2010-2011
PCP
Recertification
Trauma TOR
TOR - Overview
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Objectives
Blunt Trauma
Penetrating Trauma
TOR Key Points
Special Circumstances
TOR Objectives
Given pre-course reading and Webinars, small group
discussion of various case studies, a manikin, and
medical equipment, the paramedic will be able to:
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Describe mechanism of injuries that could result in blunt or
penetrating traumatic arrest,
Explain the differences between the Blunt Trauma TOR and the
Penetrating Trauma TOR.
Summarize the evidence for either transporting or terminating
resuscitation of traumatic arrest patients based on the conditions of
the directive,
Describe and demonstrate the proper application of the General
Traumatic Arrest Protocol – Adult and Pediatric
As evaluated by the facilitator during case presentations,
skill stations, oral scenarios, and a written evaluation.
Blunt Trauma
Mechanism of Injury
• MVC
• Sports
• Falls
• Crush
injuries
Blunt Trauma
Defib pads – analyze/interpret
1.
Shockable, or Heart Rate > 0 – no TOR!
2.
Heart Rate = 0 (non-shockable)
Penetrating Trauma
Mechanism of Injury
• Gunshot
• Stabbing
• Broken
bones
Penetrating Trauma
Monitoring Electrodes only!
1.
Heart Rate = 0 – patch!
1.
Heart Rate > 0 AND ER > 20 min – patch!
2.
Heart Rate > 0, AND ER < 20 min – no TOR!
TOR – Key Points!
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VSA
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Does not include
Drowning
• Electrocution
• Hanging
• Isolated Burn Injury
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Patient 16 years of age or older
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Obvious Death?
What if it’s NOT a TOR?
Does not meet TOR
Directives
OR
BHP determines not
to give TOR on
patch
What if it’s NOT a TOR?
Case Study:
You arrive on scene to find a 30 year old male who is
pinned under his tractor in 18” of water. You are able
to determine he has no radial pulse, but you are not
able to assess anything else. There is a 2 hour delay
until a crane can remove the tractor. What do you
do?
What if it’s NOT a TOR?
Case Study
You arrive on scene to find a 42 year old female
impaled on a fence post. The patient was attempting
to jump the fence when she became impaled in the
femur. She is VSA with HR on the monitor of 50 bpm.
Fire/Rescue state they cannot remove the patient
without amputation. Closest ED is 5 min away.
Questions ?
Contact SWORBHP
• 519-667-6718
• ParamedicEducation@lhsc.on.ca
References
• Emergency Health Services Branch. (2007). Ministry of
Health and Long Term Care BLS Basic Life Support
Patient Care Standards, Version 2.0
• Gervin AS., & Fischer RP. (1982). The importance of prompt
transport in salvage of patients with penetrating heart
wounds, Journal of Trauma, 22(6), 443-448
• Hopson LR., Hirsh, E., Delgado, J., Domeier RM., McSwain,
NE., & Krohmer J. (2003). Guidelines for Withholding or
Termination of Resuscitation in Prehospital Traumatic
Cardiopulmonary Arrest, Prehospital Emergency Care,
7(1), p141-146
•Leading Causes of Death, Canada, 2005, Males and Females
Combined. (2005). Public Health Agency of Canada.
Retrieved from
http://www.phac-aspc.gc.ca/publicat/lcd-pcd97/pdf/lcd-pcd-ti-eng.pdf
References
• Macpherson, AR., & Schull, MJ. (2007). Penetrating Trauma in Ontario
Emergency Departments: A Population Based Study. Canadian Journal of
Emergency Medicine, 9(1), 16-20
•Prentice D, Ahrens T. (1994). Pulmonary Complications of Trauma. Critical
Care Nursing, 17 (2), 24–33
•Salomone, J., Mercer, S., Chaplea, W., & Chapman, G. (2003). PHTLS
Basic and Advanced Prehospital Trauma Life Support, St. Louis,
Missouri: Elsevier
•Sasser, SM., et al. (2009). Centers for Disease Control and Prevention
Guidelines for Field Triage of Injured Patients, Morbidity and Mortality
Weekly Report MMWR Recommendations of the National Expert Panel
on Field Triage, 58(1)
•Tien, HC., Spencer, F., Tremblay, LN., Rizoli, SB., & Brenneman, FE. (2007)
Preventable Deaths from Hemorrhage at a Level 1 Canadian Trauma
Centre. Journal of Trauma, 62(1), 142-146