2013 Trauma Basics:
“Blood, Heat & Gears”
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Your SCRTAC EMS Staff…
Chris Hammes
Dan Williams
Chris Carbon
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State Trauma System…
•DHS 118
•DHS
•S.T.A.C.
•Trauma Registry
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What Is The EMS Role In The State Trauma
System?
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START Triage...
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START Triage...
 Simple
 Triage
 And
 Rapid
 Treatment
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START Algorithm...
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MUCC?
 Model Uniform Core Criteria
 24 Criteria that a triage system
should contain
 Based on science (data), and
 Based on best practice (what works
well)
 SALT Triage meets ALL 24 criteria
 (START meets about 19 criteria)
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SALT Triage: Step 1: Sort
 Sort:
 Walk?
 Casualty Collection Point
 Last to be individually assessed
 Wave?
 Assess those that do not wave 1st
 They are most likely to need life-saving interventions
 Assess those that wave next
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Your Turn.... SALT Triage Patient
(www.skatermom.com)
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Your Turn.... SALT Triage Patient
(www.skatermom.com)
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WI Trauma Field Triage Guideline...
 Approved by EMS and STAC fall of 2012
 Adapted from the CDC / ACS Guidelines
 Wisconsin has added an additional AIRWAY step
 Guideline vs. Protocol
 Intent is for every EMS agency in the state to adopt
the guideline as their protocol for triage and transport
of the traumatically injured patient
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How is the 2012 version different?
 Most changes involve wording, making it more clear
 ‘Defined Trauma Region’
 ‘Chest wall instability or deformity’
 Had been ‘flail chest’
 ‘Pulseless extremity’
 Adds vehicle ‘roof intrusion’
 Elderly patient considerations
 Systolic BP < 110 may represent shock
 Low Impact MOIs may cause serious injury
 Removes Dialysis considerations and ‘Time Sensitive
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Extremity Injury’
When In Doubt…
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Bleeding
Control
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Bandaging or Stopping the Bleeding?
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Stopping Active Bleeding...
 Direct Pressure:
 Pressure applied to actual bleeding site
 Pressure applied just proximal to the
bleeding site
 Pros:
 Cons:
www.umm.edu
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Stopping Active Bleeding...
 Tourniquet:
 Approved for EMS in WI Scope of Practice*
 State of Wisconsin – Standards & Procedures of Practical Skills
 For major extremity bleeds -- Applies
circumferential pressure
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Tourniquet Application...
 Remove clothing from
tourniquet area if possible
 Why?
 Apply 2-3” proximal from
the bleed
 Why?
www.roguemedic.com
 Do not apply over a joint
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Tourniquet Application... What to expect
 Bleeding should stop
 Patient will experience significant pain
 Patient may want the device removed
 Good idea?
 When can it safely be removed?
 Application of the device goes more
smoothly for those that practice
regularly
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DEMONSTRATION
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http://www.layoutsparks.com/1/231919/burning-flames-yellow-fire.html
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Burn Injuries... National Data
 450,000 burn victims sought medical attention (2011)
 45,000 required hospitalization
 25,000 hospitalized at a burn center
 3,500 deaths each year (fire/burn data combined)
 75% died at the scene or during initial transport
 Burn victims:
 70% male / 30% female
American Burn Association Burn Incident Fact Sheet
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Radiation Burns...
www.utilities-me.com
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Thermal Burns...
www.myspace.com
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The Skin... Our Largest Organ:
 Protection:
 Injury
 Regulation:
 Body Temperature
 Infection
 Prevention:
 Loss of Body Fluids
 Sensory:
 With the
Environment
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1st Degree Burn = Superficial
 Redness
 Dry
 Blanches with
pressure
 Top layer of
epidermal cells is
destroyed
 Heals in 3-5 days
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www.healthcentral.com
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www.myspace.com
www.telegraph.co.uk
www.claudia-dave-nelsonblog.com
www.dailyhaha.com
S
T
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Sizing-Up the Burn Injury
 The severity of the burn:
 Type
 Size (Surface Area)
 Location
 Size of a burn:
 % of total body surface area
 Rule of Nines
 Palm & Fingers
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Burn Measurement... Palm & Fingers:
 Patient’s palm and
fingers = 1% TBSA
1% TBSA
 Limitations:
 Large Burns
 Good for smaller
burns of differing
severity
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Wisconsin and Neighboring Burn Centers...
Region’s
Hennepin Co.
