TRAUMATIC

EMERGENCIES
ALS Section E 1
INITIAL TRAUMA CARE TRAUMA
NOTE: Appropriate Body Substance Isolation euip!ent !ust be used on all
trau!a patients"
CRITERIA: All trauma patients
TREATMENT:
1. Perform BTLS primary survey:
a. If loa an !o situation is present:
i. Perform only life"#riti#al interventions on s#ene.
ii. Avise re#eivin! fa#ility an transport rapily.
iii. Perform se#onary survey enroute to re#eivin! fa#ility.
iv. Perform all ot$er interventions% su#$ as I& insertion% #aria#
monitorin! an PAS' inflation enroute to re#eivin! fa#ility.
v. In all #ases% s#ene time s$oul (e limite to 1) minutes% unless
entrapment e*ists.
(. If a loa an !o situation is not present:
i. Continue se#onary survey.
ii. Provie supportive #are as ini#ate.
iii. Attempt to limit s#ene time to 1) minutes or less% unless entrapment
e*ists.
+. Conta#t Mei#al Control to report assessment finin!s.
,. Air-ay an ./0'EN aministration:
a. Apply ./0'EN at 11 Lpm (y non"re(reat$er.
(. Perform avan#e air-ay #ontrol measures% as neee.
#. Apply pulse o*imeter if availa(le.
2. .(tain SAMPLE $istory an vital si!ns3 repeat vital si!ns every 1 to 1)
minutes an relay to re#eivin! fa#ility.
1. PAS':
a. May (e use if patient #onition -arrants% an no #ontraini#ations are
present.
(. Conta#t Mei#al Control for orers to inflate.
#. Refer to PAS' Care 'uieline for pro#eure.
4. Continue reassessment of patient urin! transport:
a. Continuously reassess t$e patient5s level of #ons#iousness usin! t$e
'las!o- Coma S#ale.
(. Continuously monitor life"#riti#al interventions an ABC5s.
#. Report any #$an!es in patient #onition to Mei#al Control.
6. Conta#t Mei#al Control.
7. If patient nees immeiate intu(ation re8uirin! #ons#ious seation -it$
&ERSE9% refer to C.NSCI.:S SE9ATI.N " &ERSE9 proto#ol.
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Re#ised: Au$ust %&&&
ALS Section E +
GLASGO' COMA SCALE TRAUMA
Indicator Response Score
Eye Openin$ Spontaneous 2
To voi#e ,
To pain +
None 1
(erbal Response .riente 1
Confuse 2
Inappropriate -ors ,
In#ompre$ensi(le +
None 1
Motor Response .(eys #omman 4
Lo#ali;es pain 1
<it$ra-s to pain 2
=le*ion to pain ,
E*tension to pain +
No response 1
Total GCS: )))))
ALS Section E ,
AM*UTATION TRAUMA
NOTE: +o not delay transport o, patient to retrie#e an entrapped or lost part"
+o not co!plete partial a!putations"
CRITERIA:
1. Partial or #omplete amputation of a (oy part
TREATMENT:
1. Initial Trauma Care.
+. Air-ay an ./0'EN at 11 Lpm (y non"re(reat$er.
,. Bleein! #ontrol.
2. I& of LR enroute to re#eivin! fa#ility3 #onsier +1)"1)) mL flui (olus to
maintain SBP (et-een >) ? 1)).
1. Treat for s$o#@ if ini#ate.
4. Consier M.RPAINE S:L=ATE 1 m! I&P pus$ as neee for pain #ontrol.
May repeat * 1 after 11 minutes as neee.
6. Tissue preservation:
a. Rinse part !ently -it$ normal saline -+O NOT SCRUB..
(. <rap part in !au;e moistene -it$ normal saline.
#. Pla#e -rappe part in -ater ti!$t (a! an seal.
. La(el (a! -it$ name% ate an time.
e. Pla#e seale (a! into #ontainer fille -it$ -ater an i#e3 transport -it$
patient% if possi(le.
7. Initiate transport.
>. Conta#t Mei#al Control.
