Prehospital care in trauma

1. Principles of Prehospital Care
and Casualty Management
of a trauma victim including
principles of triage
Dr. Saurabh Sahu
MBBS DNB MNAMS
Joint Replacement and Arthroscopic Specialist
Associate Professor Dept. Of Orthopedics
LNMC and JK Hospital

2. Objectives
• Understanding the burden of trauma in India.
• Explain the vitality of prehospital (scene safety)and hospital
preparation to facilitate Rapid resuscitation of trauma patients.
• Identify correct sequence of priorities for the assessment of injured
patients.
• Explain principles of primary survey.
• Expectations from MBBS students, in case of trauma.

3. Primary Survey
• Airway with cervical spine protection.
• Breathing and ventilation.
• Circulation and haemorrhage control.
• Disability and GCS score.
• Exposure (undress)/ Events with hyperthermia control.

4. History - only AMPLE
• A- Allergy.
• M- Medication currently used.
• P- Past Illnes.
• L- Last meal taken.
• E- Events

5. Common Definitions
• Trauma- exposure to an incident or series of events that are
emotionally disturbing or life-threatening with lasting adverse effects
on the individual's functioning and mental, physical, social,
emotional, and/or spiritual well-being.
• Medical Emergency is an event that will kill or disable one or many;
where outcome can be altered by timely action.

7. Prehospital Phase
• Coordination with prehospital agencies can greatly expedite
treatment of trauma patients.
• The prehospital system Ideally is set to notify receiving hospital
before personnel transport the from the scene.
• This allows for the hospital’s trauma team members so that all the
necessary personnel and resources are present in the emergency
department at the time of the patient’s arrival.

8. PreHospital Phase
• During the prehospital phase, the main emphasis should be on –
1 - Airway Management
2- Control of Bleeding
3- Immobilisation of the patient
4- Immediate Transport to the closest healthcare facility.
• Prehospital providers must also ensure that every effort has been
taken to minimise scene time.
• Emphasis should also be made on obtaining and reporting
information needed for triage at the hospital.

10. Hospital Phase
• Advance planning for the management of trauma patients is vital.
• The handover between prehospital providers and those are the
receiving hospital should be a smooth process.
• Critical aspect of hospital preparation include-
1. A resuscitation area should be available for trauma patients.
2. Properly functioning airway equipment.
3. Warmed IV crystalloid solutions should be immediately available for
infusion.
4. A protocol to summon additional medical assistance should be in
place.

11. Triage
• Sorting of patients based on the severity of their injuries and number
of the patients.
• Goal of triage- The greatest benefit for greatest number of patients.
• Triage should be easy and fast.

12. • Patients are divided into 4 groups based on-
1. Breathing.
2. Circulation
3. Mental Status
• Red; Yellow; Green; Black.

13. Triage
• Breathing- Yes or No?
• Yes- Fast or not fast?
• Breathing fast- Red.
• Breathing normally- Yellow.
• No- Open airway with jaw thrust and chin lift.
• If patient begins to breathe- Red.
• If patient doesn’t begin to breathe- Black.

14. Circulation
• Only check when patient is breathing.
• If severe bleeding present- Red.
• Otherwise – Yellow.

15. Mental Status
• Only check if patient is breathing.
• If patient is unconscious or cannot follow simple commands – Red
• If patient can follow simple commands - Yellow.

16. Priority of Transport
• Red- Transport first need immediate care.
• Yellow- Transport after red. Need urgent medical care. Can delay upto
1 hour.
• Green- The “walking wounded.” Can be delayed upto 3 hours.
• Black- Dead or expected to die soon no matter what care you provide.

17. Benefits of Triage
• Prevents avoidable death.
• Avoid misusing assets on helpless cases.
• Proper medical treatment with mimal timeframe.

18. Remember- SRTT
• S- scene safety.
• R- Response Checking.
• T- Triage.
• T- Transport.

19. History- Only Ample
• A- Allery.
• M- Medication currently used.
• P- Past illness.
• L- Last meal taken.
• E- Events.

22. Airway with Cervical Spine Protection
• Helmet removal.
• Application of cervical collar.
• Foreign body removal.
• Jaw thrust Chin lift manoeuvre.
• In advance setting/Hospital- Airway and ET intubation.

23. Breathing and Ventilation
• Adequate gas exchange to maximise oxygenation and CO2
elimination.
• Ventilation- Adequate function of lung, chest wall and diaphragm.
• Problems in Breathing-
1. Tension Pneumothorax.
2. Flail chest
3. Massive hemothorax.
4. Open pneumothorax.

27. Circulation and haemorrhage control
• Hemorrhage is the predominant cause of death in RTA.
• Rapid and accurate assessment is essential
• Remember CLAP-
• C- chest
• L- Long bone (femur and humerus)
• A- Abdomen
• P- Pelvis.

28. Control of Hemorrhage
• Put direct pressure to stop bleeding.
• Put 2 large bore cannula.
• Infuse 2 litre warm RL very fast.
• Find out the cause of bleeding ( advice USG)

30. GCS Glasgow Coma Scale
• Total score is 15, minimum is 3.
• It is a predictor to decide the prognosis.
• Motor response is the best to decide outcome.
• If GCS<8, go for definitive airway- that is intubation.

32. Thank You