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2013 Trauma Basics:

2013 Trauma Basics:. “ Blood, Heat & Gears ”. SCRTAC Coordinator: Dan Williams dan@scrtac.org . Regional Trauma System. RTACs: Regional Trauma Advisory Councils Wisconsin Trauma Field Triage Guidelines Injury Prevention Education Performance Improvement.

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2013 Trauma Basics:

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  1. 2013 Trauma Basics: “Blood, Heat & Gears”

  2. SCRTAC Coordinator: Dan Williams dan@scrtac.org

  3. Regional Trauma System... • RTACs: Regional Trauma Advisory Councils • Wisconsin Trauma Field Triage Guidelines • Injury Prevention • Education • Performance Improvement

  4. EMS’ Role in the State Trauma System… • Quickly identify traumatic injuries at the scene • Provide highest possible level of care at the scene • Triage and transport patients according to severity of injury • Transport each patient to facility with appropriate level trauma resources and capabilities

  5. TRIAGE

  6. START Triagevs.SALT Triage

  7. START vs. SALT... VS.

  8. START vs. SALT... • The use of a triage system is strongly encouraged • Rapid determination • Number of patients • Severity of injury/illness • Resources needed • Patient identification • Unified system used by all responders is beneficial

  9. Which Triage System Will Wisconsin Use? • S.T.A.C. and the WI EMS Board have endorsed the M.U.C.C. • Therefore, they support transition to SALT Triage

  10. SALT Triage: Step 2: Assess • Assess: • Limited rapid life-saving interventions • Open airway, NPA/OPA, tourniquet, DP by others, etc • Only in your scope of practice • Only if equipment/resources are readily available • Look for Critical Criteria; (No breathing = DEAD*) • Respiratory Distress • No peripheral pulses • Major hemorrhage uncontrolled • No purposeful movement • Does not follow simple commands

  11. What is your SALT Triage Priority? • Sort • Assess • Life Saving Interventions • Triage / Transport

  12. What is this patient’s SALT priority?

  13. What else is new for Wisconsin Trauma? Wisconsin Trauma Field Triage Guidelines 2013 (Please see your handout)

  14. WI Trauma Field Triage Guideline...

  15. WI Trauma Field Triage Guideline...

  16. Transport To A…

  17. Bleeding Control

  18. Bandaging or Stopping the Bleeding?

  19. Stopping Active Bleeding... • ‘Pressure’ Dressings: • Applied over a sterile dressing • Circumferential pressure • Elasticity of the bandage • Tightness of wrap by EMT • Pros: • Cons:

  20. Tourniquets.... • Long history of military use in ALL American wars, Civil War to Operation Enduring Freedom • When properly applied, can cease extremity circulation, therefore stopping any active bleeding antiquescientifica.com www.share.com

  21. Tourniquet Application... • Follow Manufactures Instructions • Tighten until all bleeding STOPS • Secure tourniquet to make sure it cannot loosen • Note the time of application • Keep area uncovered for ongoing observation www.share.com

  22. Tourniquet Usage: Fact or Fiction? • FICTION: • Tourniquet application = loss of extremity • Tourniquets can only be applied for 20 mins. • Only commercially made tourniquets work • Tourniquets can be removed if bleeding has been stopped for over 20 minutes. • FACT: • Tourniquets application is generally safe for up to 2 hours • Tissue damage can occur, even with proper application, and for short durations.

  23. DEMONSTRATION

  24. Now, it is time to turn up the heat! http://www.layoutsparks.com/1/231919/burning-flames-yellow-fire.html

  25. Where do burns occur? • 68% Home • 10% Occupational • 7% Street / Highway • 15% Other American Burn Association Burn Incident Fact Sheet photoblog.nbcnews.com

  26. Chemical Burns... www.eplasty.com

  27. Thermal Burns... • Heat Injury: • Direct Contact / Conduction • Scalding • Convection

  28. Anatomy of the Skin... www.yalemedicalgroup.org

  29. 2nd Degree Burn = Partial Thickness • Moist • Pink/Red • Blanches • VERY painful • Cells of the Dermis destroyed too • Infection risk www.healthcentral.com

  30. 2ND

  31. Rule of Nines... Adult: • Body surface is divided into areas representing 9% ...or multiples of 9% • Limitations: • Smaller burns • Different burn types www.my.firefighternation.com

  32. What are Significant Burns? • 1. Partial thickness burns greater than 10% TSBA • 2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints. • 3. Any third-degree burns. • 4. Electrical burns, including lightning injury. • 5. Chemical burns. • 6. Inhalation injury. • 7. Burn injury in patients with pertinent preexisting medical disorders that could complicate management, prolong recovery, or affect mortality..