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Re#ised: /uly %&&0
ALS Section E 2
BURNS TRAUMA
N.TE: *atients 1it2 unstable #ital si$ns s2ould not routinely recei#e pain
!edications"
CRITERIA: Any may (e present
1. In$alation inBury
+. Ele#tri#al inBury
,. Si!nifi#ant partial or full t$i#@ness (urns
2. C$emi#al e*posure
TREATMENT:
1. Assure s#ene an res#uer safety.
+. Initial Trauma Care.
,. Remove patient from sour#e of (urn% an e*tin!uis$ flames on patient.
2. Treat (urn a##orin! to type:
a. T$ermal ? #over -it$ moist ressin!.
(. C$emi#al ? flus$ -it$ -ater or saline C(rus$ off any ry #$emi#al firstD.
#. Tar ? #ool -it$ -ater or saline3 o not attempt to remove tar.
. Ele#tri#al ? remove from #onta#t -it$ #urrent only if fully traine an
properly e8uippe3 note any se#onary fra#tures or e*it -ouns.
1. Air-ay an ./0'EN at 11 Lpm (y non"re(reat$er.
4. Perform avan#e air-ay #ontrol measures as neee.
6. Monitor.
7. I& of LR3 Consier +1) ? 1)) mL flui (olus to maintain SBP >) ? 1)).
>. Consier M.RPAINE S:L=ATE 1 m! I&P as neee for pain #ontrol. May
repeat * 1 after 11 minutes as neee or #onsier =ENTAN0L 1 m#!E@! slo-
I&P Cover 1"+ minutesD instea of M.RPAINE. May (e repeate on#e after 1
minutes at 1 m#!E@! slo- I&P.
1). .(tain (urn $istory:
a. Type of (urn3 #ausative a!ent3 time of (urn.
(. Lo#ation of (urn.
#. Estimate e!ree an per#ent surfa#e area (urne.
. InBury environment.
e. SAMPLE $istory.
11. Conta#t Mei#al Control.
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1+. If M.RPAINE anEor =ENTAN0L aller!y% #onsier 9EMER.L +1 m! I&
pus$.
Re#ised: /uly %&&0
3ebruary %&44
ALS Section E 1
C5EST IN/URIES TRAUMA
CRITERIA:
1. Si!ns an symptoms of serious #$est inBury% in#luin!:
a. Penetratin! or su#@in! #$est -ouns
(. :nsta(le #$est -all se!ment
#. Si!ns of (lunt trauma to #$est
. Parao*i#al movement
e. Ta#$ypnea or respiratory istress -it$ suspe#te #$est inBury
TREATMENT:
1. Initial Trauma Care.
+. Air-ay an ./0'EN at 11 Lpm (y non"re(reat$er% or B&M as ne#essary.
,. Perform avan#e air-ay #ontrol measures as neee.
2. Neele #$est e#ompression% if patient meets (ot$ of t$e follo-in!:
a. Si!ns an symptoms of s$o#@.
(. 9e#rease or a(sent (reat$ souns on one sie.
1. Immo(ili;ation.
4. Treat any o(vious #$est inBuries% as ini#ate:
a. Apply o##lusive ressin! to su#@in! #$est -ouns% leavin! one #orner
open.
(. Support any unsta(le #$est -all se!ments -it$ !au;e or $an.
6. Initiate rapi transport3 reassess vitals 8 1 minutes.
7. Monitor.
>. I& of LR3 #onsier +1) ? 1)) mL flui (olus to maintain SBP >) ? 1)).
1). Conta#t Mei#al Control.
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ALS Section E 4
3IEL+ TRIAGE TRAUMA
CRITERIA:
1. Multiple inBure patients (eyon immeiate #apa(ility.
+. MaBor EMS In#ient. CMEMSID
TREATMENT:
4" Se#ure s#ene an par@ in a safe lo#ation3 ACTI(ATE REGION 0 MCI
*LAN"
%" Esta(lis$ In#ient Comman System CICSD3 esi!nate #omman an tria!e
se#tors.
6" Count total num(er of patients involve% in#luin! all uninBure% ea an
refusals.
7" Rapily #ate!ori;e inBure patients usin! METTA' system:
a. Bla#@ ? .(vious eat$3 non"(reat$in! patients -it$out spontaneous
respiration after repositionin! air-ay.
(. Re ? Immeiate3 life t$reatenin! inBuries% respiratory #ompromise% s$o#@
an altere mental status.
