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2013 Trauma Basics:

“Blood, Heat & Gears”

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SCRTAC Coordinator:

Dan Williams

dan@scrtac.org

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RTACs: Regional Trauma Advisory

Councils Wisconsin Trauma Field Triage

Guidelines Injury Prevention Education Performance Improvement

Regional Trauma System...

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Quickly identify traumatic injuries at the scene Provide highest possible level of care at the

scene Triage and transport patients according to

severity of injury Transport each patient to facility with

appropriate level trauma resources and capabilities

EMS’ Role in the State Trauma System…

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TRIAGE

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START Triage

vs.

SALT Triage

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START vs. SALT...

VS.

START vs. SALT...

The use of a triage system is strongly encouraged

Rapid determination Number of patients Severity of injury/illness Resources needed Patient identification

Unified system used by all responders is beneficial

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Which Triage System Will Wisconsin Use?

S.T.A.C. and the WI EMS Board have endorsed the M.U.C.C.

Therefore, they support transition to SALT Triage

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SALT Triage: Step 2: Assess

Assess:

Limited rapid life-saving interventions Open airway, NPA/OPA, tourniquet, DP by others, etc Only in your scope of practice Only if equipment/resources are readily available

Look for Critical Criteria; (No breathing = DEAD*) Respiratory Distress No peripheral pulses Major hemorrhage uncontrolled

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No purposeful movement

Does not follow simple commands

What is your SALT Triage Priority?

Sort Assess Life Saving Interventions Triage / Transport

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What is this patient’s SALT priority?

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What else is new for Wisconsin Trauma?

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Wisconsin Trauma Field Triage Guidelines2013

(Please see your handout)

WI Trauma Field Triage Guideline...

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WI Trauma Field Triage Guideline...

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Transport To A…

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Bleeding Control

Bandaging or Stopping the Bleeding?

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Stopping Active Bleeding...

‘Pressure’ Dressings: Applied over a sterile dressing Circumferential pressure

Elasticity of the bandage Tightness of wrap by EMT

Pros: Cons:

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Tourniquets....

Long history of military use in ALL American wars, Civil War to Operation Enduring Freedom

When properly applied, can cease extremity circulation, therefore stopping any active bleeding

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antiquescientifica.com

www.share.com

Tourniquet Application...

Follow Manufactures Instructions

Tighten until all bleeding STOPS

Secure tourniquet to make sure it cannot loosen

Note the time of application Keep area uncovered for

ongoing observation

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www.share.com

Tourniquet Usage: Fact or Fiction?

FICTION: Tourniquet application = loss of extremity Tourniquets can only be applied for 20 mins. Only commercially made tourniquets work Tourniquets can be removed if bleeding has been stopped

for over 20 minutes.

FACT: Tourniquets application is generally safe for up to 2 hours Tissue damage can occur, even with proper application,

and for short durations.22

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DEMONSTRATION

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Now, it is time to turn up the heat!

http://www.layoutsparks.com/1/231919/burning-flames-yellow-fire.html

Where do burns occur?

68% Home 10% Occupational 7% Street / Highway 15% Other

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American Burn Association Burn Incident Fact Sheet

photoblog.nbcnews.com

Chemical Burns...

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www.eplasty.com

Thermal Burns...

Heat Injury: Direct Contact /

Conduction

Scalding

Convection

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Anatomy of the Skin...

28www.yalemedicalgroup.org

2nd Degree Burn = Partial Thickness

Moist Pink/Red Blanches VERY painful Cells of the

Dermis destroyed too

Infection risk

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www.healthcentral.com

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2ND

Rule of Nines... Adult:

Body surface is divided into areas representing 9% ...or multiples of 9%

Limitations: Smaller burns Different burn types

31www.my.firefighternation.com

What are Significant Burns?

1. Partial thickness burns greater than 10% TSBA 2. Burns that involve the face, hands, feet, genitalia,

perineum, or major joints. 3. Any third-degree burns. 4. Electrical burns, including lightning injury. 5. Chemical burns. 6. Inhalation injury. 7. Burn injury in patients with pertinent preexisting

medical disorders that could complicate management, prolong recovery, or affect mortality..

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Burn Injury AND other Trauma...

Patient has significant burns and s/s of major traumatic injury

Patient has significant burns and has endured a major MOI, consistent with traumatic injury

Unknown MOI, but patient unstable, or with unstable airway/breathing.

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Transport to a TRAUMA CENTER if Possible

Thermal Burn Care... 2nd Degree

Cover burn area with sterile dry dressing and elevate Protection, don’t pop blisters! Exposure to air increases pain Plastic Wrap?

