trauma protocols critical care and paramedic levels

Trauma ProtocolsCritical Care and Paramedic Levels

Trauma: Unstable Patients

• Traumatic Arrest/Unstable Airway– Closest facility

• Transport unstable patients to hospital/landing zone within 10 minutes of extrication

Trauma: Transport Guidelines

Trauma: General Guidelines

• Prolonged transport– Consider aeromedical utilization – > 45 minutes by ground and air not available• Call medical direction – consider transporting to closest

emergency department

– Transporting trauma to non-trauma center• Notify emergency department as early as possible

Trauma: Aeromedical Utilization

• Must SIGNIFICANTLY reduce transport time

• Signs of life!!!• Don’t wait for the

helicopter • <20 mile transport?• Entrapment

Trauma: Pregnant Patients

• Adult trauma pt > 20 weeks gestation– Not meeting trauma criteria – ER of their choice– Meeting trauma criteria – Adult trauma center!

Trauma: Burn Patients

• Burn Criteria for transport to burn center– >10% BSA partial thickness burns– Involvement of face, hands, feet, genitalia, or major

joints– Third degree burns– Electrical burns, including lightning injuries– Chemical burns– Inhalation injury– Circumferential burns

Trauma: Burn Management

• Fentanyl added• Less BP effect• Med control only• Rigid chest with

rapid push

Trauma: Chest

• Fentanyl added

Trauma: Crush Injury

• New Protocol• For prolonged

entrapment only • Tourniquet use?• Pre-medicate

Trauma: Head Injury

• No changes

Trauma: Extremity Injury

• Tourniquet use• Hemostatic dressing• Once applied do not

remove• Fentanyl added

Trauma: Hypoperfusion

• Differing fluid goals for compressible injury

• Reflects current ITLS/ATLS guidelines