Traumatic injury emergencies: what protocol for trauma treatment?
Despite advances in hospital and pre-hospital care over the last 50 years, trauma remains a leading cause of death
In fact, trauma is the leading cause of death in Western countries for people under 45 years of age
Rescuers play a key role in trauma care by assessing, treating and transporting patients to the nearest trauma care facility.
Rescuers save lives every day by responding to countless motor vehicle accidents and other traumatic injuries.
Their rescue efforts have a significant impact on the health outcomes of trauma victims.
It has been proven that victims of severe trauma have a 25% better chance of survival if they are taken immediately to a trauma centre.
What is a traumatic injury?
A traumatic injury is a sudden and serious injury caused by a physical force; examples include motor vehicle accidents, falls, drowning, gunshot wounds, burns, stabbings or other physical threats.
Major trauma is defined as any injury that can cause prolonged disability or death.
Blunt trauma occurs when a body part is damaged by impact, injury or physical attack.
Blunt trauma occurs when a body part is damaged by impact, injury or physical attack.
Penetrating trauma occurs when an object pierces the skin and penetrates the body, creating an open wound.
Traumatic injuries can also cause systemic shock that may require immediate resuscitation and intervention.
Symptoms of traumatic injuries
Traumatic injury is a serious and life-threatening injury.
It can affect many parts of the body.
The signs of a traumatic injury may vary depending on the body part or region affected.
In general, however, the symptoms of trauma are similar to those of any other serious injury, and include deep bleeding, bruising, bone fractures, mutilation, dismemberment, burns and extreme pain.
Many of the less obvious signs and symptoms are associated with traumatic brain injury, listed below.
The diagnosis of trauma can sometimes prove difficult, as signs of a traumatic brain injury may appear immediately after the traumatic event or weeks later.
Signs of a traumatic injury may include any of the following symptoms:
- Blurred vision, ringing in the ears, bad taste, inability to smell.
- Clear fluid leaking from the nose or ears
- Convulsions or seizures
- Difficulty sleeping
- Dilation of one or both pupils of the eyes
- Dizziness or loss of balance
- Tiredness or drowsiness
- Feeling of depression or anxiety
- Headaches
- Inability to wake from sleep
- Loss of consciousness (a few seconds to a few minutes) (for any length of time)
- Problems with memory or concentration
- Changes in mood or mood swings
- Nausea or vomiting
- No loss of consciousness but a state of confusion or disorientation
- Numbness in fingers and toes
- Speech problems
- Sensitivity to light or sound
- Sleeping more than usual
- Confused speech
Trauma, when to call the emergency services?
If you experience any of the symptoms described above, you should call the Emergency Number immediately.
Even if the symptoms seem mild or moderate, it could be a very serious injury that requires an accurate diagnosis or immediate medical assistance.
How to treat a traumatic injury
The treatment of a traumatic injury, prior to the arrival of emergency responders, depends on the type of injury, e.g. car accidents, falls, drowning, gunshots, burns, stabbings, etc.
Depending on the situation, the appropriate first aid must be applied to treat the physical symptoms of that particular injury or injuries.
For example, in case of haemorrhage, pressure should be applied to the wound to slow down the bleeding.
In the case of a car accident, or if there is a possibility that the victim has sustained a neck or back injury, moving the victim should be avoided at all costs unless he or she is at risk of suffering a more serious injury.
In these situations, simply stay close to the victim and offer comfort and emotional support.
In all cases of traumatic injuries, however, the priority is to call the Emergency Number.
When you talk to the emergency dispatcher, he/she will probably ask you several questions about the nature of the injury and may provide you with further instructions to help the trauma victim until emergency responders or paramedics arrive.
If you have witnessed an injury or arrived immediately after an injury, you may be able to provide emergency responders with critical information needed for assessment and treatment.
In the case of a traumatic brain injury, the answers to the following questions can be of great use to emergency workers when they arrive on the scene:
- How did the injury occur?
- Did the person lose consciousness? For how long?
- Were there changes in the patient’s alertness, speech or co-ordination?
- What other signs of injury did you find?
- In which parts of the body did the injury occur?
- In the case of a head injury, where did the impact occur?
- Can you provide information on the strength of the injury? In the case of a car accident, for example, how fast was the car going, how far did the fall occur, how long ago did it happen?
Overview of the treatment of trauma-related injuries
Many traumatic injuries can be treated in hospital emergency departments.
The most severe traumatic injuries can be treated by emergency room workers (EMTs and paramedics) as a trauma alarm.
A level one trauma alert is based on a rapid physical assessment of the victim’s immediate medical needs.
Based on the trauma alarm criteria, first responders deliver the patient to the most appropriate hospital.
How US EMTs and paramedics treat trauma
For all clinical emergencies, the first step is the rapid and systematic assessment of the patient.
For this assessment, most rescuers use the ABCDE approach.
The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is applicable in all clinical emergencies for immediate assessment and treatment.
It can be used on the street with or without equipment.
It can also be used in a more advanced form where emergency medical services are available, including emergency rooms, hospitals or intensive care units.
Treatment guidelines and resources for medical first responders
Trauma treatment guidelines can be found on page 184 of the National Model EMS Clinical Guidelines of the National Association of State EMT Officials (NASEMSO).
These guidelines are maintained by NASEMSO to facilitate the creation of clinical guidelines, protocols, and operating procedures for state and local EMS systems.
These guidelines are evidence-based or consensus-based and have been formatted for use by EMS professionals in the field.
Trauma can occur in any part of the body in different forms, each requiring different emergency treatment.
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Some of the common types of adult trauma covered by NASEMSO include:
- Blast injuries
- Burns
- Crush injuries
- Extremity trauma / External haemorrhage management
- Facial/dental trauma
- Head injuries
- High threat considerations / Active shooter scenario
- Spinal care
- EMS providers should refer to the CDC field triage guidelines when deciding where to transport injured patients.
The Centers for Disease Control (CDC) field triage guidelines are not intended for the triage of mass casualties or disasters.
Instead, they are designed for use with individual patients injured in the United States due to motor vehicle accidents, falls, penetrating injuries, and other mechanisms of injury.
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