#. 0ello- ? 9elaye3 inBuries -$i#$ #an -it$stan up to an $our elay
-it$out treatment% fra#tures an (urns.
. 'reen ? Am(ulatory3 all -al@in! -oune an uninBure patients.
8" Esta(lis$ treatment an loain! areas for -oune patients.
0" Treat an transport a##orin! to priority:
a. All re patients s$oul (e transporte as soon as possi(le.
(. 0ello- patients may (e ta@en to treatment area% an transporte as soon as
all re patients $ave (een eva#uate.
#. 'reen patients may (e transporte (y pu(li# transportation or ot$er
ve$i#les.
9" As#ertain family relations$ips of vi#tims an transport family mem(ers to t$e
same $ospital estination if possi(le.
:" Lo! patient information an provie upates to In#ient Commaner.
;" Reassi!n patient priorities as neee to e*peite #are% an as patient
#onitions #$an!e.
4&" Conta#t Mei#al Control.
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Re#ised: /anuary %&&0
ALS Section E 6
5EA+ OR S*INE IN/UR< TRAUMA
CRITERIA: Any may (e present
1. :nresponsive or 'CS F 1,
+. Posturin!
,. :ne8ual pupils
2. Loss of motor or sensory fun#tion
1. Me#$anism t$at ini#ates potential for inBury.
E/CL:SI.N:
1. SBP F >) ? See s$o#@ proto#ol
TREATMENT:
1. Initial Trauma Care.
+. Air-ay an ./0'EN at 11 Lpm (y non"re(reat$er.
,. If un#ons#ious or semi"#ons#ious% intu(ate as per avan#e air-ay
mana!ement3 if si!ns of elevate intra#ranial pressure Cposturin!% unilateral
pupil ilation% 'CS 7 -it$ $ypertensionE(ray#ariaD% initiate #ontrolle
ventilation at 12"+) (reat$sEmin -it$ 1))G o*y!en @eepin! en"tial pC.+ at
,,",1G if availa(le.
2. Immo(ili;e patient an #ontrol (leein!.
1. Initiate transport.
4. Monitor
6. I& of LR at H&..
7. A0PERT.NIC SALINE C,G solutionD at 1##E@! I& over ,) minutes if si!ns
of elevate intra#ranial pressure present% if availa(le.
>. Assessment fa#tors to #onsier:
a. Restlessness may (e a si!n of $ypo*ia.
(. Assume #ervi#al spine inBury in all patients -it$ si!nifi#ant $ea inBury.
#. .(serve patient #losely for #$an!es in L.C.
. Avoi t$e use of nasal air-ays in patients -it$ suspe#te fa#ial fra#tures.
e. 9o not treat $ypertension in t$e $ea"inBure patient.
1). Conta#t Mei#al Control.
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11. Consier PAS' for refra#tory $ypotension -it$ suspe#te spinal #or trauma.
Re#ised: October %&&8
No#e!ber %&&0
ALS Section E 7
*AIN3UL= S'OLLEN OR
+E3ORME+ E>TREMIT< TRAUMA
N.TE: *atients 1it2 a 2ead in?ury@altered LOC or patients 1it2 unstable
#ital si$ns s2ould not recei#e pain !edications"
CRITERIA: Any may (e present
1. .(vious open fra#ture
+. 9eformity
,. S-ellin!
2. Point tenerness
1. Aistory of inBury #onsistent -it$ a fra#ture.
TREATMENT:
1. Initial Trauma Care.
+. Evaluate pulse% motor an sensory CPMSD fun#tion istal to t$e inBury.
,. Immo(ili;e fra#ture% #overin! open -ouns -it$ sterile !au;e.
2. Reassess PMS istal to inBury.
1. Monitor.
4. I& of LR at H&..
6. Initiate transport.
7. Consier M.RPAINE S:L=ATE 1 m! I&P as neee for pain #ontrol. May
repeat * 1 after 11 minutes as neee or #onsier =ENTAN0L 1 m#!E@! slo-
I&P Cover 1"+ minutesD instea of M.RPAINE. May (e repeate on#e after 1
minutes at 1 m#!E@! slo- I&P.
>. Conta#t Mei#al Control.
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1). If M.RPAINE or =ENTAN0L aller!y e*ists% #onsier 9EMER.L +1 m! I&
pus$.
