Trauma Introduction :Trauma Introduction EMS Professions Temple College


Topics :Topics Morbidity & Mortality Trauma Systems Prevention Kinematics & Energy Transfer Predicting Injuries


Morbidity & Mortality :Morbidity & Mortality Leading cause of death 1 - 44 years 4th cause overall 140,000 unexpected deaths/yr > 40,000 related to automobiles Expense $177 billion in 1991


Morbidity and Mortality :Morbidity and Mortality Focus of EMT creation in 1960s Survival largely (not entirely) dependent upon time to definitive care “The Golden Hour”: Concept vs. Rule EMS role Early recognition through assessment Prevention of Secondary Injury Rapid transport to appropriate facility


Trauma System Components :Trauma System Components Injury prevention Prehospital care Transportation Trauma triage guidelines Emergency department care Interfacility transportation Trauma critical care Rehabilitation Data collection/ trauma registry Research


Trauma Systems :Trauma Systems Trauma centers Levels I, II, III and IV Qualifications Essential Desired Voluntary Designation


Trauma Transport Considerations :Trauma Transport Considerations Level of receiving facility needed Mode of transport Ground transport Appropriate facility reached within reasonable time To a landing zone for air medical transport Air medical transport Indications Contraindications Procedure


Prevention :Prevention Integral part of EMS Early Immediate Late


Recognition: Mechanisms of Injury :Recognition: Mechanisms of Injury Simple Classifications of Mechanisms Cause Related Motor Vehicle Accident/Crash Fall GSW Stabbing Useful in initial assessment Classification by True Mechanism Force / Energy Related (Kinematics) Deceleration vs Acceleration Blunt vs. Penetrating Blast Thermal/Chemical


Predicting Severe Injury :Predicting Severe Injury Incident Biomechanics Ejection from Vehicle Death of other occupant Falls > 10 feet Pedestrian (> 20 mph) High energy Transfer Head on, T-bone Significant Intrusion Motorcycle, ATV, Bicycle Prolonged Extrication/Transport


Predicting Severe Injury :Predicting Severe Injury Co-Morbid Factors Extremes of Age Underlying Disease & Poor General Health Pregnancy Environmental Extremes Protective Devices TIME


Kinematics vs. Mechanism :Kinematics vs. Mechanism What’s the difference?


Kinematics & Energy Transfer :Kinematics & Energy Transfer Physical Laws Newton’s First Law A body at rest or a body in motion will remain in that state until acted upon by an outside force Multiple collisions Conservation of energy Energy cannot be created nor destroyed It can change form


Kinematics & Energy Transfer :Kinematics & Energy Transfer Physical Laws Force Force = Mass x Acceleration Force = Mass x Deceleration Kinetic energy (KE) KE = ½ m x V2 What factor has the greatest influence on KE?


Energy Transfer :Energy Transfer Cavitation Energy exchange produces particle motion Temporary cavity Short lived Produced by stretching Dependent on the elasticity of the object involved Produces particle compression at the limits of the cavity Permanent cavity Visible when the energy exchange has been completed Produced by compression and destruction


Energy Transfer :Energy Transfer Dependent on number of particles & Density of bodies involved in the interaction Air Density Lungs, Intestinal Tract Water Density Vascular system, Liver, Spleen, Muscle Solid Density Bone, asphalt, steel Area of Interaction Shape, Position, or Fragmentation of Object


Energy Transfer :Energy Transfer Blunt Tissue not penetrated Cavitation away from site of impact Cavitation in direction of impact Penetrating Tissue penetrated Cavitation at 90o to bullet pathway Tissue inline to penetration is crushed


Predicting Injuries :Predicting Injuries Frontal Collisions Lateral Impact Rear-End Collisions Rotational & Roll-Over


Frontal Collision :Frontal Collision What are the potential injuries? Key determining factors Down & Under Up & Over


Lateral Impact :Lateral Impact What are the potential injuries? Key determining factors


Rear-End Collisions :Rear-End Collisions What are the potential injuries? Key determining factors


Rotational & Roll-Over :Rotational & Roll-Over What are the potential injuries?


Organ Collisions :Organ Collisions Blunt Trauma Compression Change in Velocity Acceleration or Deceleration Shear or Avulsion


Organ Collisions :Organ Collisions Restraint Systems Lap Belt Hold torso away from dash and steering column Prevents multiple impacts in rollover Prevents ejection Shoulder Harness Prevents forward motion of upper torso Prevents hyperflexion of upper torso around lap belt


Organ Collisions :Organ Collisions Restraint Systems Air Bags Alter rate of deceleration Child Safety Seats


Motorcycle Collisions :Motorcycle Collisions Differences from Automobile Rider impacts motorcycle parts Rider ejected over motorcycle Trapped between motorcycle and vehicle No protection from effects of deceleration Limited Protection Helmet 300% increased risk of brain injury w/o helmet Leathers Boots


Pedestrian vs Motor Vehicle :Pedestrian vs Motor Vehicle Injury patterns depend on height body surface facing impact child vs adult Waddell’s triad: Femur/Pelvis, Abdomen/Chest, Head collisions initial, hood/windshield, ground


Falls :Falls Factors Contributing to Injury Height of fall Surface of the impact Objects struck during the fall Body part of first impact Feet first Head first Parallel


Penetrating Injuries :Penetrating Injuries Energy Exchange Area of Interaction Density Bullet deformation Tumbling Fragmentation Cavitation Permanent Temporary Available Energy


Penetrating Injuries :Penetrating Injuries Available Energy Low Energy Weapons knife, ice pick, axe injury primarily due to cutting edge minimal cavitation


Penetrating Injuries :Penetrating Injuries Available Energy Medium Energy Weapons muzzle velocity < 1500 ft/sec hand guns, low power rifle small projectile moderate cavitation dependent on frontal area of bullet


Penetrating Injuries :Penetrating Injuries Available Energy High Velocity Weapons muzzle velocity > 1500 ft/sec military-type small caliber weapons (AK47, M16) severe cavitation dependent on frontal area of bullet


Penetrating Injuries :Penetrating Injuries Pathway of missile Entrance wound skin tissue crushed inward at site of entry usually small, dark round or oval wound may have abrasions at edge of wound may have burn near site due to close proximity of weapon to skin Exit wound skin tissue pushed outward may be larger than entrance “rough” edges


Blast Injuries :Blast Injuries Sources of Blasts 3 phases with different energy patterns Primary pressure wave heat wave Secondary struck by flying debris Tertiary patient becomes flying object


Patient Management :Patient Management Primary Focus Rapid Assessment Airway Control Immediate and/or Preventative Ventilatory Ability  Inspired O2 Adequate rate and TV Correct mechanical obstacles Organ Perfusion BP target >90 mm Hg Control internal & external bleeding Prevent further Spinal Injury Immediate & Continued Minimize Secondary Injury


Patient Management :Patient Management Therapies Extrication SMR Airway Control Suctioning Endotracheal Intubation Ventilation Oxygen BVM Chest decompression Perfusion Controllable Bleeding IV Access Cautious fluids PASG/MAST Minimize 2° injury RAPID TRANSPORT to Surgical Facility


Summary :Summary Traumatic mechanisms constitute a significant portion of EMS responses Most result in minor or no injury Small percentage are severe or life-threatening injuries Paramedic’s role lies in recognition and aggressive management of this small group Focus preventing secondary injury appropriate transport