Bonner County EMS System Patient Care Treatment Guidelines-Trauma and Environmental EmergenciesTrauma Guidelines: Multi-System Trauma - 6000

MULTI-SYSTEM TRAUMAGeneral Prehospital Care for the Multi-SystemTrauma PatientHistory

Time and Mechanism of Injury Damage to structure or vehicle Location in structure of vehicle Others injured or dead Speed and details of MVC Restraints/ protective equipment Past medical history Medications

Signs and Symptoms Pain, swelling Deformities, lesions Bleeding Altered mental status or unconscious Hypotension or Shock Cardiac and or respiratory arrest Core temperature

ASSESSMENT Chest (Tension

pneumothorax, Flail chest, Pericardial tamponade, Open chest wound, Hemothorax)

Intra-abdominal bleeding Pelvis/Femur/Spine fracture Head injury/Cord injury Extremity Fracture/

Dislocation Facial injury/ Airway

obstruction Hypothermia

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial Patient Contact (2000). Observe for underlying medical conditions. Trauma Triage Guidelines (1011-1012). Vital signs with Glascow Coma Score

(A2). Airway Management (4000), Oxygen Administration (9000). Control external hemorrhage using direct pressure. Consider Hemostatic Agent

(9081) and or Trauma Tourniquets (9083). Occlude sucking chest wounds, cover eviscerations (9080).

R For abnormal vital signs, notify Medical Control to determine and transport to

appropriate destination. Consider utilizing Air Medical Transport (1017). Consider Spinal Immobilization (9062)1, and Pelvic Sling (9061).2,3,4

Expose patient so that any hidden injuries may be found. For stable vital signs, complete assessment, splint suspected fractures (9063).1

E

Establish IV with NS, draw labs; do not delay transport for IV access.2

For hypotension administer NS 10-20 cc/kg IV bolus; reassess, repeat bolus if indicated.2

A ALS required for all Mult-System Trauma. Repeat patient assessment. Prioritize treatment based upon critical injuries.

Injuries to the head and spine, chest, abdomen and pelvis take priority over other injuries.

Consider Head Injury (6010) Guidelines. Chest decompression for Tension Pneumothorax (9060). Consider Administration of Narcotics for Pain Control (2060).

P ** Call Medical Control for trauma patients with abnormal vital signs requiring

rapid triage and transport to a trauma center, and to assist with Air Medical Transport.** M

1EMR, 2EMT, 3AEMT, and 4Paramedic providers may perform these procedures if credentialed with the appropriate OM.Pearls:

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/9/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Trauma and Environmental EmergenciesTrauma Guidelines: Multi-System Trauma - 6000

If bleeding is rapid and uncontrolled, manage patient in following order: C (control bleeding), then A (airway), then B (breathing). Geriatric patients should be evaluated with a high index of suspicion. Occult injuries are more difficult to recognize in elderly patients who may decompensate unexpectedly.Mechanism is the most reliable indicator of serious injury. Do not overlook the possibility of domestic violence or abuse. In prolonged extrications or serious trauma, consider Air Medical Transport to shorten transport time. Scene times should not be delayed for procedures. These should be performed en-route. Rapid transport of the unstable trauma patient is the goal. Scene times under 10 minutes are desired.

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/9/2023 page 2 of 2