Trauma

Management

Trauma patients must be assessed quickly and transported to an appropriate facility as soon as possible. Good patient outcome in trauma cases is based on assessment skills and results from:

• Early recognition
• Clearly defined priorities
• Early notification
• Early preparation by receiving facility

Allowing for access and extrication an Ambulance Officer’s objective for scene time should be a maximum of twenty minutes.

Assessment

Conduct Primary Survey

The objective of the initial assessment is to rapidly detect life threats, if life threats are present, correct them. If they can’t be corrected, support airway, breathing and circulation and commence Priority 1 transport with notification to receiving medical facility.

Priority of Injuries

• Correct airway and oxygenation problems promptly and monitor.
• Conduct a Primary Survey, remembering that immobilisation of the cervical spine should take place alongside airway assessment, if indicated (i.e. Danger, Response, Airway (with C-Spine consideration), Breathing, Circulation, Disability, Exposure/Environment).
• Manage more serious injuries before less serious ones (unless logistic reason for re-ordering priorities).
• If time critical, administer only essential life-saving care before starting transport to a medical facility. With critical trauma you may never get beyond the Primary Survey.
• Assess potential for deterioration.
• Reassure patient and effectively administer oxygen and analgesia. 
• Recognise and treat forms of shock.
• Immobilise and splint possible fractures prior to movement, unless there is an urgent reason to remove patient rapidly from a dangerous situation.
• Recognise and respond promptly to fresh difficulties as they arise and change priorities.
• Complete Secondary and CNS Survey to identify injury if appropriate for patient condition.
• Dress wounds.

Special Notes

• Avoid delaying resuscitation.
• Minimum time on scene, maximum treatment en route.
• If transport from scene is delayed due to patient behavioural issues (not related to extrication/patient care activities) e.g. patient unwilling to comply with treatment directives, or delays caused by police, other individuals, contact CSPSOC for advice, if concerned that delay may impact on patient wellbeing / deterioration of presenting condition.
• If still unresponsive/unconscious  and / or airway impaired after primary survey, patient can be placed in the Lateral Trauma Position with cervical spine stabilisation if indicated. It should take 30 seconds or less for the primary assessment.
• A blood pressure or an exact respiratory or pulse rate should NOT be necessary to tell if your patient is critical.
• Differential Diagnosis: always consider other causes and conditions.
  • Medical e.g. hypoglycaemia, epilepsy, stroke, heart attack etc. may all be causes of the trauma.
  • Other trauma e.g. was the driver hit by something thrown through the window?

Special Considerations are included in the relevant CPG’s:

• Shock
• Spinal Injury
• External Haemorrhage
• Internal Haemorrhage
• Fractures, Dislocations and Sprains
• Facial Injuries
• Eye Injuries
• Head Trauma
• Chest Injuries
• Abdominal Injuries
• Penetrating Trauma
• Trapped Patient
• Amputated Parts
• Burns
• Oleoresin Capsicum Spray Exposure
• Electrocution

Key Terms & Links

See Trauma Management Principles for detailed intervention and management priorities