Trauma
pg 3
- a physical injury or wound caused by external force or violence.
- Can be either blunt or penetrating
- 3rd leading cause of death in US; 1st for people under 44.
Penetrating Trauma
pg3
- when an object (arrow, knife, bullet, or other object) enters body and exchanges energy with human tissue causing injury.
Blunt Trauma
pg 3
- injury that occurs as energy and collision forces associated with an object - not the object itself - enter the body and damage the tissue
The five steps of the public health care model
pg 4
- Surveillance
- Risk analysis
- Intervention Development
- Implementation
- Evaluation
Surveillance
pg 4
- collection of data to identify the significance, existance, and characteristics of disease
- The study of disease based on such surveillance is called epidemiology
Risk Analysis
pg 4
- looks at disease and determines various factors that impact its development, course, and consequences
- Haddon Matrix - tool used to ID risks associated with trauma
Haddon Matrix
pg 4
- 3x3 matrix - tool used to help ID risk elements associated with trauma
- when applied to trauma it segregates causative and contributive factors that can be modified to reduce trauma incidence, severity, and outcome.
- Pre-event - Things that can be mitigated before event or injury takes place ie training, education saftey equiptment, protocols
- Event - factors that exist during event; occupant health, drugs & alcohol, weather
- Post-Event - factors that worsen or improve victims outcome; ie access to EMS systems, weather, victims health
Intervention Development
pg 5
- creates or modifies programs to reduce both the incidence and the seriousness of trauma
- ie. safety developments for vehicles and roadways; ie OnStar, airbags, and barriers that deflect/absorb impact
- EMS was created as a way to provide better care for injured patients
Implementation
pg 6
- Putting an intervention into practice; ie enforcing traffic laws, reducing speed limits in hazardous areas, education etc.
Evaluation
pg 6
- repeating the surveillance to ensure implemented measures are effective
- injury prevention is an evolving role of the modern EMS system
Level I Trauma Center
pg 7
- Regional Trauma Center
- Commits resources to address all types of specialty trauma 24hrs/day x 7
- usually a medical university teaching center
Level II Trauma Center
pg 7
- Area Trauma Center
- Commits resources to address the most common trauma emergencies with surgical capability 24/7; will stabilize and transport for speciaty cases to Level I facility
- some services may be on-call rather than in-house
Level III Trauma Center
pg 8
- Community Trauma Center
- Commits to special emergency department training and has some surgical capability, but will usually stabilize and transfer seriously inhured trauma patients to a higher level trauma center as needed.
Level IV Trauma Center
pg 8
- Trauma Facility
- Remote areas, small community hospital or medical facility designated as a trauma recieving facility. Stabilizing and prepare seriously injured for transport, to a higher level facility, often by air.
Specialty Centers
pg 8
- Specialty focus centers
- neurocenters
- burn centers
- pediatric trauma centers
- hand/limb replantation
- hyperbaric oxygenation
MOI Analysis & Index of Suspicion
pg 9
mentally recreate incident from evidence available at the scene
- Identify
- strength of forces involved
- direction of force
- areas of pt most likely affected
- Index of Suspicion - mental summation of anticipated injuries based on analysis of event
Physical Signs that suggest serious trauma include
pg 9
- S&S of Shock
- Signs of internal Head Injury
If you suspect internal injury, closely monitor vital signs for shock and altered mental status
Environmental Impact
pg 9
- anticipate the impact that environmental extremes may play on your assessment
- Adverse weather may merit moving patient to ambulance earlier in assesment
Primary Assessment - Trauma
pg 10
- Form General Impression
- Evaluate need for C-Spine considerations
- Evaluate A/B/C’s
- Determine need transport priority
*Evaluation of C-spine depends on whether patient is a reliable reporter of spinal
**If you suspect the patient is in cardiac arrest begin assessment with CAB
Golden Period
pg10
- time from incident to surgery
Trauma Triage Criteria
pg 11
- GCS
- Vital Signs
- Anatomy of the injury
- MOI
- Special Considerations: age, existing medical conditions
Trauma Registry
pg 11
- a uniform and standard set of data collected by regional trauma centers
- used to analyze types of patients and injuries responded to and ID factors that +/- survival
CDC Field Triage Guidelines
Quality Improvement/Management
pg 13
- examination of performance with the aim of improving patient care
- indicators are used to determine if selected care modalities are being met
- application of trauma triage criteria
- field skill performance
- time spent in response/assessment/care/transport
- appropriateness of trauma patient destinations
- True QI is not punitive and does not look to id fault with indicidual providers
The leading killer of persons under age 44 in the US is ________?
