BASIC TRAUMA MANAGEMENT

AND
TRIAGE SYSTEM

Billy Rosan
 DEFINITION
• Trauma is as tissue injury due to direct effects of externally applied energy.

• Energy:

• Mechanical

• Thermal

• Electrical

• Electromagnetic

• Nuclear.

• Triage → ‘triar’ which means ‘to separate out’

• A method of quickly identifying victims who have immediately life-threatening injuries and who have the best
chance of surviving
• The Global Burden of Disease project,
a projected 40% increase in global deaths due to injury between 2002 and 2030,
predominantly due to the increasing number of road traffic collision deaths
• Mechanism of Injury:
• Blunt injury

• Penetrating injury

• Thermal (Burn/cold) injury

• Blast injury (Combination)

 BASIC TRAUMA MANAGEMENT

• level of care provided by the first responders is usually BLS (the responders can include highly
trained paramedics)

Pre Hospital Hospital

 BASIC TRAUMA MANAGEMENT

Life-threatening
Key:
 BASIC TRAUMA MANAGEMENT
• The Trauma team
• Doctors
• Team leader
• Airway Doctors
• Circulation Doctors
• Nursing Staff
• Team leader
• Airway nurse
• Circulation nurses
• Relatives’ nurse
• Radiographer
 BASIC TRAUMA MANAGEMENT
• Roles of trauma team members
• Medical Team leader
• Co-ordinates of the whole team.

• Performs immediately life-threatening problems.

• Ensures that airway and circulation team members

• Allocates a suitably skilled team member

• Constantly prioritises

• Information from prehospital team is noted.

• Ensures that other specialist clinicians

 BASIC TRAUMA MANAGEMENT
• Airway doctor
• Clears and secures the airway cervical spine precautions.

• Inserts central and arterial lines if required.

• Circulation doctors
• The removal of the patient’s clothes.

• Peripheral intravenous infusions and take blood samples

• Carry out other procedures depending

• Radiographer
• Takes X-ray films
 BASIC TRAUMA MANAGEMENT

• Nursing Team leader

• Co-ordinates the nursing team and liaises with the medical team leader.

• Records

• Prepares sterile packs

• Assists the circulation nurses and brings extra equipment

 BASIC TRAUMA MANAGEMENT
•Airway nurse
• Assists in securing the airway and the cervical spine.
• A rapport with the patient in the resuscitation room.
• Information should be fed through this nurse to the patient.

•Circulation nurses
• The removal of the patient’s clothes.
• Assist with starting intravenous infusions, blood bottle labelling
• tasks allocated to the circulation doctor.
• Measure the vital signs and connect the patient to the monitors.

•Relatives’ nurse
•
 BASIC TRAUMA MANAGEMENT

Primary Survey
Airway support
Trauma PRE HOSPITAL Breathing support
HOSPITAL
Circulating support
Airway support Dissability
Breathing support Environment /exposure
Circulating support Adjuncts
Dissability Secondary Survey
Environment Definitive Care
 BASIC TRAUMA MANAGEMENT

• Pre-Hospital Response Team

• Personnel → Medical Staff → Skill (A B C D E)
• Vehicle
• Controlled drugs and equipment
• Communication
• Command and control
• Record-keeping
• End of shift
 BASIC TRAUMA MANAGEMENT
• Pre hospital
Airway
• assessment of the adequacy of the airway and ventilation
• Stridor
• Snoring
• Gurgling
• Hoarsness
• Airway management with Restricted C-Spine motion
• The Jaw Thrust Manoeuvre
• The Chin lift Manoeuvre
• Basic Adjunct (OPA, NPA, LMA)
• Intubated…..?
• O2 with Non Rebreathing Mask (NRM) 10 – 12 lt/mnt
BASIC TRAUMA MANAGEMENT
 BASIC TRAUMA MANAGEMENT