  33. Burn Injury AND other Trauma... • Patient has significant burns and s/s of major traumatic injury • Patient has significant burns and has endured a major MOI, consistent with traumatic injury • Unknown MOI, but patient unstable, or with unstable airway/breathing. Transport to a TRAUMA CENTER if Possible

  34. Thermal Burn Care... 2nd Degree • Cover burn area with sterile dry dressing and elevate • Protection, don’t pop blisters! • Exposure to air increases pain • Plastic Wrap? • Pain management! • Do not use ice/cold water, etc to cool large areas of 2nd degree burns • Hypothermia • Decreased circulation from vasoconstriction • Remove Jewelry ASAP IV Fluids

  35. www.blog.supermedia.com

  36. Given a ‘scene’ to manage From onset to transport of all patients to definitive care You MUST follow a few simple parameters… The Main Event… 36

  37. You Must… • Use SALTTriage • Use The Wisconsin Trauma Field Triage Guidelines

  38. What we know so far... • House Explosion • Multiple Victims • Probable Methamphetamine Lab

  39. No purposeful movement

  40. Triage: Patient #1 Individual Assessment... • Life-Saving Interventions: • No major bleeds, airway is open • Breathing?: Yes • Obeys Commands?: No • Radial Pulse?: Yes • Not in Respiratory Distress?: No • Expected to Survive given current resources? Yes

  41. Triage: Patient #2 Individual Assessment... • Life-Saving Interventions: • Opened the airway..now agonal gasps • Breathing?: Yes, agonal? • Obeys Commands?: No • Radial Pulse?: No • Not in Respiratory Distress?: No • Expected to Survive given current resources? No

  42. Triage: Patient #3 Individual Assessment... • Life-Saving Interventions: • Profuse bleed from right thigh... Now what? • Breathing?: Yes • Obeys Commands?: Yes • Radial Pulse?: No • Not in Respiratory Distress?: Yes • Expected to Survive given current resources? Yes

  43. Triage: Patient #4 Individual Assessment... • Life-Saving Interventions: • No major bleeds; airway patent • Breathing?: Yes • Obeys Commands?: Yes • Radial Pulse?: Yes • Not in Respiratory Distress?: Yes • Expected to Survive given current resources? Yes All Minor Injuries?

  44. Hospital Communications... • Early hospital communications vital to the success of the incident. • 2-waycommunication • Scope of incident • # and severity of patients, ages • Special considerations • Hospital capability • # and severity of patients, ages • Establish ‘Base’ Hospital concept? • On-going communications

  45. Patient #1... Rapid Trauma Assessment: • Head/Neck: Partial thickness facial/neck burns on the anterior • Chest: GSW entrance to right anterior chest wall • Abdomen: Soft, not distended • Pelvis: Stable • Extremities: Angulated right forearm; partial thickness hand burns bilaterally • Posterior: No exit wounds; no burns.

  46. Patient #1… Ongoing concerns • Airway: Potential loss of patency • Decreasing LOC • Airway constriction from inhalation injury • Breathing: Potential need for ventilatory support • CNS Depression from hypoxia/hypoperfusion • Inability to create negative pressure • Tension Pneumothorax • Circulation: SHOCK!

  47. Patient #2... Rapid Trauma Assessment: • Head/Neck: Large open skull fracture, grey matter visible and not intact • Chest: No signs of trauma • Abdomen: No signs of trauma • Pelvis: Stable • Extremities: Partial and full-thickness burn to bilat arms and hands distal from the elbow • Posterior: No signs of trauma

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