Re#ised: /uly %&&0
3ebruary %&44

ALS Section E >
S5OCA 3ROM TRAUMA TRAUMA
NOTE: I, patient is pre$nant= do not in,late abdo!inal section o, *ASG"
CRITERIA: Any may (e present
1. Systemi# $ypotension
+. Altere L.C
,. Inae8uate perfusion3 pale% #ool or mottle s@in
2. Massive (loo loss
1. Crus$ Synrome
4. Suspe#te pelvis or lon! (one fra#ture
TREATMENT:
1. Assure res#uer safety3 maintain inline sta(ili;ation t$rou!$out assessment an
treatment.
+. Initial Trauma Care.
,. Air-ay an ./0'EN at 11 Lpm (y non"re(reat$er% or B&M as ne#essary.
2. Perform avan#e air-ay #ontrol measures as neee.
1. Assess #ir#ulation an #ontrol (leein!.
4. Immo(ili;e -it$ PAS' as ini#ate an initiate transport.
6. Initiate + lar!e (ore I& of LR3 flo- -ie open as neee to maintain SBP
1))"11). 9o not aminister more flui t$an is ne#essary to maintain SBP
1))"11).
7. Monitor.
>. Conta#t Mei#al Control.
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1). Consier PAS' inflation as ne#essary% a##orin! to PAS' !uielines.
11. If neuro!eni# s$o#@ is suspe#te% #onsier 9.PAMINE:
a. Pla#e 9.PAMINE 2))m! in +1) ml 91< -it$ mi#rorip tu(in!.
(. Start at 11 !ttEmin an titrate to maintain SBP >)"1)).
ALS Section E 1)
TRAUMATIC ARREST TRAUMA
CRITERIA:
1. Pulseless an apnei# trauma patient not meetin! t$e Trau!a 3ield +eat2
+eclaration #riteria Crefer to t$e Trau!a 3ield +eat2 +eclaration proto#olD.
TREATMENT:
1. Assure res#uer safety3 maintain inline sta(ili;ation t$rou!$out
assessment an treatment.
+. Perform avan#e air-ay #ontrol measures3 initiate CPR.
,. Immo(ili;e an initiate rapi transport -it$in 1) minutes of
e*tri#ation.
2. Monitor
1. Esta(lis$ t-o lar!e (ore I&5s of LR:
a. Run -ie open until patient re!ains pulse
(. Maintain SBP 1))"11)
4. Aminister EPINEPARINE 1:1)%))) 1m! I& I,"1 minutes until
pulses return or until arrival at $ospital.
6. Treat su(se8uent ysr$yt$mias per appropriate proto#ol.
7. Conta#t Mei#al Control.
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>. Consier PAS' inflation as ini#ate
1). Mei#al Control may orer Peri#ario#entesis Cif your servi#e
$as t$at #apa(ilityD as per Peri#ario#entesis Care 'uieline.
Re#ised: /anuary %&&%
May %&&7
3ebruary %&44
ALS Section E 11
TRAUMA 3IEL+ +EAT5 TRAUMA
+ECLARATION
Si!nifi#ant traumati# inBury AN+
patient foun pulseless an apnei# NO
upon EMS arrivalJ
<ES
InBury in#ompati(le -it$ lifeJ
Ce#apitation% torso transa#tionD
NO Initiate Traumati#
Arrest Proto#ol an
TransportK
<ES Presen#e of si!inifi#ant
interval sin#e eat$J
Cliviity% ri!or mortis% e#ompD
NO
Patient less t$an 12 years of a!eJ
Call Mei#al Control
for 9eat$ 9e#laration
at s#ene C#all CoronerD NO <ES
<itnesse EMS arrestJ
NO
NO Any si!ns of life reporteEo(serveJ
Cor!ani;e EH' a#tivity% spontaneous
movement% pupillary refle*esD
BEMS 1itnessed cardiopul!onary arrest and 48 !inutes o, unsuccess,ul resuscitation and
C*R per protocol !ay be pronounced dead in t2e ,ield as per Medical Control"
April %&&7
ALS Section E 1+
+irect Trau!a Transport
Tria$e Criteria Trau!a
Purpose: To efine patients -$o nee rapi transport to a trauma or spe#ialty #enter.