Pain management! Do not use ice/cold water, etc to cool large areas of

2nd degree burns Hypothermia Decreased circulation from vasoconstriction

Remove Jewelry ASAP 34

IV Fluids

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www.blog.supermedia.com

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The Main Event…

Given a ‘scene’ to manage From onset to transport of all

patients to definitive care You MUST follow a few simple

parameters…

You Must…

Use SALT TriageUse The Wisconsin Trauma Field

Triage Guidelines

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What we know so far...

House Explosion

Multiple Victims

Probable Methamphetamine Lab

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No purposeful movement

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Triage: Patient #1 Individual Assessment...

Life-Saving Interventions: No major bleeds, airway is open

Breathing?: Yes Obeys Commands?: No Radial Pulse?: Yes Not in Respiratory Distress?: No Expected to Survive given current

resources? Yes43

Triage: Patient #2 Individual Assessment...

Life-Saving Interventions: Opened the airway..now agonal gasps

Breathing?: Yes, agonal? Obeys Commands?: No Radial Pulse?: No Not in Respiratory Distress?: No Expected to Survive given current

resources? No44

Triage: Patient #3 Individual Assessment...

Life-Saving Interventions: Profuse bleed from right thigh... Now what?

Breathing?: Yes Obeys Commands?: Yes Radial Pulse?: No Not in Respiratory Distress?: Yes Expected to Survive given current

resources? Yes45

Triage: Patient #4 Individual Assessment...

Life-Saving Interventions: No major bleeds; airway patent

Breathing?: Yes Obeys Commands?: Yes Radial Pulse?: Yes Not in Respiratory Distress?: Yes Expected to Survive given current

resources? Yes46

All Minor Injuries?

Hospital Communications...

Early hospital communications vital to the success of the incident. 2-way communication

Scope of incident # and severity of patients, ages Special considerations

Hospital capability # and severity of patients, ages

Establish ‘Base’ Hospital concept?

On-going communications47

Patient #1... Rapid Trauma Assessment:

Head/Neck: Partial thickness facial/neck burns on the anterior

Chest: GSW entrance to right anterior chest wall

Abdomen: Soft, not distended Pelvis: Stable Extremities: Angulated right forearm; partial

thickness hand burns bilaterally

Posterior: No exit wounds; no burns.48

Patient #1… Ongoing concerns

Airway: Potential loss of patency Decreasing LOC Airway constriction from inhalation injury

Breathing: Potential need for ventilatory support

CNS Depression from hypoxia/hypoperfusion Inability to create negative pressure Tension Pneumothorax

Circulation: SHOCK! 49

Patient #2... Rapid Trauma Assessment:

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Head/Neck: Large open skull fracture, grey matter visible and not intact

Chest: No signs of trauma Abdomen: No signs of trauma Pelvis: Stable Extremities: Partial and full-thickness burn to

bilat arms and hands distal from the elbow

Posterior: No signs of trauma

Patient #2… Ongoing Concerns

SALT Triage allows this patient to be re-assessed after other patients have been managed

START Triage -- would categorize the patient as Immediate due to ‘failure to obey simple commands’

- OR –

Deceased due to ‘not breathing (agonal) after airway

positioning'

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Patient #3... Rapid Trauma Assessment:

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Head/Neck: No signs of trauma Chest: Abrasions to anterior

chest by right clavicle

Abdomen: Soft, not distended Pelvis: Stable Extremities: Large laceration to right

leg at the mid-thigh; major active

bleed Posterior: No signs of trauma

Patient #3… Ongoing Concerns

Hemorrhage control: Is the bleeding really stopped

Bleeding through dressings? Bleeding resumes after initially stopped

Shock!: The clock is ticking Be prepared for rapid deterioration

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Patient #4... Rapid Trauma Assessment:

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Head/Neck: Partial-thickness facial and neck burns; singed nasal hairs

Chest: Partial-thickness and superficial burns to anterior and posterior chest

Abdomen: Superficial burns to anterior abdomen Pelvis: No signs of trauma Extremities: Circumferential full-thickness burns to

bilat lower arms Posterior: Partial-thickness burns to 50% of

back

Patient #4… Ongoing Concerns

Inhalation Injury: Potential for rapid deterioration Pro-Active vs. Re-Active management

55www.entandallergy.comwww.udel.edu

Fluid Resuscitation When? How much? What fluid?

Which Hospital?

Our Patients… Initial treatment

1 2 3 4

Hospital Options…

CONGRATULATIONS!

Triage

Assessment

Treatment

Transport

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Any questions about the Wisconsin Trauma Field Triage Protocol,

tourniquet devices, or burn care?

Special thank you to…

Bob Nack

and

Acme Regional Hospital

for hosting this program.

SCRTAC…

Saving Lives By Strengthening Our Region’s Trauma Care System