Pre-Hospital Trauma Care

TRAUMA CARE

Based on the latest clinical evidence through #FOAMed

Niall Magee. BSc (Hons) Student Paramedic. London,UK.

With everything medical and trauma related.

One thing…

KEEP IT SIMPLE!

ABC … 123

TOPIC COVERAGE:

- INFORMATION- INITIAL ASSESSMENT & TRIAGE - PRIMARY SURVEY- C.ABCDE ASSESSMENT- AIRWAY MANAGEMENT- SECONDARY SURVEY - MECHANISM OF INJURY - SPINE IMMOBILISATION/INJURY- TRAUMATIC INJURIES- TRAUMA RESUSCITIATION - ADVANCES IN RESUSCITATION

INFORMATION

CALL REPORT – e.g. Car V Pedestrian Lorry V Cyclist Multiply Car Crash Stabbing Shooting

ON SCENE ASSESSMENT – As you approach the scene “windscreen report” - what you see) (*Danger*)

INFORMATION – MDT, Ambo Radio, Fire, Police, Security, Patients relatives/friends, Bystanders

“where, what, when & why”

INITIAL ASSESSMENT & TRIAGE

Handover & pre-alert call C.A.T.M.I.S.T

CADAssess anatomy of Injury AgeTime of InjuryChildren's vital signs Assess mechanism of Injury

GCSInjuries found & suspectedTreatment/Interventions Special Patient ConsiderationAppropriate hospital for patients condition

PRIMARY SURVEY

Medical PS – DRABCDE

Trauma PS – DRC.ABCDE

D - DangerR - Response C - Catastrophic HaemorrhageA - Airway B - BreathingC - Circulation D - Disability Neurological E- ExposeF- Full Vital Signs

ATLS

ADVANCED TRAUMA LIFE SUPPORT

Secondary Survey

AMPLE

A – ALLEGRIES M - MEDICATIONSP – PREVIOUS MEDICAL HISTORYL – LAST MEAL EATENE – EVENTS LEADING UP TO INJURY/ILLNESS

Airway Management

Pre-Hospital Rapid Sequence Intubation (RSI)

Mechanism of Injury (MOI)

Frontal Impact CollisionsLateral Impact Collisions (T bone)Rear Impact CollisionsRollover MechanismOpen Vehicle or Motorcycle/MopedPedestrian Vs. CarPenetrating Injury (Guns vs. Knives)

Lorry Vs. Cyclist Motorsport Crash Fall from height

WARNING!

GRAPHIC TRAUMA RELATED IMAGES

7.62mm Rifle Round. Gunshot to the face.

Gun Shot Blast “Peppered”

Central Chest Stabbing. Kitchen Knife.

Butcher knife Attack. Stabbing.

Boston Bombing, 2013. Blast injury, amputation/deglove.

“Tombstoning” Spinal/pelvic/limb Injuries

- Fractured Vertebrate (s)- Spinal Cord Compression- C-Spine Flexion, Extension, Rotation injuries - Internal Injuries - # Pelvis- # Tib/Fib/Femuor

*Death*

Impact injury

- Misjudged safe water depth- Shallow water - Unseen underwater environment (rocks, pipe outlets) - Water impact - Increased Height + Increased Speed = Higher risk of injury

- Fall from height -

Cervical Spine Injury (C-SPINE)

C-Spine Immobilisation

Use of head blocks with taping combined with C-Collar.

Debatable evidence on the use & effectiveness of C-Collars – see #FOAMed

Long board use is discontinued by many NHS ambulance trusts for patient transport.

Orthopaedic Stretcher “Scoop” preferred method of immobilisation during transport.

KED

Kendrick Evacuation Device (KED) – Spinal Immobilisation -Used mainly in the sitting positon i.e. sitting in a car.

Limb/Spinal Injuries

# FEMOUR – Kendrick Traction Device # TIBULA – Vacuum Splint / Frac# FIBULA – Vacuum Splint / Frac # FOOT – Vacuum Splint / Frac# LOWER & UPPER ARM – Vacuum/ Frac / SAM

#NECK OF FEMUR

- Deformity of anatomy - Rotation of limb - Shortening of the limb- Inability to move limb - Extreme pain

Age Range – Mainly in the elderly. Factors: Osteoporosis Disease Major Trauma

Surgery Treatment: Depending on severity, health of bone & blood supply

- Rod & Pins fixture- Hip replacement

#Pelvis

Pre-Hospital Intervention

Prometheus Pelvic Splint

Increased pelvic pressure will lead to increased pressure on bladder… wanting to urinate.

SPINAL VERTEBRA & NERVE INJURY

# C2 Hangman’s Fracture

Sport Injury – Rugby # Mainly Cervical & Thoracic #

“Career ending” “life changing Injuries” “life threatening injuries”

- Road Traffic Collusions- Rope Hanging- Impact injury

Nerve Compression

BY NIALL MAGEE 05/15 BSC HONS PARAMEDIC SCIENCE, UoG-AVERY HILL/ LONDON

Damage Control Resuscitation

Battlefield Emergency Medicine Civilian Pre-Hospital Emergency Care

HYPOVOLEMIC SHOCK CARDIAC ARREST

EZ-IO, QUICKCLOT, C.A.T. Combat Application Tourniquet

“Only 10% of United States servicemen wounded in Iraq and Afghanistan between 2003 and 2009 died, compared with 24% in the first Gulf War (1990-1991) and Vietnam War (1961-1973).”

http://www.bmj.com/content/338/bmj.b1778

ABC TO CABC

BY NIALL MAGEE 05/15 BSC HONS PARAMEDIC SCIENCE, UOG-AVERY HILL/ LONDON

Damage Control Resuscitation

1. Permissive Hypotension

2. Haemostatic Resuscitation

3. Damage Control Surgery

“The concept of damage control resuscitation (DCR) was proposed in the mid 2000s as an alternative resuscitation approach to haemorrhagic shock.”

http://www.perioperativemedicinejournal.com/content/2/1/13

BY NIALL MAGEE 05/15 BSC HONS PARAMEDIC SCIENCE, UoG-AVERY HILL/ LONDON

Blood products at the roadside

- Fresh Frozen Plasma- Red Blood Cells- Platelets Ratio 1:1:1

BY NIALL MAGEE 05/15 BSC HONS PARAMEDIC SCIENCE, UoG-AVERY HILL/ LONDON

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

CODE RED!

An Hour to Save a Life- London's Air Ambulance

MAJOR TRAUMA- MAJOR HAEMORRHAGE (PELVIS)

http://www.bbc.co.uk/programmes/p01tbbp5

BY NIALL MAGEE 05/15 BSC HONS PARAMEDIC SCIENCE, UOG-AVERY HILL/ LONDON

Pre-Hospital Resuscitative Thoracotomy

- Carried out by HEMS- BASICS Trauma Doctor- Paramedic & Doctor Team

Critical – Last resort procedure to restart the heart

Pre-hospital ultrasound

BY NIALL MAGEE 05/15 BSC HONS PARAMEDIC SCIENCE, UOG-AVERY HILL/ LONDON

- Device used by highly skilled Paramedics and Doctors.

- Mainly used by HEMS.

http://www.sonoguide.com/ems_pre-hospital.html

http://resus.me/prehospital-ultrasound/

Focused Assessment with Sonography for Trauma