elderly patient considerations

Systolic BP < 110 may represent shock Low Impact MOIs may cause serious injury

Removes Dialysis considerations and ‘Time Sensitive Extremity Injury’

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When In Doubt…

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Bleeding Control

Bandaging or Stopping the Bleeding?

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Stopping Active Bleeding...

Direct Pressure: Pressure applied to actual bleeding site Pressure applied just proximal to the

bleeding site

Pros: Cons:

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www.umm.edu

Stopping Active Bleeding...

Tourniquet: Approved for EMS in WI Scope of Practice*

State of Wisconsin – Standards & Procedures of Practical Skills

For major extremity bleeds -- Applies circumferential pressure

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Tourniquet Application...

Remove clothing from tourniquet area if possible Why?

Apply 2-3” proximal from the bleed Why?

Do not apply over a joint

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www.roguemedic.com

Tourniquet Application... What to expect

Bleeding should stop Patient will experience significant pain Patient may want the device removed

Good idea? When can it safely be removed?

Application of the device goes more smoothly for those that practice regularly

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DEMONSTRATION

24http://www.layoutsparks.com/1/231919/burning-flames-yellow-fire.html

Burn Injuries... National Data

450,000 burn victims sought medical attention (2011) 45,000 required hospitalization 25,000 hospitalized at a burn center

3,500 deaths each year (fire/burn data combined) 75% died at the scene or during initial transport

Burn victims: 70% male / 30% female

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American Burn Association Burn Incident Fact Sheet

Radiation Burns...

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www.utilities-me.com

Thermal Burns...

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www.myspace.com

The Skin... Our Largest Organ:

Protection: Injury Infection

Prevention: Loss of Body Fluids

Regulation: Body Temperature

Sensory: With the

Environment

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1st Degree Burn = Superficial

Redness Dry Blanches with

pressure Top layer of

epidermal cells is destroyed

Heals in 3-5 days

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www.healthcentral.com

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1ST

www.telegraph.co.uk

www.myspace.com www.claudia-dave-nelsonblog.com

www.dailyhaha.com

Sizing-Up the Burn Injury

The severity of the burn: Type Size (Surface Area) Location

Size of a burn: % of total body surface area Rule of Nines Palm & Fingers

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Burn Measurement... Palm & Fingers:

Patient’s palm and fingers = 1% TBSA

Limitations: Large Burns

Good for smaller burns of differing severity

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1% TBSA

Wisconsin and Neighboring Burn Centers...

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UW Hospital / Am. Fam. Children’s

Columbia St. Mary’s Hospital

Hennepin Co.

Region’s

Univ. of Chicago

Loyola Univ.

Thermal Burn Care... 1st Degree

Cover burn area with a dry dressing Protection Exposure to air increases pain Plastic Wrap?

Pain management as needed Do not use ice/cold water, etc to cool large areas of

1st degree burns Hypothermia

Remove Jewelry ASAP

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March 23rdFennimore, WI.

Hwy 61 at County Rd. T

Domestic BatteryAwaiting Police Arrival

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Standing-By at a safe distance,

Waiting for law enforcement,

Observing the residence...

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Updates to the Incident...

Law Enforcement on-scene: SCENE IS SAFE

Fire Department has been requested Not on-scene yet

Your assignment is EMS

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No purposeful movement

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Triage: Global Sorting

1 patient on the ground waving / screaming

1 patient walking toward you / severely burned

2 patients motionless on the ground / No purposeful movement

Who should be assessed 1st? 2nd?

Last?

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Patient #2...

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Patient #3...

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Patient #4...

46www.cicletrack.com

Let’s update our scene...

Additional resources have been requested and are responding Ground ambulances

ALS BLS

Medical Helicopter

(Base) Hospital Communications:

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Patient #1... Primary Assessment:

LOC: Unconscious, withdraws to pain, moans Airway: Patent, protected by swallow reflex Breathing: Rapid & labored Circulation: Radial pulse absent; brachial is weak,

and rapid, min or external bleeds

Interventions? Priority Decision?

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Patient #1… Treatment

Airway: Basic vs. Advanced?

Oxygen: Device, Flow? Breathing: BVM… When, why?

Chest seal? Why? Circulation: ALS… Fluid or not? Burn care: What? When?

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Patient #2... Primary Assessment:

LOC: Unconscious; Unresponsive Airway: Made patent by EMS

positioning Breathing: Agonal, slow, irregular Circulation: Radial and femoral pulses absent

Carotid +/- palpable, thready

Interventions? Priority Decision?

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Patient #2… Treatment

Place in an open-airway position Re-assess:

After all patients have been triaged After all IMMEDIATE patients

have been managed Re-tag and treat as indicated:

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Patient #3... Initial Assessment:

LOC: Conscious ; AOx2 Airway: Patent and protected Breathing: Rate increased, not labored Circulation: No radial pulse; Tachycardic

Significant bleed from right thigh

Interventions? Priority Decision?

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Patient #3… Treatment

Immediate direct pressure Rapid tourniquet application If no tourniquet available:

application of pressure dressing

Bleeding must be stopped!

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Patient #4... Initial Assessment:

LOC: Conscious; AOx3 Airway: Patent; hoarse

voice Breathing: Rate / Depth / Effort

normal Circulation: Strong radial pulse;

No major bleeds

Interventions? Priority Decision? 54

Patient #4…Treatment

High-Flow Oxygen Dyspnea CO

Airway management Inhalation injury present Emergent RSI indicated

Pain management Not with cold products! Why?

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Which Patient?

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Our Patients… As we found them

1 2 3 4

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Transport and Trauma Level Needs…

Please refer to the…

Wisconsin Trauma Field Triage GuidelinePatient # 1 Patient #3 Patient #4

Major Trauma Patient

Major Trauma Patient

Major Trauma Patient

Not Major Trauma Patient

GSW to chestALOC

Likely Unsurviveable Now PNB

ShockMajor Bleed

Significant BurnsInhalation Injury

Level I or II Trauma Center

Non-Transport Level I or II Trauma Center

Burn Center p RSI

BLS + ALS Coroner / Law Enforcement

BLS + ALS *ALS Needed*

Patient # 2

59www.stocktradingtogo.com

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Any questions about the State Trauma System, the SCRTAC, and your role

in the system?

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BEFORE YOU LEAVE:

Be sure that you have signed-in with your name, email, and EMS Service. Attendance certificate will be emailed to you or

your service/training director SCRTAC Newsletter

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SCRTAC…

Saving Lives By Strengthening Our Region’s Trauma Care System