Breathing
• Assessment of the Breathing
• potentially Life-threatening injuries
• Simple pneumothorax
• Hemothorax
• Flail chest
• Pulmonary contusion
• Blunt cardiac injury
• Traumatic aortic disruption
• Traumatic diaphragmatic injury
• Blunt esophageal rupture
• Monitoring of The Saturation with Pulse Oximetry
• Chest Tube….?
 BASIC TRAUMA MANAGEMENT
Circulating
• Assessment and Clinical finding of the Shock
• Internal Bleeding
• Intrathoracal bleeding
• Intraabdominal bleeding
• Pelvic bleeding → Pelvic stabilization with Pelvic Binding
• Long Bones Fractures → Splints immobilization
• External Bleeding → Control Bleeding with Direct
pressure / Torniquet
• Fluid therapy (Cristaloid) and Blood Replacement
• NGT for Decompression
• Catheter Urine for evaluation respons
 BASIC TRAUMA MANAGEMENT
Disability (Neurologic evaluation)
• Assessment
• AVPU (Alert, Vocal, Painful, Unresponsive) or The patient’s GCS score
• Pupillary light response (Isochor / Unisochor)
• Focal neurological deficit.
 BASIC TRAUMA MANAGEMENT
Exposure
• completely undress
• cover the patient with warm blankets or an external warming device
• Log Roll

Secondary Survey
• History (AMPLE)
• Complete examination head to toe

Hospital
 BASIC TRAUMA MANAGEMENT
Hospital
• The Trauma Team
• Doctors
• Nursing Staff
• Advanced team
• Management :
• Primary Survey (ABCDE)
• Adjunct
• Secondary Survey
• Definitive Care
 TRIAGE SYSTEM
• A method of quickly identifying victims
• categorized :
• Multi-casualty Incidents (MCIs)
• Mass-casualty events (MCEs)
• The general principles of triage include:
• Recognize that rescuer safety is the first priority.
• Do the most good for the most patients using available resources.
• Make timely decisions.
• Prepare for triage to occur at multiple levels.
• Know and understand the resources available
• Plan and rehearse responses with practice drills.
• Determine triage category types in advance.
• Triage is continuous at each level
 TRIAGE SYSTEM

• Key Concept
• Resources are limited
• Supplies
• Personnel
• Time for evacuation / help unknown or prolonged
• Only austere field interventions are available
• Types of Triage types objectives / methodology
PRIMARY TRIAGE EARLY TRANSPORTATION “START” & “SAVE” DISASTER
( FIELD TRIAGE ) SCENARIO
SECONDARY TRIAGE
( ED TRIAGE ) TIMELY & APPROPRIATE INTERVENTION COLOUR CODING
TERTIARY TRIAGE Specialist Care

ED Triage
Static, single point in time
Triage tags frequently used
Few patiens
Used for mass Casualty scenes
TRIAGE SYSTEM
Disaster
Dynamic, multiple points in time
Documentation needs may exceed triage
tag capacity
Large patient numbers
Used for wide-spread disaster scenes
 TRIAGE SYSTEM

• Disaster Triage

START → SAVE
 TRIAGE SYSTEM

• Simple Triage And Rapid Treatment (START)

• a quick assessment of
• Respirations
• perfusion
• mental status
TRIAGE SYSTEM
TRIAGE SYSTEM
 TRIAGE SYSTEM

• Patients with exposure (potential or real) to

contaminants → BLUE

START

SAVE
TRIAGE SYSTEM
 TRIAGE SYSTEM
• SAVE (Secondary Assessment of Victim Endpoint)
• To have significantly delayed transport from a scene
• helpful to identify patients who are most likely to benefit from the care
available under austere field conditions.
• Assessment:
• Vital Signs
• Airway
• Chest
• Abdomen
• Pelvis
• Spine
• Extremities
• Skin
• Neurologic Status
 TRIAGE SYSTEM
Cate
gory Definition CARE PROVIDED

Patients who will die regardless of how

1 much care they receive COMFORT CARE

Patients who will survive whether or not

2 they receive care DELAYED CARE

Patients who will benefit significantly from

3 IMMEDIATE CARE
austere field interventions

Periodic Assessment !!
 TRIAGE SYSTEM
• TRIAGE IN THE EMERGENCY
DEPARTMENT

• Priorities for care and determines the clinical

area of treatment

• If triage has been done at the scene, triage is

needed at the ED entrance

• Evaluate all patients arriving at the ED and

classify their conditions
 TRIAGE SYSTEM

Red
First Most Life-threatening shock or hypoxia is present or imminent, but the patient can likely be stabilized and, if
priority urgent given immediate care, will probably survive

The injuries have systemic implications or effects, but patients are not yet in life-threatening shock or
Second
Yellow
priority Urgent hypoxia; although systemic decline may ensue, given appropriate care, can likely with stand a 45- to 60-
min wait without immediate risk

Third Non-
Green
priority urgent
Injuries are localized without immediate systemic implications; with a minimum of care,

Black Dead unresponsive patient who has no spontaneous ventilation or circulation is classified as dead.
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