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2013 Trauma Basics:2013 Trauma Basics:

“Blood, Heat & Gears”“Blood, Heat & Gears”

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Your SCRTAC EMS Staff…Your SCRTAC EMS Staff…

Chris HammesChris Hammes Dan WilliamsDan Williams Chris CarbonChris Carbon

State Trauma System…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?

What Is The EMS Role In The State Trauma System?

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START Triage...START Triage...

START Triage...START Triage...

Simple

Triage

And

Rapid

Treatment

Simple

Triage

And

Rapid

Treatment

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START Algorithm... START Algorithm...

MUCC?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)

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)9

SALT Triage: Step 1: SortSALT 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 next

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 PatientYour Turn.... SALT Triage Patient

11(www.skatermom.com)

Your Turn.... SALT Triage PatientYour Turn.... SALT Triage Patient

12(www.skatermom.com)

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WI Trauma Field Triage Guideline...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

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?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’

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… When In Doubt…

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Bleeding Control

Bandaging or Stopping the Bleeding?Bandaging or Stopping the Bleeding?

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Stopping Active Bleeding...Stopping Active Bleeding...

Direct Pressure: Pressure applied to actual bleeding site

Pressure applied just proximal to the bleeding site

Pros:

Cons:

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...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

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...Tourniquet Application...

Remove clothing from tourniquet area if possible Why?

Apply 2-3” proximal from the bleed Why?

Do not apply over a joint

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 expectTourniquet 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

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 DataBurn 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

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...Radiation Burns...

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www.utilities-me.com

Thermal Burns...Thermal Burns...

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www.myspace.com

The Skin... Our Largest Organ:The Skin... Our Largest Organ:

Protection: Injury

Infection

Prevention: Loss of Body Fluids

Protection: Injury

Infection

Prevention: Loss of Body Fluids

Regulation: Body Temperature

Sensory: With the

Environment

Regulation: Body Temperature

Sensory: With the

Environment

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1st Degree Burn = Superficial1st Degree Burn = Superficial

Redness

Dry

Blanches with pressure

Top layer of epidermal cells is destroyed

Heals in 3-5 days

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 InjurySizing-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

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:Burn Measurement... Palm & Fingers:

Patient’s palm and fingers = 1% TBSA

Limitations: Large Burns

Good for smaller burns of differing severity

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...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 DegreeThermal 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

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 23rd

Fennimore, WI.

Hwy 61 at County Rd. T

Domestic Battery

Awaiting Police Arrival

March 23rd

Fennimore, WI.

Hwy 61 at County Rd. T

Domestic Battery

Awaiting 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...Updates to the Incident...

Law Enforcement on-scene: SCENE IS SAFE

Fire Department has been requested Not on-scene yet

Your assignment is EMS

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 movementNo purposeful movement

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Triage: Global SortingTriage: 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

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?

Who should be assessed 1st? 2nd?

Last?

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Patient #2...Patient #2...

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Patient #3...Patient #3...

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Patient #4...Patient #4...

46www.cicletrack.com

Let’s update our scene...Let’s update our scene...

Additional resources have been requested and are responding Ground ambulances

ALS

BLS

Medical Helicopter

(Base) Hospital Communications:

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: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?

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… TreatmentPatient #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?

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: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?

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?50

Patient #2… TreatmentPatient #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:

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: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?

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?52

Patient #3… TreatmentPatient #3… Treatment

Immediate direct pressure

Rapid tourniquet application

If no tourniquet available: application of pressure dressing

Bleeding must be stopped!

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: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?

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…TreatmentPatient #4…Treatment

High-Flow Oxygen

Dyspnea

CO

Airway management Inhalation injury present

Emergent RSI indicated

Pain management Not with cold products! Why?

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?Which Patient?

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Our Patients… As we found themOur Patients… As we found them

1 2 3 41 2 3 4

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Transport and Trauma Level Needs…Transport and Trauma Level Needs…

Please refer to the…

Wisconsin Trauma Field Triage Guideline

Please refer to the…

Wisconsin Trauma Field Triage Guideline

Patient # 1 Patient #3 Patient #4

Major Trauma Patient

Major Trauma Patient

Major Trauma Patient

Not Major Trauma Patient

GSW to chest

ALOC

Likely Unsurviveable

Now PNB

Shock

Major Bleed

Significant Burns

Inhalation 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?

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

in the system?

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BEFORE YOU LEAVE: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

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…SCRTAC…

Saving Lives By Strengthening Our Region’s Trauma Care System

Saving Lives By Strengthening Our Region’s Trauma Care System