pg 3
Trauma
The best care you, as a paramedic, can offer a trauma patient is to :
pg 4
- immobilize the cervical spine
- secure the airway
- ensure adequate respirations
- control hemorrhage
- provide rapid transport to definitive care
Certain trauma centers located in smaller communities situated in generally rural areas commit to special emergency department training and have a degree of surgical capability but usually stabilize and transfer seriously injured patients are designated as a ___________ facility
pg 7/8
Level III
One specialty service important in the treatment of carbon monoxide posioning and problems related to sucba diving is the ____________.
pg 8
hyperbaric oxygenation center
When determining the MOI you will identify the _______?
pg 9
forces involved in the collision
You will begin your consideration of the mechanism of injury during the ________.
pg 9
scene size-up
In the ideal scenario, you should provide the primary and rapid trauma assessments, emergency stabilization, patien packaging, and initiation of transport in under __ minutes.
pg 10
10
In the QI process, comittees look at selected care midalities to determine if the designated standards of care are being met. These modalities are also called ______.
pg 13
indicators
Auto accidents account for how many deaths each year?
pg 3
34,500
T/F - Although trauma poses a serious threat to life, its presentation often masks the patient’s true condition.
pg 3
True
T/F - Some 90% of all trauma pt’s don’t have serious, life-endangering injuries.
pg 4
True
T/F - Trauma triage criteria are MOI or physical signs exibited by the patient that suggest serious inury.
pg 4
True
The legislation that helped establis guidlines, funding, and state-level leadership and support for trauma systems was the _________.
pg 7
Trauma Systems Act of 1963
The trauma system is prediccated on the principle that serious trauma is ________
pg 7
a surgical disease.
A Level I Trauma Center is usually a
pg 7
teaching hospital with resources available full time for emergency cases.
The small community hospital or health care facility in a remote area, designated as a receiving facility for trauma is a Level ___.
pg 7
Level IV
Trauma centers may also be designated for provision of what types of special services?
pg 8
Pediatric trauma center
Burn Center
Neurocenter
Hyperbaric Center
You arrive onscene to find a 4-yr old child who has fallen out of a second story window. The child responds to verbal stimulus. Respirations and puls are WNL. You note a broken left arm but no other apparent injuries. Your index of suspicion for possible injuries includes:
What is your primary concern?
Pg 9
Internal bleeding, head injury, C-Spine Injury
Rapid packaging and transport
The period of time between the occurrence of serious injury and surgery as a goal for prehospital care providers is the _______.
pg 10
Golden Period
TF - In applying trauma triage criteria, it is best to err on the side of precaution
pg 11
True
T/F - Trauma Triage criteria are designed to over triage trauma patients to ensure those with more serious injuries are not missed.
pg 11
True
You arrive on scene to find a 26-yr old male pt ejected from motor vehicle. The pt is unconscious but breathing at a rate of 28. He is bleeding profusely from the head. You note an open **femur fx ** on the left leg. The trauma triage criteria that is most indicative of a serious injury is:
pg 12
Ejection from the vehicle
The reduction in the incidence and seriousness of trauma in recent years can be credited to:
pg 11
better highway design
better auto design
use of auto restraint systems
development of injury prevention programs
The standardized data retrieval system used to evaluate and improve the reauma system is the ______.
pg 11
Trauma Registry
T/F - Quality Improvement is a significant method of assessing system quality and providing for its improvement
pg 13
True
Trauma accounts for about what death toll each year?
pg 3
177,000 deaths
T/F - Serious life-threatining injury occurs in about 30% of all trauma.
pg 4
False - 10%
Surgical intervention rates for serious trauma are greatest in what type of trauma?
pg 7
Penetrating Trauma
A level III trauma center is a
pg 8
Community hospital
The guidelines that help determine the need of a trauma patient for the services of the trauma center are called the____.
pg 8
Trauma Triage Criteria
The result of the analysis and the MOI is the _____.
pg 9
Index of Suspicion
T/F - Because paramedics are usually at the side of seriously injured patients so quickly, the S&S of serious injury and shock will be be apparent.
pg 11
False
T/F - One of the most effective methods of reducing trauma morbidity and mortality is through injury prevention programs.
Pg 11
True
Which of the following indicates a trauma pt’s need for immediate transport to a trauma center?
- Systolic < 90
- Flail Chest
- Ejection from a vehicle
- fall from greater that 3x victims height
- all of the above
pg 12
All of the above
