Chapter+01_9th+Edition_ITLS_04-2020.pdf

Copyright © 2020. All Rights Reserved
Ninth Edition
INTERNATIONAL
Trauma Life Support
for Emergency Care Providers
CHAPTER 1
Introduction to
Traumatic Disease

Introduction to Traumatic Disease
(Courtesy Pixabay)

Objectives
1. Identify the most common causes of death
due to traumatic injury.
2. Summarize the components of scene size-
up.
3. Describe the role of scene-size-up in
provider safety and anticipation of patient
injuries.
4. Explain the relationship between kinetic
injury and injury severity.

Objectives
5. Identify the three collisions associated with a
motor vehicle collision and relate potential
patient injuries to the deformity of the
vehicle, interior structures, and body
structures.
6. Describe how vehicle safety mechanisms
affect anticipated injury patterns.

Objectives
7. List the factors that predict the type and
severity of injury due to a fall.
8. Describe how bullets cause tissue injury and
explain the relationship between bullet
characteristics and injury severity.
9. Relate the five injury mechanisms involved
in blast injuries to scene size-up and patient
assessment.

Objectives
10.Describe the priorities of prehospital trauma
care and relate them to preventable causes
of death.
11.Discuss the role of preventative efforts in
reducing injury and death due to trauma.

Most Common Causes of
Traumatic Death
• Road traffic injury
• Intentional injury
• Suicide
• Falls
© Pearson

Time is the Key Factor
• There is a relationship between time and
patient survival
• The “golden period” in prehospital care
• Teamwork is important and you need to have
an organized approach!

Scene Size-up
• First step in ITLS Primary Survey
© Pearson

Scene Size-up
© Pearson
© Pearson

Scene Safety
© Pearson
üScene safety
•Position response vehicle away from hazards, but close
enough to retrieve equipment efficiently and in a direction
to leave scene easily.
•Consider using vehicle as barrier to hazards (such as
oncoming traffic) to create a safe place to work.

Scene Safety
© Pearson
Windshield survey
•Look out windshield for hazards before leaving your
response vehicle.
•Look for threats to you as you approach:
vThreats to or from patient
vThreats to or from bystanders

Mechanism of Injury
• Types of MOI
– Generalized
– Focused
• Traumatic injuries are predictable
• Trauma is directly related to the laws of
physics
• High-energy = risk of severe injury

Basic Motion Mechanisms
• Blunt injuries
– Rapid forward deceleration
– Rapid vertical deceleration
– Blunt instrument energy transfer

Motor Vehicle Collisions
Each collision is three collisions:
© Pearson
© Pearson
Photo copyright Mark C. Ide

Clues to Injury
• Deformity of the vehicle
– What forces were involved in collision?
• Deformity of the interior structures
– What did the patient hit?
• Deformity or injury patterns on patient
– What anatomic areas were hit?

Frontal-Impact Collision
• Windshield injuries
• Steering wheel injuries
• Dashboard injuries
(Photo copyright Mark C. Ide)

Lateral-Impact Collision
• Similar to frontal-impact
with lateral energy
• Check impact side
• Check non-impact side
as well
(Courtesy iStockphoto)

Rear-Impact Collision
• Posterior displacement
• Headrest position
• Damage back and front
(Courtesy Pixabay)

Rollover Collision
• Multiple impacts
• Axial-loading injuries
• Ejection
(Chance of death
increases 25 times)
Courtesy of Bonnie Meneely, EMT-P
(Courtesy Pixabay)

Small Vehicle Crashes
• Small vehicles
– Motorcycles
– All-terrain vehicles
– Personal watercraft
– Snowmobiles
• Injury factors
– Protective gear
– Additional impacts
(Courtesy Pixabay)

Occupant Restraint
• Airbags
– First impact only
– Always “lift and
look”
- Powder, etc., is not
dangerous
(Courtesy of Olivier Le Queinec, Shutterstock)

Falls
• Vertical deceleration
– Distance of fall
– Anatomy impacted
– Surface struck
– Patient age

Penetrating Trauma
• Knife wound severity
– Anatomic area penetrated
– Length of the blade
– Angle of penetration
• Stabilize impaled object © Pearson

Penetrating Trauma
• Trauma related to gunshot wound depends on:
- The part of the body damaged
– The bullet velocity
– The bullet caliber
(Courtesy Roy Alson, PhD, MD, FACEP, FAEMS) © Pearson

Trauma Triage Decisions
• Over-triage:
– Transporting patients to
a trauma center who
can be managed at a
local hospital
• Under-triage:
– Not transporting
patients requiring
specialized trauma care
to a trauma center © Pearson

Prevention and Public Education
• Trauma itself is a disease
– Specific causes
– Methods of prevention or mitigation
– Methods of treatment

Summary
• Trauma is a disease of time and energy
• Organization improves outcomes
• Scene safety and size-up come first
• Understanding the MOI is critical

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