UNCONTROLLED WHEN PRINTED

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.

References
References

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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Date

Review Date

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