Team Work
- Team should communicate to share information, ensure safety, avoid duplication or overlap and optimise patient care
- Team Leader (if available) should coordinate and manage the scene, otherwise one Officer should take control
- Assistant should follow directions of leader unless dangerous
- Assistant should anticipate management needs
Determine and manage the Trauma or Medical patient as they present
Patient Packaging & Movement
- Protect the airway
- Protect the cervical spine and the rest of back
- Perform Secondary Survey and splint fractures prior to movement if possible
- Use blankets and pillows to minimise pressure points
- Roll or move as a unit; avoid spinal twisting
- Use appropriate lifting/movement device e.g. Scoop stretcher, Ferno Washington stretcher, wheelchair, etc.
- For all lifts, spread or share the load. Use available resources, including safe utilisation of bystanders, to minimise load on each person. One officer to take charge and coordinate lift, ensuring effective communication with all parties and patient
- Perform a smooth and safe transfer. Avoid sudden jolts as they can cause a rapid drop in blood pressure
- Move patients as little as possible, consistent with hazards and surroundings
Extrication
- Survey scene for potential hazards, number of patients, need for specialist help. Call for medical or technical back-up as needed
- Protect rescuers first; ensure hazards are dealt with e.g. fuel spills, power lines, unstable vehicles
- Remove crushing force as soon as possible. Manage any hypovolaemia
- Apply C-Spine precautions where indicated, prior to extrication
- Expedite safe extrication after the management of life-threatening problems (utilising specialists if required).
Time-Critical Guidelines
Recognition of the time-critical patient is a vital component of pre-hospital care. Time-critical refers not only to trauma but also medical problems where the patient is in acute physiological distress. It is recognising that which can be stabilised in the field and that which requires expedient transport to a medical facility for definitive care. This will influence decision making for the management of the patient, so called 'stay and play' or 'treat en route'. It may also influence method of transport, i.e. by road or air (ERHS/RFDS).
Identify the time-critical patient as soon as possible at scene using the following criteria:
History | High speed MVA > 60 kph |
| MVA with rollover or fatality of an occupant of the same car | |
| Accident involving cyclist, motorcyclist or pedestrian hit at 30 kph or more | |
| Patient ejected or trapped | |
| Fall >3m (10ft) | |
Injuries | Head injury with a decreased conscious state |
| Spinal cord injury | |
| Chest injury with impaired respiration | |
| Major abdominal injury | |
| Major pelvic fracture | |
| Two or more proximal long bone fractures | |
| All penetrating injuries to head, neck, chest, abdomen, pelvis, groin and back | |
Vital Signs | Systolic BP < 100 |
| Respiratory rate < 10 or > 20 | |
| GCS < 12 | |
Multiple Patients | Multi-casualty or disaster situation |
Inter-hospital transfer | Any inter-hospital transfer with Vital Signs as above |
NOTE: Observe vital signs every 5 minutes if possible.
Other examples of time-critical patients include:
- Upper airway obstruction or injury: Laryngeal injury, airway burns, epiglottitis.
- Internal bleeding, including gunshots, stabbing and blunt force trauma, can only be controlled in hospital
- Tension pneumothorax: rare, but deteriorates rapidly
- Traumatic cardiac arrest is associated with a poor outcome; the patients only chance is in hospital. Patients very rarely respond to prehospital management.
Key Terms & Links
Document Control
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