1 2013 trauma basics: “blood, heat & gears”. 2 your scrtac ems staff… chris hammes dan...
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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
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