4Primary/Secondary Survey Why is it important?What and where are the wounds?What resuscitation is required?Mode of EVAC?Why is it important?What and where are the wounds?What resuscitation is required?Mode of CASEVAC?
5Will this approach work in firefight? What is the Approach?ATLSCreated by surgeons for the non-surgeonDesigned in the urban environmentPerformed in the hospital settingRequires a lot of high tech resourcesThis is our classical training platformWill this approach work in firefight?
6How Do We Develop Our Approach? What are we going to see?Injury patternsCivilian trauma?Firefight trauma?
7How Do We Develop Our Approach? Civilian traumaTrimodal death distributionFirst peakDeath results in the pre-hospital setting from massive head injury and massive vascular injury.Second peakDeath in the first few minute of arrival to the hospital and due to massive head, chest and abdominal injuryThird peakPost resuscitation/operative complicationsFirefight TraumaWe don’t know the death distributionIt is believed that if the casualty can arrive alive and relatively stable to the ER…they will live.
8How Do We Develop Our Approach? ATLSBased on urban injury patternsPrimary SurveyA-Airway/c-spine controlB-BreathingC-CirculationD-DisabilityE-ExposureDetailed secondary surveyHead-to-toe exam
9How Do We Develop Our Approach? The Firefight CasualtySlightly different injury pattern-in this order!Penetrating extremity traumaTension pneumothoraxLoss of airwayInstead of ABCs……think CBAs
10The Firefight Casualty Primary Survey Assess for hemorrhage firstIntervene for life threatening bleed only!Then, assess for tension pneumothoraxThen, assess for an airwayUtilize a Combitube or surgical airwayRarely a need for c-spine control
15The Firefight Casualty Primary Survey D-disability- decision to evacuateE-exposureExplore ideas on how to expose your casualty while protecting them from the environmentHypothermia is BADRemember, they may need that kevlar!!!
18The Firefight Casualty Secondary Survey Occurs after you have performed your primary survey and appropriate interventionsHead-to-toe exam along ATLS guidelines.Be very thorough-many injuries are subtle!