Columbia St. Mary’s
Hospital
UW Hospital / Am.
Fam. Children’s
Loyola Univ.
Univ. of Chicago
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Thermal Burn Care... 1st Degree
 Cover burn area with a dry dressing
 Protection
 Exposure to air increases pain
 Plastic Wrap?
 Pain management as needed
 Do not use ice/cold water, etc to cool large areas of
1st degree burns
 Hypothermia
 Remove Jewelry ASAP
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March 23rd
Fennimore, WI.
Hwy 61 at County Rd. T
Domestic Battery
Awaiting Police Arrival
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Standing-By at a safe distance,
Waiting for law enforcement,
Observing the residence...
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Updates to the Incident...
 Law Enforcement on-scene:
 SCENE IS SAFE
 Fire Department has been
requested
 Not on-scene yet
 Your assignment is EMS
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No purposeful movement
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Triage: Global Sorting
 1 patient on the ground
waving / screaming
 1 patient walking toward
you / severely burned
Who should be
assessed 1st?
2nd? Last?
 2 patients motionless on
the ground / No
purposeful movement
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Patient #2...
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Patient #3...
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Patient #4...
www.cicletrack.com
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Let’s update our scene...
 Additional resources have been requested and are
responding
 Ground ambulances
 ALS
 BLS
 Medical Helicopter
 (Base) Hospital Communications:
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Patient #1... Primary Assessment:
 LOC:
Unconscious, withdraws to pain, moans
 Airway:
Patent, protected by swallow reflex
 Breathing:
Rapid & labored
 Circulation:
Radial pulse absent; brachial is weak,
and rapid, min or external bleeds
 Interventions?
 Priority Decision?
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Patient #1… Treatment
 Airway:
Basic vs. Advanced?
 Oxygen:
Device, Flow?
 Breathing:
BVM… When, why?
Chest seal? Why?
 Circulation:
ALS… Fluid or not?
 Burn care:
What? When?
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Patient #2... Primary Assessment:
 LOC:
Unconscious; Unresponsive
 Airway:
Made patent by EMS positioning
 Breathing:
Agonal, slow, irregular
 Circulation:
Radial and femoral pulses absent
Carotid +/- palpable, thready
 Interventions?
 Priority Decision?
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Patient #2… Treatment
 Place in an open-airway position
 Re-assess:
 After all patients have been triaged
 After all IMMEDIATE patients
have been managed
 Re-tag and treat as indicated:
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Patient #3... Initial Assessment:
 LOC:
Conscious ; AOx2
 Airway:
Patent and protected
 Breathing:
Rate increased, not labored
 Circulation:
No radial pulse; Tachycardic
Significant bleed from right thigh
 Interventions?
 Priority Decision?
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Patient #3… Treatment
 Immediate direct pressure
 Rapid tourniquet application
 If no tourniquet available:
 application of pressure dressing
 Bleeding must be stopped!
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Patient #4... Initial Assessment:
 LOC:
Conscious; AOx3
 Airway:
Patent; hoarse voice
 Breathing:
Rate / Depth / Effort
normal
 Circulation:
Strong radial pulse;
No major bleeds
 Interventions?
 Priority Decision?
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Patient #4…Treatment
 High-Flow Oxygen
 Dyspnea
 CO
 Airway management
 Inhalation injury present
 Emergent RSI indicated
 Pain management
 Not with cold products! Why?
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Which Patient?
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Our Patients… As we found them
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2
3
4
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Transport and Trauma Level Needs…
Please refer to the…
Wisconsin Trauma Field Triage Guideline
Patient # 1
Major Trauma
Patient
GSW to chest
ALOC
Level I or II
Trauma Center
BLS + ALS
Patient # 2
Major Trauma
Patient
Likely
Unsurviveable
Now PNB
Non-Transport
Coroner / Law
Enforcement
Patient #3
Major Trauma
Patient
Shock
Patient #4
Not Major Trauma
Patient
Significant Burns
Major Bleed
Inhalation Injury
Level I or II
Burn Center p RSI
Trauma Center
BLS + ALS
*ALS Needed*
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www.stocktradingtogo.com
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Any questions about the State Trauma
System, the SCRTAC, and your role
in the system?
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BEFORE YOU LEAVE:
 Be sure that you have signed-in with your name,
email, and EMS Service.
 Attendance certificate will be emailed to you or
your service/training director
 SCRTAC Newsletter
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SCRTAC…
Saving Lives By Strengthening Our
Region’s Trauma Care System
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