Poli#y: Any patient meetin! t$e #riteria (elo- s$oul stron!ly re#ommen
transport ire#tly to t$e fa#ility most #apa(le of meetin! t$eir nees as
efine (y t$e #riteria !roupin!s or al!orit$m. If prolon!e s#ene time or
transport is anti#ipate% refer to L:se of Aeromei#al Transport &e$i#lesM
poli#y. Conta#t t$e Resour#e Aospital for ire#tion as soon as possi(le if
8uestions e*ist re!arin! a spe#ifi# patient or situation.
Patients meetin! #riteria A or B: Initiate rapi transport -it$ s#ene time
no !reater t$an 1) minutes.
Air-ay #ompromise or mana!ement (y a Basi# level EMS provier
-it$out ALS inter#ept s$oul (e transporte to t$e nearest fa#ility.

Criteria:
1. Presen#e of any of t$e follo-in! s$oul stron!ly re#ommen ire#t transport to a
Level I trauma or spe#ialty #enter #apa(le of immeiate sur!ery E tar!ete
invasive intervention:
a. Sustaine $ypotension CAult >)mmA!3 Pes 7)mmA!D -it$
me#$anism or e*am finin!s su!!estin! on!oin! (loo loss
(. 'CS C'las!o- Coma S#aleD 1) or less
#. 'S< to t$e a(omen% (a#@% #$est or ne#@ -it$ suspi#ion of si!nifi#ant
inBury
. Sta( -oun to t$e a(omen% (a#@% #$est or ne#@ -it$ suspi#ion of
si!nifi#ant inBury
e. :n#ontrolle (leein!
f. Pulseless e*tremity
!. :nsta(le pelvis fra#ture C$emoynami#ally or anatomi#ally unsta(leD
$. Paralysis Cspinal #or inBuryD
i. Burns% +
n
or ,
r
e!ree N+2G TBSA or involvin! fa#e E air-ay not
meetin! ot$er Cate!ory A #riteria C9ire#t to Burn CenterD
B. Amputation pro*imal to -rist or an@le not meetin! ot$er Cate!ory A
#riteria Cire#t to Re"Implant CenterD
@. Caria# Tamponae E Tension Pneumot$ora*
+. Presen#e of any of t$e follo-in! s$oul stron!ly re#ommen transport to a
$ospital #apa(le of ur!ent sur!ery:
a. Respiratory Rate F1) or N+>
(. 'CS C'las!o- Coma S#aleD 11 ? 1+ an loss of #ons#iousness N 1
minutes
#. =ull arrest not meetin! Re!ion 4 =iel 9eat$ 9e#laration Criteria
. Sta((in! or 'uns$ot -oun to a(omen% (a#@% #$est or ne#@ Csta(leD
e. =lail #$est E C$est -all insta(ility
ALS Section E 1,
f. Aea inBury -it$ sei;ure a#tivity% unilaterally ilate pupil% or open E
epresse s@ull fra#ture
!. T-o or more pro*imal lon! (one fra#tures
$. M&C Cmotor ve$i#le #ras$D -it$ eBe#tion
i. 9eat$ of o##upant in same passen!er #ompartment
B. =alls O +) ft CC$ilren: N1) ft or +" , * $ei!$t of t$e #$ilD
@. Separation of rier from motor#y#le
l. Peestrian E (i#y#list stru#@ (y ve$i#le an t$ro-n or run over
m. &e$i#le rollover -it$ un(elte passen!ers
Treatment:
1. BLS an ILS units s$oul a#tivate a tiere response or aeromei#al transport to
!ain ALS level s@ills for t$e patient if t$ey anti#ipate prolon!e s#ene or transport
time.
+. BLS units -it$out mutual ai E rapi tiere response option s$oul transport t$e
patient to t$e nearest lo#al $ospital.
,. Consier aeromei#al transport if 8ui#@er an of #lini#al (enefit.
2. Pre"etermine lanin! ;ones s$oul (e utili;e -$enever feasi(le for patient
$anoff to aeromei#al teams. T$e lanin! ;ones s$oul (e availa(le to all
aeromei#al transport a!en#ies.
October %&4&
ALS Section E 12
October %&4&
ALS Section E 11