Trauma

Inclusion Criteria: Patients with traumatic injuries. If patient suffers a cardiac arrest due to trauma, refer to Cardiac Arrest guidelines. Treat pain according to the Pain Management guidelines.

NOTE: Notify BioTel as soon as possible when encountering serious or critical trauma patients. BioTel can then advise the receiving Trauma Center to prepare for the patient’s arrival.

          Basic Level

1. Assess and support ABCs while controlling C-spine. If the initial survey is abnormal, minimize scene time. Continue this treatment guideline en route.
   
   
2. Initiate spinal movement restrictions, as needed. If no spinal injury suspected, place the patient in a position of comfort.
   
   
3. If evidence of shock, place the patient supine with the feet elevated and monitor airway closely. Treat shock according to the Shock guidelines
   
   
4. Administer oxygen as needed to maintain a SpO2 of at least 96%.
   
   
5. Control any obvious external bleeding. Initiate basic care for specific injuries (ALL PATIENTS):
   a.    Open abdominal wound - Saline soaked dressing, cover with waterproof material, maintain body heat
   b.    Open chest wound - Seal with occlusive dressing on three sides
   c.    Hyperthermia - Place patient in cool environment; place cold packs at head, neck, axillae, and groin
   d.    Hypothermia - Protect patient from further cooling
   e.    Flail chest - Splint the injured area and closely monitor the respiratory status
   f.     Stable fractures - Splint as they lie if not grossly angulated
   g.    Impaled objects - Use bulky dressings to stabilize and secure object
   
   
6. Begin transport as soon as possible.
   
   
   
   Advanced Level
   
   
7. When medics suspect the presence of traumatic brain injury
   a.     Attempt to maintain an EtCO2 reading between 35 mmHg and 40 mmHg, if assisting ventilation.
   b.     If seizures develop, administer anticonvulsants as directed in the Seizure guidelines.
   
   
8. Establish IV access at a TKO rate. If the patient is hypotensive, refer to Shock guidelines.
   
   
9. Apply ECG and EtCO2 monitors if respiratory distress or shock is present or develops.
   
   
10. If mechanism of injury AND symptoms AND physical exam suggest a tension pneumothorax:

    Adult perform needle thoracostomy

    Pediatric Contact BioTel

    
    
    
11. For additional patient care considerations not covered under standing orders, consult BioTel.

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