Trauma






EMS Protocols Quick Guide – Trauma


EMS Protocols Quick Guide – Trauma

General Trauma
Non-Trauma Alert Considerations
Burns
Traumatic Arrest
Crush Injury
Open Fractures
Hemorrhagic Shock

General Trauma Management

Refer to Handtevy™ for pediatric dosing.

  • Initial Assessment:
    • Control external hemorrhage.
    • Airway: Jaw thrust.
    • Breathing:
      • Sucking chest wound: Cover with occlusive dressing.
      • Suspected tension pneumothorax: Needle thoracostomy.
    • Circulation:
      • Reassess for external hemorrhage.
  • Treatment:
    • Apply c-collar to all blunt trauma alerts.
    • Obtain full set of vitals.
    • Place patient on continuous ETCO2 monitoring.
    • Establish IV/IO access.
    • Administer 0.9% NS 500 mL IV/IO bolus with goal of SBP ≥ 90 mmHg (pediatric goal: SBP 70 + (2 x age)).
    • Maximum dose of NS: 2000 mL.
  • Injury-Specific Management:
    • Refer to specific protocols as needed.
  • Transport:
    • Goal: Initiate transport to an appropriate facility within 10 minutes.
    • If patient meets trauma alert criteria, call trauma alert as soon as possible.
    • Do not delay transport due to procedures.
    • Keep patient warm.

Non-Trauma Alert Transport Considerations (TCTC)

  • Purpose:
    • Identify trauma patients who don’t meet trauma alert criteria but might benefit from transport to a trauma center.
  • Criteria:
    • Falls > 12 ft (adult) or > 6 ft (pediatric).
    • Trauma with evidence of head injury and on anticoagulant or antiplatelet medication.
    • Death of an occupant in the same passenger compartment.
    • Extrication time > 15 minutes.
    • Major intrusion into vehicle compartment.
    • MVC with rollover or speed > 55 mph.
    • Pedestrian or bicycle vs. motor vehicle.
    • Blunt abdominal injury with firm, distended, tender abdomen.
    • Use of tourniquet.
  • Additional Considerations:
    • Traumatic injury with one blue criteria plus anticoagulants, antiplatelets, or beta blockers.
  • Notes:
    • Apply c-collar to all TCTCs.
    • If c-collar is not used, document reason in ePCR.
    • If patient does not meet trauma alert criteria but may benefit from trauma center transport, document reason in ePCR.

Burns

Refer to Handtevy™ for pediatric dosing.

  • Initial Assessment:
    • Remove source of heat or burning clothes.
    • Chemical burn: Consider HazMat response, brush off chemical, flush with water.
    • Electrical burn: Obtain EKG and manage per appropriate protocol.
    • Cover burns with clean, dry dressing or burn sheet.
  • Treatment:
    • If ≥ 5% 2nd or 3rd degree burn or any burn to face/airway, hands, feet, genitalia, or circumferential to chest or extremities, transport to burn center (unless multi-system trauma, then transport to nearest trauma center).
    • Administer NS:
      • Adult: Administer NS bolus at 60 drops/minute on 15 drop/mL set (approx. 1 drop/sec); max dose 1 L.
      • Pediatric:
        • Infant: 15 drops/minute on 15 drop/mL set (approx. 1 drop every 4 seconds).
        • Child: 30 drops/minute on 15 drop/mL set (approx. 1 drop every 2 seconds).
    • Consider pain management per Protocol 4.11.
    • Consider CO inhalation or cyanide gas exposure per Protocol 5.3.
  • Transport:
    • Adult: Blake or Tampa General.
    • Pediatric: Transport to pediatric center via aeromedical transport if possible, otherwise contact OLMC.

Traumatic Cardiac Arrest

  • Blunt or Penetrating Trauma:
    • If no signs of life (SOL) on arrival, do not initiate resuscitation.
  • Blunt or Penetrating Traumatic Arrest:
    • If arrest occurs AFTER arrival and BEFORE patient loaded into rescue:
      • Remain on-scene, initiate resuscitation.
      • Perform bilateral needle thoracostomy.
      • Administer 2000 mL NS bolus.
      • Attempt resuscitation for at least 15 minutes.
      • After 15 minutes, consider termination of resuscitation if no ROSC.
    • If arrest occurs AFTER arrival and AFTER patient loaded into rescue:
      • Initiate resuscitation.
      • Perform bilateral needle thoracostomy.
      • Administer 2000 mL NS bolus.
      • Transport to closest ED.
  • Penetrating Trauma:
    • If total time from arrest to arrival at ED is < 15 minutes, consider resuscitation efforts and transport even if arrest unwitnessed by EMS.

Crush Injury

Refer to Handtevy™ for pediatric dosing.

  • Before Extrication:
    • If entrapped for > 30 minutes:
      • Monitor EKG/SpO2.
      • Administer 1 L of NS.
  • Immediately Prior to Extrication:
    • Administer Sodium Bicarbonate 1 mEq/kg (max 50 mEq) IV/IO.
    • Flush line after administration.
  • After Extrication:
    • If signs of hyperkalemia:
      • Administer Calcium Chloride 1 g IV/IO.
      • Administer Sodium Bicarbonate 1 mEq/kg (max 50 mEq) IV/IO.
      • Administer Albuterol 15 mg nebulized.

Open Fractures

Refer to Handtevy™ for pediatric dosing.

  • Indications:
    • Open fracture identified or suspected.
    • Gunshot wound to extremity(ies).
    • Severe soft tissue injury.
  • Contraindications:
    • Known cephalosporin allergy.
  • Treatment:
    • Administer Cefazolin 2 g IV.
  • Special Considerations:
    • If allergic to penicillin and reaction is anaphylaxis, DO NOT administer Cefazolin.
    • If allergic to penicillin and reaction is NOT anaphylaxis, administer Cefazolin and monitor for reaction.
    • If patient is unresponsive or unable to provide allergy history, administer Cefazolin.
    • Safe to use in pregnancy.
    • Do not delay scene time to administer Cefazolin; administer en route.
    • Transport all pediatric open fractures to state-approved pediatric trauma center.

Hemorrhagic Shock

Refer to Handtevy™ for pediatric dosing.

  • Indications:
    • High suspicion of hemorrhagic shock from significant MOI.
    • Clinical parameters:
      • SBP ≤ 70 mmHg OR
      • SBP ≤ 80 mmHg with HR ≥ 120 bpm OR
      • ETCO2 < 25 mmHg
  • Treatment:
    • Advise dispatch of “TXA Alert” via radio.
    • Administer Tranexamic Acid (TXA):
      • Adult: 1 g over approx. 10 minutes via IV/IO mixed in 100 mL NS (1.5-2 drops/sec on 10 drop/mL set).
      • Pediatric: Refer to Handtevy™. If < 6 years old, contact OLMC.
    • Administer whole blood per EMS Captain’s orders. Do not prolong scene time for blood.
  • Special Considerations:
    • Issuing a TXA alert dispatches an EMS Operations Captain with a goal of whole blood administration.
    • TXA alert is an internal alert and does not replace issuing a “Trauma Alert” to the trauma center.
    • TXA is not indicated in isolated closed head injury.
    • If using TXA for hemorrhagic shock due to trauma, issue a trauma alert and transport to a trauma center.
    • Do not prolong scene time to administer TXA; administer en route.
    • For non-traumatic hemorrhagic shock, contact OLMC.
    • Contact OLMC for patients with SBP ≤ 80 mmHg and HR < 120 bpm who are taking beta blockers or calcium channel blockers.